CPAPtalk.com

Pugsy wrote:If you want to study some protocols

https://www.resmed.com/us/dam/documents ... lo_eng.pdf

All I have for Respironics is the ASV protocol but it does touch on obstructives and again the basics are the same.
http://www.isetonline.org/yahoo_site_ad ... 190318.pdf
If anyone has a simpler Respironics titration guide I would love to have the link.

The minimum pressure has to be high enough to prevent the airway from collapsing in the first place.
When using auto adjusting pressures it has to be high enough that if it needs to go higher it can get there quickly enough to get the job done.
If using fixed pressures it simply has to be high enough period. People who might need higher pressures for part of the night get to use higher pressures all the night just to cover the "maybe".

I have used both epap and ipap in an effort to keep that airway open. You learn with time and experience that sometimes using both in various ways can accomplish a goal easier.
Again it doesn't really matter how we get the job done...it's just that we get the job done and there is more than one way to accomplish our goals.
How we go about it can be influenced by a person's specific needs or problems even.
Like with aerophagia...maybe we don't want ipap going very high.
Or maybe the mask leaks too much and sleep gets disrupted.
Or maybe the pressure that would do the job simply is low and not comfortable for someone. Maybe someone feels like they are suffocating at 7 cm and prefers 9 or 10. It hurts nothing to use more pressure than would technically get the job done as long as using it doesn't create a problem.

Often there doesn't have to be one set pressure set in stone to get the job done.
You can use one or both if someone is using exhale relief and thus has a little bit of bilevel situation going on.
With most of this stuff there isn't anything set in stone where someone has to just exactly so and so pressure. No hard fast rules and a lot of it is common sense anyway.

And then there are those pesky cpap pressure triggered centrals that can mess up things.
I know one person who gets 15 to 20 centrals with PS of 4 but none beyond a normal occasional sleep onset at PS 3.
She needs a high EPAP because of the obstructive stuff but we had to have some exhale relief because using 17 cm fixed...sucks.
By having IPAP available it helps with holding the airway open...so she could get the obstructive stuff well controlled with EPAP of 15 instead of 17 and IPAP of 18...She had a ResMed bilevel auto...so we used PS of 3 instead of EPR of 3 in auto mode but end result is pretty much the same. So if using fixed pressures she would need 17 but that's hard to exhale against...so we made use of PS and by having IPAP go a little higher than 17...it helps offset the lower than 17 on exhale. End result is the OAs get taken care of and she can breathe and sleep better.

We liked to never figure out that the centrals were related to PS and not the pressure itself.

So both EPAP and IPAP are important and can play significant roles in success or not but you have to start with the baseline pressure which is the minimum ...be it EPAP or whatever if exhale relief isn't used.
IPAP is just a little bit extra help if needed.

Also..you don't want too big of a difference between EPAP and IPAP....it can cause centrals. I had a friend decide to use PS of 10 on her bipap. Talk about central city....those little suckers were all over the place. To me that much difference isn't comfortable anyway.
But some people need a bigger PS for ventilation issues.

In other words when looking at what pressure to use it isn't always where we can say x amount of pressure needs to be used. Period.
Most often we can tweak one or more various settings and get the job done.
We have to look at the big picture and decide what the goals are...what potential problems we might have...and what are acceptable modifications that could get the same job done.

All this gets compounded by the fact that we don't sleep the same each night anyway and at best when we come up with these ideas were are planning for the trends and patterns we see and hope that not too many outlier weirdo nights happen.
I still get a weirdo fluke night every now and then with my current setup. Perfection for all nights is an unreasonable expectation.
Sometimes we do make compromises.
Nothing is set in stone.

Okie bipap wrote:They recently made a change on my wife's machine. We have been using what the sleep specialist has prescribed. The recently opened her maximum IPAP to 25 and raised her raised her minimum EPAP to 12. The EPAP had been set to 8 in the past. Since raising the EPAP, her IPAP has actually been running lower than it did before the change. Her flow limits have been reduced from 1 to around 0.2. This has caused the machine to quit going higher in order to cut off events before they can happen, thus lowering the maximum IPAP the machine is actually going to.

