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RE: Changing Max Pressure and starting a BiPAP trial
It is as we have found out. But ask him how? And let us know his response.
We typically increase the "Trigger" parameter incrementally to "High" then "Very High" for an off book treatment of mild to low moderate Central Apnea. The VAuto is not designed to treat Centrals.
In a similar manner we can often reduce Centrals on an AutoSet to where they are not a concern.
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter
03-14-2023, 01:44 PM (This post was last modified: 03-14-2023, 01:48 PM by Lampshade. Edited 5 times in total.)
RE: Changing Max Pressure and starting a BiPAP trial
Sleeprider, Gideon and Dormeo, thanks again for your insights.
The DME specialist is not so special. When I asked him about the difference between CPAP with EPR and BiPAP, he said that each increment of EPR was 0.1 cmH2O, but he wasn't sure, but they were not equivalent. Thanks to this board, I read the clinical manual for the ResMed AUTOSET and found out he was wrong, they are in fact in 1 cmH2O increments. It is true that BiPAP can go to higher levels than the 3 cmH2O EPR limit on CPAP, so they are not equivalent in that regard.
Now that you have helped me figure out what I need to do independent of the device using positioning, the question comes back to the benefits of BiPAP over CPAP for me. I want to optimize the BiPAP device and lock that in for a 7 day trial to get average statistics before I return the device. Next I want to optimize the CPAP and get 7 days of side-sleep+SSC and compare the two machines. Then I can decide if BiPAP is worth the out-of-pocket cost (I am on a High Deductible Plan) to reap the benefit (if any). I understand that PS 3 on a BiPAP is equivalent to EPR 3 on the CPAP, so I might try that one night before starting 7 days of fixed settings.
Besides the AHI score, a benefit of BiPAP claimed by the sleep PA was a reduction in the frequency of waking up to release air in the stomach (aerophagia). The PA said not to worry about how often I wake up in the night as everyone wakes up during the night. An astonishing statement from a sleep doctor! I currently experience aerophagia with my current levels on BiPAP. Perhaps I should repeat the Titration routine with the positional improvements to search for a new pressure that prevents OA. It may be low enough that I don't suffer from aerophagia.
The DME specialist mentioned that if there were unanswered questions, another 2-week trial might be approved by the sleep PA.
I welcome any suggestions on the best order of testing now that I am at the dawn of a new era!
RE: Changing Max Pressure and starting a BiPAP trial
I leave most of your questions to more experienced people, but I will just mention that EPR measures a drop in set pressure when you exhale, while PS measures an increase in your set pressure when you inhale.
So just to simplify, imagine you have a ResMed Airsense 10 Autoset with a fixed pressure of 7 and EPR of 3. Then your pressure when you inhale will be 7 and when you exhale it'll be 4. If you have an Aircurve VAuto with a fixed (EPAP) pressure of 7 and PS of 3, your pressure when you inhale will be 10 and when you exhale it'll be 7.
RE: Changing Max Pressure and starting a BiPAP trial
Fifth night of BiPAP - Second night side-sleeping+SCC
BiPAP Results:AHI = 2.54 (OA = 0, CA = 2.54) Min EPAP: 4, PS: 4 to perform a side-sleeping "titration" (see #19).
Fourth night BiPAP Results: AHI = 1.6, CA =0.9 at Min EPAP: 9, PS 4. Does a higher EPAP affect CA events?
Shout out to Gideon. I really appreciate the ease of use of OSCAR after just a few days of use. The plots are attached below.
The first period of 1 hour, I did not fall asleep, but early on I needed to clear my sinuses and that showed up as a snore.
Later in the first hour, my nasal passages swelled up, constricting air flow, which sometimes happens when side-sleeping.
In the past, I would avoid this problem by lying on my back, but now I understand this will lead to OAs without a large EPAP.
When I first started CPAP therapy with nasal pillows, I purchased a Neti Pot in case I had clogged sinuses. I never used it.
When lying on my side causes swollen nasal passages, an infrequent event, I sit upright for 10 minutes and it goes away.
The last period, was after I woke up wanting to roll onto my back to relief some stiffness on my left side.
I shut off the air so I could rearrange the pillows to sleep on my right side, but sleep never came so I am writing this.
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