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I don't agree at all with ajack. From reading the sleep study I found the main reason for using the BPAP is due to expected pressures above 15cm and not for any lung issues with Oxygen. The drop in O2 levels were caused by Apnea events and had nothing to do with any lung problems. I would not raise the Pressure Support to 10 knowing you already get some Centrals. Increasing the PS will result in increased Central events. You are on a BPAP without backup. If you start having Centrals it will cause a problem with not getting enough Oxygen. While it's true that a PS of 10 is used for lung problems it normally is with a BPAP with a backup system to provide you with Oxygen when you stop breathing due to centrals.

When you tried fixed pressure before was it with EPR or just one pressure?
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It doesn't look like it has been suggested, but you may want to try wearing a cervical collar....I see you are NOT using a full face mask so maybe the effect won't be the same, but I would think trying a collar may be worth a try. 

A collar can help keep the neck in a straight line and many find that it helps cut down on obstructive events.  I don't have obstructive apnea and as soon as I started wearing a full face mask, OA events showed up.  For me I think having a strap around the lower part of my head to tighten the mask causes my chin to tuck in, which restricts air flow. 

If it helps, then it may begin to show a better definition for your clear airway events and how to better manage the machine pressures.
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I read both sleep studies, and you clearly did not achieve acceptable results with CPAP. Using bilevel, you showed nearly no events with setting at 14/9.0, 15/10, 16/10 and 17/11. At 18/12 you had one obstructive events, and again at 19/13 there were no events, but sleep efficiency at the higher pressures is poor. Subjectively, your best results were at 15/10 with very good sleep efficiency no apena or hypopnea and very good SpO2 results.

Let's translate that a bit more. You are currently running your machine in Vauto mode at PS 1.6 in a range from 12 to 20 cm. None of the pressures currently being provided by your Aircurve 10 VAuto were tried at titration, but they most closely approximate the unsatisfactory CPAP results. At those pressures in CPAP titration (between 12 and 14 cm), you had AHI between 7.7 and 24 events per hour with mixed central, obstructive and hypopnea events. After 14 cm pressure, the sleep test moved to bilevel.

With bilevel at pressures less than 13/8, you had large numbers of events, and the titration demonstrated a "bright-line" minimum requirement for EPAP pressure of 9.0 cm to avoid obstructive events. Your current settings are above that minimum EPAP pressure, so your obstructive events are fairly well controlled; however, you are seeing centrals and hypopnea, which were eliminated by using pressure support in the 5 to 6 cm range, while you are using only 1.6. Although your current settings are not even close to your titrated pressure, you are doing surprisingly well, however, I recommend we get back to pressures and pressure support indicated by your sleep study.

I think you need to take a look at this bilevel titration and learn from it (see table at the top of Page 3). You need a minimum EPAP of 9.0 or 10.0 to resolve OA events. Your pressure support requirement to make other events go away and to make it easier to breath is 5.0 cm. Therefore in fixed bilevel mode (VPAP-S), you could set your machine to EPAP 9.0 and IPAP 14.0 and you should see good results. If you want to use VAuto mode, then your settings need to be EPAPmin 9.0, PS 5.0 and IPAPmax 17.0.

All of the setting options I have posted above, should result in better and more comfortable results that have been demonstrated effective by your sleep test. I encourage you not to over-think this. There is absolutely no need to guess or experiment with your pressures, these should work. I disagree with some of the advise you have received so far. There is absolutely no indication of a pulmonary issue or even central apenea in your case. Your reaction to pressure support, which in your case appears to reduce CA events, is not one we see very often, but based on your titration tests, you do better with PS at 5 than with PS less than 4. I want you to feel comfortable, and assured you can achieve good treatment at levels your sleep study demonstrated for you. Please give serious consideration to trying these settings and letting us help you to fine tune from there. We should not however attempt to use pressures your studies demonstrated are a problem.

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Thank you so much, Sleeprider - I was sitting here freaking out that I was not getting any oxygen and having much worse problems than I thought.

It makes sense what you are recommending and is close to what the original sleep setting prescription was - she had recommended an upper of 20, a lower of 9, and a pressure support of 5. When I had the BiPap titration she told them to use a PS of 3. 

When I got home and began using the BiPap, that first night felt so difficult to breathe when I was trying to fall asleep, that's when I started lowering the pressure support and raising the lower pressure.  I had the impressions that the PS was the same as EPR on an Auto and since I used a 1 on the Auto, I should lower the PS on the BiPap

What really surprised me with the second opinion doctor was him wanting me to use a PS of 10 and insisting that it Must be the difference between IPAP and EPAP - what is the Real Story on that?  

I am right now using the VAuto mode, so tonight I will try the EPAP of 9, the PS of 5, and the IPAP of 17.  The only one I am confused about is the IPAP of 17.  The original recommendation of the sleep titration was an IPAP of 25, which seemed crazy high to both myself and the sleep doctor.  She wanted to start with 20, and I'm a little concerned that 17 might be a bit too low?

Could you please explain exactly how the Pressure Support works because all the "medical" people have told me so many different and non-understandable versions of that, it causes anxiety for me not knowing what it does.

Thank you again for your response - I was getting very upset about the "possible" oxygen problem.
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For some reason the forum in general, has an aversion to use pressure support. I wouldn't disregard 2 doctors and 2 lab techs over a forum.
You have had a doctor and sleep report saying ps5, you had a second doctor and a lab tech review of your symptoms and data. They suggested an increase to PS10 and higher than the original PS5.
new http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or charts for auto-cpap, set the min 1cm below median pressure, or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
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I don't think there's an aversion to using pressure support. The disagreement is how much is applied and for what reasons.

I like Sleeprider recommending fixed pressure settings. I think that will help. Not sure about the PS at 5. I would've gone 3 maybe 4. But he knows more than me so I'll watch and learn.
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Agree - I am going to try a Pressure Support of 5 tonight as a beginning.
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It will be interesting - as I mentioned, the PS of 5 seemed like it was very hard to exhale, but I'm going to try it.
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Walla Walla - I have had the same impressions as you on Pressure Support.  I think, at least for me, I was assuming that PS is the same as EPR on an Auto.  Apparently that is not the case at all, although I still don't understand how it works.  Both "sleep doctors" had completely different explanations for it - not only different but dramatically different, and neither explanation matched what I have read elsewhere that it is the "difference between the EPAP and IPAP". The illogical problem with that is there can be a wide high and low pressure - just like my "report" that suggested setting the EPAP at 9 and the IPAP at 25 - well, the PS I don't think goes up to 14......

I don't know anything else but to try tonight to somehow calm my anxiety about this seemingly complex BiPap and see if I can sleep with it without generating Panic Attack #30.  I've now gotten into a 24 hour cycle of Panic and Anxiety (yes, for no appropriate reason) and it's escalated from just waking up frightened to All Day Major Anxiety.  Ridiculous, but that's what Anxiety does.
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If you were using your S9 with a min pressure of 10 and a max pressure of 17. Than you used step 1 on the EPR

It would be the same as min EPAP 9 Max IPAP of 17 PS 1.     So starting off EPAP would be 9 IPAP would be 10. If you used EPR 2

Than it would be EPAP 8 IPAP 10. With a VAUTO instead of dropping the bottom pressure your increasing the top pressure. So starting out

it would be EPAP of 10 IPAP of 11.    As the pressure rises both EPAP and IPAP rise together 1cm apart. However it won't rise above 17 because that's the max IPAP.

So your going to have a min pressure, a max pressure, and a pressure support (PS) which is the gap between EPAP and IPAP.

Hope that doesn't confuse you too much.

P.S. I just used those numbers as an example.
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