[Pressure] Reaching maximum IPAP - Time to change settings?

[Frajola81]

@Dave, I saw the Corflex collar online but decided to go with the one I got because I could choose a larger neck length and because it had better reviews online. Should have checked here first....    And to make things worse, my collar keeps rubbing on or against the straps of the mask that I wear and it irritates the skin behind the head. Annoying....

@Sleeprider, being an automatic algorithm, that's what I was thinking about doing too: let it increase the pressure until the FLs are resolved. I will do that (just hope the NP doesn't give me a hard time on my follow up with her in the end of the year haha.)

Thanks for the help guys!

[Sleeprider]

It works or it doesn't. You have efficacy, we're just fine-tuning.

[Frajola81]

Hi there!

I ended up increasing the maxIPAP to 20cm H20. And the pressure went all the way there at times. Please look at the data from the past 3 nights and see if you notice any improvement.

Comfort-wise,  in the first day that I increased the pressure, I started again to feel super bloated at night and in the morning. Could adjusting PS alleviate that?

Thanks!

[SarcasticDave94]

If it is a case where the soft collar is necessary to prevent positional apnea, your PAP/VAuto doesn't have enough strength to physically open a forced closed airway. AND that is not the machine's designed job nor is it a flaw in your PAP. Note I do not see positional clusters here, so maybe you're wearing a collar?

The VAuto is jumping to nearly 20, your Max setting. FL flow limit may be part of the reason.

You can set the VAuto to override what it needs to attempt addressing what it cannot, as in lowering the 20 to something that's better, maybe PS may be needing altered. I let this to the guru pressure team. But having said all the above, you need edits to the comfort side. You are no longer needing therapy edits for apnea related events per se. This fact does not cancel positional apnea, collar, or other needful attention to make both therapy and comfort excel. And final comment, your numbers say you are well treated, circling back to comfort being your needed area to improve.

[Frajola81]

If it is a case where the soft collar is necessary to prevent positional apnea, your PAP/VAuto doesn't have enough strength to physically open a forced closed airway. AND that is not the machine's designed job nor is it a flaw in your PAP. Note I do not see positional clusters here, so maybe you're wearing a collar?

The VAuto is jumping to nearly 20, your Max setting. FL flow limit may be part of the reason.

You can set the VAuto to override what it needs to attempt addressing what it cannot, as in lowering the 20 to something that's better, maybe PS may be needing altered. I let this to the guru pressure team. But having said all the above, you need edits to the comfort side. You are no longer needing therapy edits for apnea related events per se. This fact does not cancel positional apnea, collar, or other needful attention to make both therapy and comfort excel. And final comment, your numbers say you are well treated, circling back to comfort being your needed area to improve.

Hi Dave, nope, no collar. I was surprised too with the lack of clusters...

You say that I am well treated but what about the snores? The machine doesn't address that? 

I am in hopes of finding what makes me sleepy during the day but like you said, I may need to wear the collar (or lose weight since when I was skinny, I didn't snore at all..... )

[SarcasticDave94]

Snores to me indicate needing more pressure in some fashion. What for you? I know not. Maybe the guru team will swing by and answer that one. I am poor at some of the suggestions to edit pressures for others. I am pretty good for my own though because I have nobody to blame or complain about.

My take on snores proven true or partially so is that since snores are vibrations of the tissues that are in process of blocking the airway, these make noise as their obstruction makes itself heard. This indicates more pressure of some sort OR the collar maybe as something must inhibit the closing off of the airway. If a PAP's air pressure cannot do it then maybe the physical collar device is thus indicated.

[Sleeprider]

With your current charts, I don't see snores as significant, and flow limitation has fallen to 0.0 at the 95th percentile. Snores can be respiratory, but can also be your tube dragging on a table top. You are not at your maximum set pressure, but came close once. There are some OA events still showing up, but an event every two hours is nothing to worry about.

[Frajola81]

@Dave, yes, the snores seems to be the cause of increase in pressure as well as the FLs. I need to read the wiki again to understand better the difference between the 2.

Of course it is too early too tell but I am less sleepy today, with that, I intend to keep the pressures as they are now.

But what about PS? Adjusting that could help somehow improve the amount belching/gassy belly? That's the only annoying part of the therapy now.....

I went from an AutoSet CPAP to this biPAP because of this very symptom!

[sheepless]

looking at the left most screenshot in post #43, you can see there's an association between snores, flow limitations and increasing pressure. if you're getting aerophagia, you have to find the right combination of epap and ps to resolve opposite problems of snores/flow limitations and relieving aerophagia. your screenshot shows you at 4.4 over 7-20. there are several options; someone else might have a stronger opinion about one or another. any scenario should first reduce max ipap. you can do this incrementally or drop to a pressure you know doesn't cause aerophagia (and adjust from there depending on results). meanwhile, your median epap is nearly 9 so one suggestion is to raise it to at least 8. another is to incrementally raise min ps. it may take a bit of tweaking over time to find your sweet spot. best to make one change at a time but my suggestion is reduce max ipap and raise min ps a hair first. this is because you have few obstructive events (for which you'd need higher epap) and ps will help with snores and flow limitations.

[Frajola81]

Hmmm.... thanks Sheepless. That makes sense. I was thinking that if I indiscriminately increased PS, I could solve the aerophagia problem but not quite simple.

As far as decreasing IPAP, even when it was at 16, I could already feel the aerophagia. And the pressure was topping off. So I am still not sure how to handle this "give and take".

Could you (or someone else) please elaborate on how increasing EPAP and PS have the same effect?