High pressure with BIPAP issues

[madmoe]

Hi! I've been using a BIPAP for about 2 weeks now. My sleep study reported an initial AHI of around 50 (very high). They said I had a combination of Central Apnea and Obstructive Apnea. The recommended pressure setting for the BiPap was 25. When I started with that pressure, I had a lot of problems with swallowing air and just getting to sleep. The therapist dropped the high pressure to 21 which helped, but it is still hard. My machine has a ramp feature so it starts at 11 and ramps up to 21 over 30 minutes. I can't breath well through my nose, so a nose only mask would not work for me.

My API has dropped to 25 now using the machine, which is an improvement, but still high. The pressure feels so high once it hits the 21 pressure that mask feels like it is blowing off my face. I've switched masks once to a larger one. The mask itself feels good (the one used at the sleep lab bruised my nose) but am still struggling with this. I know this is something I HAVE to do, not a choice, but that doesn't make it any easier. The pressure is blowing my mouth wide open, to the point that my lower lip sometimes slips out of the bottom of the mask, even though the mask itself has not moved.

Any suggestions appreciated!
Michael

[Pugsy]

Could you please add your equipment to your profile...there are many, many BiPap models.
wiki/index.php/Registering_Equipment_in_User_Profile

You might want to watch this video which explains a bit about when we have a mixture of central and obstructive apneas.
http://www.youtube.com/watch?v=CU-XTcfg ... e=youtu.be

[Denial Dave]

hi

I'm about 1 week into my acclimation with Bipap... my settings are 21 over 15..... so I have high settings for inhalation and exhalation... using a full face mask

during the 1st few days, I had my ramp set to max time & occasionally I could feel my cheeks being blown open.... I'm guessing that I was having obstructions just prior to falling asleep.

I've reduced the ramp time to 20 minutes and seems like "la machine" & I have settled down.

high pressure is a bear.... mask leaks are nasty to overcome

good luck

[Pugsy]

during the 1st few days, I had my ramp set to max time & occasionally I could feel my cheeks being blown open.... I'm guessing that I was having obstructions just prior to falling asleep.

More likely the cheeks being blown open was because the existing air pressure was trying to exit the airway via the oral cavity because the tongue moved so it couldn't block that potential exit. Has nothing to do with obstructions occurring prior to sleep or any changes in pressure.
The tongue when properly placed will act like a door and block air from entering the mouth.
When it moves out of position the air will take the first chance to fill a void.. that would be the oral cavity.
If lips are closed...cheeks inflate and we call this "chipmunk cheeks". Highly annoying.
If lips are open there is a loud gush of air exiting the mouth...Highly annoying.

It's hard for the tongue to stay in position for some people and maintain a closed door. We can normally do a good job of keeping the door closed while awake but as we drift off to sleep the tongue relaxes and moves a bit so air pressure can enter the mouth.
My tongue is so well trained to stay in position now that I have a difficult time getting it to move out of the way so that I can even have any air enter my mouth at all. I can even do a full wide open mouthed yawn and never have one bit of air pressure try to exit the airway through my mouth.

[JDS74]

Hi Madmoe

Sounds like my problem. I use the Oracle 2 oral mask from Fisher-Paykel and it works just fine for me. As you can see on my equipment list, my pressures are nearly as high as your most current settings.

The Oracle 2 mask does come with a strap that wraps around the back of your neck and will help keep the mask in place with pressure changes.

Take a look at my post on adjusting to the Oracle mask:

viewtopic.php?f=1&t=63139&p=639238#p639238

It was posted almost a year ago and the only change since then is the addition of an in line viral filter and the addition of a second layer of insulation on the hose.

If you do try one, send me a PM with your snail mail address and I'll send you a sample nose clip that actually works to use instead of the one supplied with the mask. I've got a box of them I no longer need as I have learned to sleep without air escaping through my nose.