Bipap advice

[readyforsleep]

So I raised epap to 15.6 and ipap to 19.6.  I am not even going to post - ahi 4.4.  Leaks up, rough nite.

Ajack I just got your post this morning.  I have not had time to study it yet. I will later today.    I do want to mention that based on my height and weight my TidAL Volume  seems on target..my median is 360, I calculate it should be around 380.

[ajack]

OK, normal is good. That would put you around 5'1-5'4, I wonder why the respiration rate is up a bit? The links were about using median and 95% numbers, to help with adjusting auto pressures. It's some thing tangible you can see and relate to. I know when I first looked at a titration chart, it was a head scratch to make it out.

[Sleeprider]

Your results on January 20 were not so bad at 3.4 for PS 3.0 over pressure 14.6-18.6. This might have been too big of a bite, and you should go back to that previous pressure. We know lower pressure does not work, and that you continue to have positional obstruction, but don't tolerate a cervical collar. I'm curious if you ever tried one of the stomach sleeping pillows to facilitate your stomach sleeping.

[readyforsleep]

Well I caved and bought a cvs cervical collar. It fits better than the collar I had this summer so I am hopeful.  I just did a dry run (nap) and was able to fall asleep.  The good news is that I was able to get rid of my chin strap with the cervical collar.

 The pillow I have been using is firm but uncomfortable.  I am still considering a cpap pillow as discussed in the forum if the collar doesn't work.

So planning another adventure tonight with the pressures I used on Jan 20th and the cervical collar.

[jaswilliams]

Good luck

[Shin Ryoku]

I did try a cervical collar this past summer.  At the time I was using nasal pillows and trying to avoid a full face mask.  It did not help.

I see you are trying the collar again. If again it does not help, I wouldn't keep torturing yourself with it. Clusters of OAs can be from chin tucking, but there is no good basis for the claim that they are usually from chin tucking. Could be from REM sleep, back sleeping, etc.

My ahi and number of events are moving in the right direction.  For the last 3 days I have been using a firmer pillow and raised EPAP. 

https://imgur.com/a/GxrHc

I would like to keep tweaking.  Not sure which way to go right now.  Lower EPAP? I goofed and broke my rule of only changing one thing at a time.  I raised EPAP and tried the firmer pillow. The firmer pillow is helping alot. Try a lower IPAP and EPAP?  Any advice?

When I saw this chart, my first thought was "That looks exactly like one of mine".

So I raised epap to 15.6 and ipap to 19.6.  I am not even going to post - ahi 4.4.  Leaks up, rough nite.

Faced with basically the same results you are getting after increasing Pmin to 16-17, I went back down to a Pmin of 14. It's worked out a lot better for me than continuing to increase the pressures.

Using a higher Pmin ~17 might shave 1-2 off my AHI, but that's not a good tradeoff since it causes me to sleep poorly.

Your mileage may vary; just relaying my own experiences.

[readyforsleep]

Thanks Shin for sharing your experiences. Very helpful.

I have had some interesting results the last 5 nites with the cervical collar.  Now that I am comfortable with my full face mask ( been using since August) the addition of the cervical collar has not been as cumbersome as it was in the summer.    It has definitely helped with lowering my leaks.  The first few nites I had fantastic AHI's of 2.6 and 1.45!  I have never gotten ahi's so low.  Lately my ahi has been in the upper 3's.  Not bad for me...  My chin has been slipping down under the cervical collar and I see positional AHI's.     I guess this calls for a tighter collar?  or maybe a different one. 

Thank you Sleep Rider and others for gently pushing the Cervical Collar.

[Shin Ryoku]

Excellent, I hope you continue to have success with the collar!

[Sleeprider]

Thanks Shin for sharing your experiences. Very helpful.

I have had some interesting results the last 5 nites with the cervical collar.  Now that I am comfortable with my full face mask ( been using since August) the addition of the cervical collar has not been as cumbersome as it was in the summer.    It has definitely helped with lowering my leaks.  The first few nites I had fantastic AHI's of 2.6 and 1.45!  I have never gotten ahi's so low.  Lately my ahi has been in the upper 3's.  Not bad for me...  My chin has been slipping down under the cervical collar and I see positional AHI's.     I guess this calls for a tighter collar?  or maybe a different one. 

Thank you Sleep Rider and others for gently pushing the Cervical Collar.

It's not for everyone, but it looked right for you.  Hopefully you find the fit and comfort that works.  Nice to hear things are getting better, or even good.

[readyforsleep]

It have had my bilevel since 1/7/18 and wanted to give you an update.  I am excited to report definite improvements in my ahi, and sleep. When I started with the bilevel my ahi was 4 or above.  Now I see ahi's around 2.  I sleep for 7 - 8 hours!    See attached.   As you can see from my chart I am not using the cervical collar - still see some positional obstructions.  I may give it a try again but want to see how I do without it for awhile.  I never got consistent results with the cervical collar.  Too loose, too tight, high ahi - I really need to spend more time with it..   My current results tell me that maybe I just needed to be patient and get used to my new machine.  

https://imgur.com/a/MveLb

See anything I should tweak?