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[Pressure] Question about how BiPap pressures are determined
#1
Question 
Question about how BiPap pressures are determined
I had a home sleep study in January and was diagnosed with severe OSA (92 events per hour).  While waiting for a backordered CPAP my sleep doc scheduled me for an in-lab titration sleep study, where they determined I actually needed a BiPap instead.  Fair enough.  It came in super fast (compared to the CPAP wait time) and I have been using it for 7 nights.  They titrated my pressures at 10/16.  I used a ResMed Airfit N20 (nasal mask) in my in-lab study and did well with it, but I wanted to make sure I had one for mouth breathing because my allergies like to congest me, so when I picked up my machine from the dealer they fitted me with a Dreamwear full face mask.  It worked fine in the fitting (sitting up only, they didn't have me lay down or anything like that, and I didn't know enough to ask), but upon getting it home that night, the hurricane force 16 pressure winds basically blew the bugger right through the ceiling.  I found the fitting guide in the fit pack and I think my nose might be too small for the medium mask, and also my nose is really flexible and the mask kinda just pushes my nose up out of the way lol, but I wanted to try it a few nights before going back to the DME for a new mask.  Also, I can't fathom why the AirCurve does the "mask fit" routine at a lower pressure than what I'm using throughout the night...

In the meantime I was watching some YouTube vids and reading up online, and since my AHI on the first couple nights at home were below 1, I decided to lower my pressures.  After a few nights at 10/16 I changed them down to 8/12, and still my AHI was below 1.  So the next night I lowered it again to 6/10, and STILL my AHI is below 1.

"Finally," you might think, "She's going to ask a question."

Is there some other factor besides AHI that made them decide to set my pressure at 16?  If AHI is the only factor then why would they prescribe me that high when much lower and more tolerable pressures seem to be controlling my apnea with a fraction of the mask leaks and MUCH more comfort?


I still plan to hit up the DME again because even at the lower pressures that Dreamwear full mask still blows out around my nose, but before I go back in and tell them I jacked around with my settings, I would like to know if I did the right thing, or if there's some other reason that I need to increase it back up where the lab said.

I have included some screenshots of some of my nights for comparison, and I apologize in advance if this isn't how this information is supposed to be shared.  Also, I'm not sure why the Oscar data for March 27th is showing 0 AHI, the MyAir app is showing .1 for that night.


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#2
RE: Question about how BiPap pressures are determined
Welcome to Apnea Board,

The first post and OSCAR data is fine how you did it.

A few things that may be hindering therapy, the VAuto is running S mode. Others that use VAuto can help better on settings, but I'd suggest the actual VAuto mode. Then the Ramp...it's feeding you really small sips of air on pressure 4 for 45 minutes then bam there's your higher therapy pressure. A possible source of disruptions and being robbed therapy time. Maybe try weaning yourself off the too low pressure for too long Ramp time.

And the mask choice with strap adjustment. Welcome to the hardest part of PAP therapy, getting those 2 items correct.

Also you can request your sleep test results, both diagnostic PSG and Titration, from the doctor. Get them so you may post the info redacted here. You'll want detailed copies for yourself anyway. And if doc stalls the request, remind their office HIPAA permits the request.
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#3
RE: Question about how BiPap pressures are determined
(03-29-2022, 09:21 PM)SarcasticDave94 Wrote: A few things that may be hindering therapy, the VAuto is running S mode. Others that use VAuto can help better on settings, but I'd suggest the actual VAuto mode.

I will see if any others have any suggestions about this, too.  And in the meantime I'll try to do some reading on the different modes.  I didn't want to change anything other than the pressures since I don't really know what any of them do.

(03-29-2022, 09:21 PM)SarcasticDave94 Wrote: Then the Ramp...it's feeding you really small sips of air on pressure 4 for 45 minutes then bam there's your higher therapy pressure. A possible source of disruptions and being robbed therapy time. Maybe try weaning yourself off the too low pressure for too long Ramp time.

Actually I did disable the ramp on the second night! Smile  I decided that I would rather blow a leak from the high pressures right away than have it wake me back up if I manage to fall asleep before 45 minutes.

(03-29-2022, 09:21 PM)SarcasticDave94 Wrote: Also you can request your sleep test results, both diagnostic PSG and Titration, from the doctor. Get them so you may post the info redacted here. You'll want detailed copies for yourself anyway. And if doc stalls the request, remind their office HIPAA permits the request.

Good advice, I will very much do this.  Maybe they will also tell me why they prescribed such a high pressure when lower pressure seems to be managing it.  I was hoping folks here will be able to help with that without me having to talk to a doctor that I've never even met, especially when the lady at the DME said that the doctor would want at least two months of data before making any adjustments.  I took that to mean they were just going to tell me to do what I'm told for two months before they will adjust it.  Maybe I shouldn't assume that, but I do not think I would make it two months on a 16, unless I am able to find a perfect mask anyway.
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