TedVPAP wrote:I finally get it. That makes sense. I never thought about the physical distinction between apnea and hypopnea/flowlimitations. Although the definitions vary only in severity, they are in fact trying to identify the difference between full collapse, and partial since the remedy can be different.

TedVPAP wrote:Full collapse must happen towards the end of exhalation since dynamic pressure is now zero (no flow) and static pressure is at its lowest (since EPAP<=IPAP). Thanks

xxyzx wrote:

Pugsy wrote:If you want to study some protocols

https://www.resmed.com/us/dam/documents ... lo_eng.pdf

All I have for Respironics is the ASV protocol but it does touch on obstructives and again the basics are the same.
http://www.isetonline.org/yahoo_site_ad ... 190318.pdf
If anyone has a simpler Respironics titration guide I would love to have the link.

The minimum pressure has to be high enough to prevent the airway from collapsing in the first place.
When using auto adjusting pressures it has to be high enough that if it needs to go higher it can get there quickly enough to get the job done.
If using fixed pressures it simply has to be high enough period. People who might need higher pressures for part of the night get to use higher pressures all the night just to cover the "maybe".

I have used both epap and ipap in an effort to keep that airway open. You learn with time and experience that sometimes using both in various ways can accomplish a goal easier.
Again it doesn't really matter how we get the job done...it's just that we get the job done and there is more than one way to accomplish our goals.
How we go about it can be influenced by a person's specific needs or problems even.
Like with aerophagia...maybe we don't want ipap going very high.
Or maybe the mask leaks too much and sleep gets disrupted.
Or maybe the pressure that would do the job simply is low and not comfortable for someone. Maybe someone feels like they are suffocating at 7 cm and prefers 9 or 10. It hurts nothing to use more pressure than would technically get the job done as long as using it doesn't create a problem.

Often there doesn't have to be one set pressure set in stone to get the job done.
You can use one or both if someone is using exhale relief and thus has a little bit of bilevel situation going on.
With most of this stuff there isn't anything set in stone where someone has to just exactly so and so pressure. No hard fast rules and a lot of it is common sense anyway.

And then there are those pesky cpap pressure triggered centrals that can mess up things.
I know one person who gets 15 to 20 centrals with PS of 4 but none beyond a normal occasional sleep onset at PS 3.
She needs a high EPAP because of the obstructive stuff but we had to have some exhale relief because using 17 cm fixed...sucks.
By having IPAP available it helps with holding the airway open...so she could get the obstructive stuff well controlled with EPAP of 15 instead of 17 and IPAP of 18...She had a ResMed bilevel auto...so we used PS of 3 instead of EPR of 3 in auto mode but end result is pretty much the same. So if using fixed pressures she would need 17 but that's hard to exhale against...so we made use of PS and by having IPAP go a little higher than 17...it helps offset the lower than 17 on exhale. End result is the OAs get taken care of and she can breathe and sleep better.

We liked to never figure out that the centrals were related to PS and not the pressure itself.

So both EPAP and IPAP are important and can play significant roles in success or not but you have to start with the baseline pressure which is the minimum ...be it EPAP or whatever if exhale relief isn't used.
IPAP is just a little bit extra help if needed.

Also..you don't want too big of a difference between EPAP and IPAP....it can cause centrals. I had a friend decide to use PS of 10 on her bipap. Talk about central city....those little suckers were all over the place. To me that much difference isn't comfortable anyway.
But some people need a bigger PS for ventilation issues.

In other words when looking at what pressure to use it isn't always where we can say x amount of pressure needs to be used. Period.
Most often we can tweak one or more various settings and get the job done.
We have to look at the big picture and decide what the goals are...what potential problems we might have...and what are acceptable modifications that could get the same job done.

All this gets compounded by the fact that we don't sleep the same each night anyway and at best when we come up with these ideas were are planning for the trends and patterns we see and hope that not too many outlier weirdo nights happen.
I still get a weirdo fluke night every now and then with my current setup. Perfection for all nights is an unreasonable expectation.
Sometimes we do make compromises.
Nothing is set in stone.

try these

https://www.sleepapnea.com/downloads/10 ... fGuide.pdf

http://incenter.medical.philips.com/doc ... %3d9792335

http://www.isetonline.org/yahoo_site_ad ... 190318.pdf