[Pressure] Help me understand EPAP, IPAP and Pressure Support

[Kahri]

to avoid aerophagia use these settings
IPAP Max 11.0
EPAP min 4.0
PS 4.0
Either turn off ramp or set to auto mode.
These settings will reduce the pressure you can experience.  Try this and let us know how you feel.  A wedge or incline of the head of your upper body can help with air ingestion.

Thank you. I tried using this site via my phone and got horribly lost, so I may be answering this same post twice. Forgive me.
I've played around with ramp - I only need it if the EPAP is over 7. It seems sily to some that ipap of 12 doesn't hurt me, but epap of 8 does. I'm working WITH ipap when inhaling, so my body is not fighting it; but when exhaling, if the pressure fighting me hits 8, my body does not like it and I end up yanking off my mask, starting and stopping the machine, or waking in the morning lying on top of the mask. (I was told my best night's sleep was the same date that I woke up sleeping on top of the mask all night. Good grief.)

I have slept in recliners and have a hammock in my bedroom now. The hammock works best for it cocoons me, so there's less flailing if I get uncomfortable. But, given the surgeries I've been through, I need to be able to sleep in a bed - worst case, hospital bed - else getting out of a Brazilian hammock after knee replacement surgery would be... well, probably impossible to do safely.

Thank you for your suggestions.

[Sleeprider]

to avoid aerophagia use these settings
IPAP Max 11.0
EPAP min 4.0
PS 4.0
Either turn off ramp or set to auto mode.
These settings will reduce the pressure you can experience.  Try this and let us know how you feel.  A wedge or incline of the head of your upper body can help with air ingestion.

Thank you. I tried using this site via my phone and got horribly lost, so I may be answering this same post twice. Forgive me.
I've played around with ramp - I only need it if the EPAP is over 7. It seems sily to some that ipap of 12 doesn't hurt me, but epap of 8 does. I'm working WITH ipap when inhaling, so my body is not fighting it; but when exhaling, if the pressure fighting me hits 8, my body does not like it and I end up yanking off my mask, starting and stopping the machine, or waking in the morning lying on top of the mask. (I was told my best night's sleep was the same date that I woke up sleeping on top of the mask all night. Good grief.)

I have slept in recliners and have a hammock in my bedroom now. The hammock works best for it cocoons me, so there's less flailing if I get uncomfortable. But, given the surgeries I've been through, I need to be able to sleep in a bed - worst case, hospital bed - else getting out of a Brazilian hammock after knee replacement surgery would be... well, probably impossible to do safely.

Thank you for your suggestions.

The maximum EPAP of the settings I suggested would be 7.0 cm.

[Kahri]

"On the VAuto EPAP is the ONLY pressure that is changed until the pressure reaches IPAP Max when upward adjustment stops.

Repeating
IPAP Max = 7.6 (This will prevent the VAuto from generating pressures >= 8)
EPAP Min = 4 (The same start as your CPAP)
Pressure Support = 3 (Low for a biLevel but will let the VAuto algorithms kick in.
(Therapy from the above settings could be achieved with a ResMed Autoset)

This will closely match your CPAP which you said you tolerated.  Again, THESE ARE SAFE SETTINGS based on the CPAP info you provided
START with this and post the charts when you can so we can see what is happening.
Don't be surprised if we recommend increasing IPAP Max to > 8 and also increasing PS to 4 and possibly beyond.'

So Bonjour, given my doctor knows my largest problem and pain with CPAP was not being able to safely exhale against a pressure of 8 or more Epap, why in the world put me in a machine with settings that guarantee I'd be over 8 on Epap every night?
Mathematically, your suggested settings are great, but my doctor's settings are twice that, and I was trying to stay close to those settings without allowing EPAP to go over 8. It appears that is impossible, given what you've shown me the past week.

yours: 7.6;4;ps3 
Doc's 14;8;ps4
So your's couold generate a max EPAP of 7 == great
Doc's could generate a max EPAP of 12 == miserable. But this doc has seen me for almost 4 years - why deliberately put EPAP to MINIMALLY be 8, when 8 causes pain?

It seems what I needed was no upper limit on IPAP ceiling as long as PS was not allowed to creep up the EPAP value, thus a limit of 7 on EPAP ceiling

I also notice that as I exhale, for the last few moments, the machine is rhythmically pulsing air against me, but not hard enough to make me sick, as if impatient for me to inhale.
When I am awake, I'm inhalling 2 seconds for every 6 seconds exhale. Never paid much attention to that in the past, but given the pulsing, I wondered if normal breathing were of a different ratio.

Also, just breathing at CPAP 4-8 on th is machine feels different than at 4 on the Fisher & Paykel icon +. 
Even though I'm notl sure of settings yet, this machine is incredibly far less harsh.

[thibaulthib]

Normal I:E ratio is 1:2, or 50% is you prefer, meaning the the exhalation should be twice longer than inhalation.

1:1 (100%, inhale = exhale) or 1:3 (33%, exhale = 3 times inhale) is also ok.

However if you have normal lungs the inhale time should be around 1 or 1.5s. I let you compute the exhale time.

[Gideon]

o 

yours: 7.6;4;ps3 
Doc's 14;8;ps4
So your's couold generate a max EPAP of 7 == great
Doc's could generate a max EPAP of 12 == miserable. But this doc has seen me for almost 4 years - why deliberately put EPAP to MINIMALLY be 8, when 8 causes pain?

yours: 7.6;4;ps3 This means EPAP range from 4 to 4.6  IPAP range from 7 to 7.6

Doc's 14;8;ps4 This means EPAP range from 8 to 10  IPAP range from 12 to 14

Doc's could generate a max EPAP of 12 == miserable. But this doc has seen me for almost 4 years - why deliberately put EPAP to MINIMALLY be 8, when 8 causes pain?   I don't know.  I suspect that he feels the BiPAP will allow you to NOT have that problem.

The plan would be to start in a range that would be totally safe and then raise pressures in an attempt to get you to a solid therapeutic pressure for you.  This means pressures that work for you.  But we need to start somewhere and work from there, either up or down.  The settings I suggested I feel are a totally safe place.  I would adjust from there.  
The first change would be to increase IPAP Max to 8 and PS to 4 so 8;4;ps4 This means EPAP range from 4 to 4  IPAP range from 8 to 8.  
The second step would be to increase the range slowly,  to increase IPAP Max to 8.4 leave PS at 4 so 8.4;4;ps4 This means EPAP range from 4 to 4.4  IPAP range from 8 to 8.4. 
The third step would be to continue to increase the range slowly,  to increase IPAP Max to 8.8 leave PS at 4 so 8.8;4;ps4 This means EPAP range from 4 to 4.8  IPAP range from 8 to 8.8. 
Eventually 14;4;ps4 This means EPAP range from 4 to 10  IPAP range from 8 to 14. (This is because this is where the doctor suggested, and yes)

Then we would work on the EPAP pressure slowly raising it to the 8, your doctor's recommendation, in .4 increments.

All this assumes that you wish to work with your doctors.  If you choose to go rogue without your doctors, we will work with you too.  The goal then will be simply to get you to a therapeutic value in your treatment. 

The question is how do you want to proceed?

Note: that we would stop when any pressure becomes a problem and address the issue.