Gainerfull's Bilevel Titration Thread

[gainerfull]

I was finally able to get my hands on a Resmed Aircurve 10 VAUTO and wanted to share the results from my last night on the Airsense 11 compared to my first night on the Aircurve




As most know here, getting insurance approval is a long and arduous process so while I was waiting for my bipap titration and the dme to process the order I was able to get my therapy to a great spot on CPAP. What I learned along the way was what was causing a lot of my problem was RERAs which I was able to mostly solve with a high constant pressure of 16cmH20 and EPR at 2. 

My hope in switching to bilevel would give me even greater control over RERAs as even at 16cmH20 I was still seeing 3-5 a couple nights a week and additional pressure increases yielded the same results. I was also encouraged by this post:
https://www.apneaboard.com/wiki/index.ph..._and_BiPAP

Last night I tried my sleep lab titrated pressure as my minimum 12/7 (IPAP Max 18, EPAP Min 7, PS 5) in VAUTO mode for the first part of the night and woke up to pretty terrible sp02 stats and decided to switch it to CPAP to salvage the night. Any thoughts on how I can get a better night's sleep on bilevel? Seems like the IPAP pressure is near the right spot considering the lack of obstructive events. Should I be considering changing trigger sensitivity to resolve the central apneas?

[Sleeprider]

Go back to Vauto mode, and cut back on pressure support to PS 4. My suggestion is EPAP min 9.0, Max Pressure 16, PS 4, trigger sensitivity High. We may need to cut things back to PS 3, or something between 3-4 as you adapt to the higher PS, but I think the main problem was PS 5 was overkill.

[gainerfull]

Thanks for the recommendation, had great quality sleep last night. Is there any opportunity to further optimize? sp02 is much better and it could just be a bad night but typically spend 5-10 mins in 90-94% and last night was 43 mins

[Sleeprider]

I think with this improvement we hold fast an observe for a bit. I do think we hit the pressure "sweet spot".

[gainerfull]

Thanks for your help, will report back next week.