ShinRyoku wrote:'m a little uncomfortable with the fact that the titration guidelines suggest considering BPAP when over 15 cm H2O and that a minimum recommended PS is 4 cm H2O. It makes me wonder if there is some reason other than comfort that the experts feel that PS ought to be used at high pressures. But I can't find any evidence to support those recommendations, so I'm sticking what works: EPAP 14-20, PS 0.
I think the bulk off the 4 cm PS recommendation is purely comfort related but there could be some instances where IPAP is wanted to be higher but only briefly so PS is used.
The general consensus is EPAP for OAs and IPAP for hyponeas. There are several ways to accomplish this goal.
I suppose it might be possible that if someone was having a lot of hyponeas and not many OAs then maybe having PS do some of the work instead of having EPAP always higher (which will also kill hyponeas) .
And maybe with EPAP always higher instead of sometimes higher other problems are reduced or avoided. Like maybe aerophagia issues.
You know the old saying "more than one way to skin a cat"....well there's more than one way (or setting(s)) to achieve whatever desired results we are looking for.
I like PS...I like bilevel and I actually noticed a difference in how I felt when using bilevel (PS of 4) both in terms of how I felt during the day and how long I slept from the very first night I tried bilevel. The AHI with or without PS didn't really change but since how I sleep and feel is REALLY important to me (and actually more important to me than minor AHI variations) I opt to use/do whatever it takes to maximize my sleep quality/quantity and since I learned a long time ago that sleep quantity makes a huge difference in how I feel that's what I work hard towards.
I discovered that with all other things being equal I was sleeping approx an hour longer on bilevel than on apap with Flex relief (using Respironics back then). For me that extra hour or so made a significant difference in how I felt. Now I never could figured out why I slept an hour longer and I tried but I never could figure out for sure why. I had a sleep tech tell me once that maybe the body/brain just liked the predictability of the bilevel and the comfort. It just happens that way for some people.
Now not everyone likes or needs bilevel or even exhale relief but I figure that people should use/do whatever makes them feel the happiest and most satisfied with their therapy because it's their therapy. I know that what works for me doesn't/won't necessarily work for the next person.
You have done your experimenting and figured out what gives you the results you desire and you are good with it. That's the important thing...that you are good with your results.
It's not just AHI that I measure...I always look at the big picture with sleep quality being right up there at the top of the list because if I get crappy sleep I feel crappy no matter what that AHI is.
Some people want to target the AHI and that's fine if that is what makes them feel good about their therapy.
I have other health issues that mess with my sleep and my sleep quality is already really fragile so for that reason I have to look at a bigger picture anyway.
If you feel better...sleep better...get better AHI ....without PS or any exhale relief and you are happy doing it then by all means do it.
More than one way to skin a cat.
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