Bipap regulation

[Unionpsychos]

I was dx with pretty severe osa. I started bipap therapy 12/31. My original settings were 15/24. I couldnt tolerate it. Had the mask so tight to stop leaks i got sore on my face. After about a week i changed to a dream something nose mask. That was better but still very painful for my nose. I changed the settings myself to 12/18, and now i can get through most nights. My AHI's ha bee mostly in the 1's with a record of 0.4. Ive been checking my oxygen level randomly at night and have stayed in the mid to high 90's. I have raised my humidity level but still feel like i have a bad head cold all the time. Does it make sense for me to continue to titrate my pressures down until I become more comfortable? Will this ever get better?

[Julie]

No reason for you not to get better... 100% who knows, but certainly better.

Have you tried lowering or even turning off the humidity? If it's too high for ambient conditions, local climate, etc. it can cause congestion and you need it only for facilitating Cpap, your comfort - it's not 'therapy' and you should experiment with settings. I never use mine, others have it on 6 all the time.. just depends.

Your having overtightened the mask was counterproductive - the little silicone cushion needs to inflate, and if you get leaks (always best to try FF masks when lying down as your face changes then) you need to either get a diff. size, or diff. mask - there are oodles on Cpap.com to look at and assess and they let you have them for either no fee x 30 days, or a small 'return' fee, so you can try on various ones to find the best for you (we've all had to do that).

I can't really tell you much about bipaps, but others will, I just think you need to give yourself more of a chance to find the right equipment for you and the rest should follow more easily.

[Sleeprider]

It would help to know what make and model of machine you are using. A bilevel pressure of 12/31 sounds crazy, and 15/24 mildly insane as fixed bilevel pressure support. In most of us it would cause central apneas due to the huge pressure support. Your current settings of 18/12 sound okay with a pressure support of 6. The thing is, these might be limits for auto bilevel, or they might be fixed pressure settings???

Anyway, post back with what machine you are using and whether the EPAP /IPAP settings are minimum, maximum or exactly how they are implemented. Other than that, most of us have taken over the control of our machines and make changes to optimize the treatment. It also helps to use software like Sleepyhead to help visualize the therapy and events.

[OkyDoky]

I was dx with pretty severe osa. I started bipap therapy 12/31. My original settings were 15/24. I couldnt tolerate it. Had the mask so tight to stop leaks i got sore on my face. After about a week i changed to a dream something nose mask. That was better but still very painful for my nose. I changed the settings myself to 12/18, and now i can get through most nights. My AHI's ha bee mostly in the 1's with a record of 0.4. Ive been checking my oxygen level randomly at night and have stayed in the mid to high 90's. I have raised my humidity level but still feel like i have a bad head cold all the time. Does it make sense for me to continue to titrate my pressures down until I become more comfortable? Will this ever get better?

No machine that I'm aware of has a IPAP of 31. So to begin with we need you to reqister and give us your machine information so we know how to help you. This link will help with listing your equipment in your users profile. wiki/index.php/Registering_Equipment_in_User_Profile
Once we know your equipment we will get you your clinical manual so you can learn about your machine. I don't recommend changing pressures blindly. But with learning and data you can see what is happening and what is needed.

[palerider]

A bilevel pressure of 12/31 sounds crazy,

er, that's because it's a date.

and 15/24 mildly insane as fixed bilevel pressure support. In most of us it would cause central apneas due to the huge pressure support. Your current settings of 18/12 sound okay with a pressure support of 6. The thing is, these might be limits for auto bilevel, or they might be fixed pressure settings???

pressures need to be whatever pressures need to be to control apneas, some people NEED a lot more pressure support for co-morbidities. guessing without data is bad form.

[palerider]

No machine that I'm aware of has a IPAP of 31.

I know of one or two that'll go to 30, but, 12/31 was Dec 31. ... I missed it the first time I scanned over it too.

[OkyDoky]

No machine that I'm aware of has a IPAP of 31.

I know of one or two that'll go to 30, but, 12/31 was Dec 31. ... I missed it the first time I scanned over it too.

Oops

[Julie]

Has anyone READ the OP's note? He never said 12/31 was a setting or pressure - he gave it as the date in the first line!

[palerider]

Has anyone READ the OP's note? He never said 12/31 was a setting or pressure - he gave it as the date in the first line!

with all the other x/y stuff, it was a bit easy to get confused.

[Unionpsychos]

Ha! Thanks everyone. I should have said December 31.

[OkyDoky]

With your 15/24 perscription the difference between the EPAP and IPAP is called pressure support and yours was 9 which is on the high side. Do you have any lung conditions?

[TedVPAP]

Based on physics and proven by my own experience, the best mask for high pressure are pillows. They are self sealing and the pressure is over a very small area so the straps do not have to resist blowoff loads. The full face is the worst since there is so much force due to pressure acting over such a large area.
My DME was surprised that I insisted on trying the pillows best. He said that they don't work well for high pressures. He was wrong.

[palerider]

Based on physics and proven by my own experience, the best mask for high pressure are pillows. They are self sealing and the pressure is over a very small area so the straps do not have to resist blowoff loads. The full face is the worst since there is so much force due to pressure acting over such a large area.
My DME was surprised that I insisted on trying the pillows best. He said that they don't work well for high pressures. He was wrong.

here's another thing about FFMs and bilevels.... when you've got different pressures during the breath, the many larger masks inflate and deflate noticeably while you breath,.... THAT can take some getting used to.