(04-11-2015, 02:21 PM)randeh Wrote: Since I do not want another night like last night I am going to go ahead and lower my Max PS to 10 and Max EPAP to 13. My only concern is if there are ratios that should be maintained for Min and Max Epap. I was thinking of dropping the Min Epap to 8. Would that be okay or should I leave it at 10?
If last night was representative, your EPAP settings probably can be lower, as pointed out by Sleeprider.
Our pressure needs vary hour to hour. Obstructive apneas are usually strongly positional, and the worst cases are usually if we are on our back, or during REM sleep, or both.
Assuming you were asleep most of the time you were using the machine last night, I think 8 or 9 would be a reasonable setting for the Min EPAP, especially in view that you are experiencing a painful amount of air swallowing, and temporarily lowering Min EPAP may tend to help a little.
My general rule of thumb is that Min EPAP should not be lower than about 3 or 4 cm H2O lower than the 90% pressure or 95% pressure. But some patients do better in fixed-EPAP mode, where the fixed EPAP may be chosen near the 90% pressure or 95% pressure as measured in APAP mode.
(The 95 percentile pressure is the pressure we were at or below at least 95% of the time; the 95 percentile pressure is also the pressure we were at or above for at least 5% of the time.)
Actually, I suggest leaving Min EPAP at 10 (so you are not adjusting so many things at once), but I think it would be reasonable to lower the Min EPAP to 9 or 8. (A Min EPAP of 8 would be 3 lower than the 95% Pressure from last night.)
Lowering the Max EPAP would tend to limit aerophagia more effectively than lowering Min EPAP. I would suggest lowering Max EPAP either to what was measured last night (around 12.6) or perhaps a little lower, like 12.
This is in addition to lowering Max PS to 10.
I also suggest raising the ramp Start Pressure to 6 or higher, for increased comfort when starting.