UARS Bipap settings I need help

I'm going to bullet point my experience to make it more digestible to read

- I had a sleep study done and it showed low AHI but a high RDI so I assumed o had UARS because I still experienced all the symptoms and I have the structural signs ( thin, small jaw, scalloped tongue...)

-After some research I rented a Resmed s9 Bipap machine to see if It can help because I live in the UK and even though I talked to my GP I know it's going to take forever

- I was suggested to start with MAX ipap 20 and MIN epap 6 PS 5 on VAUTO for a few days to get accustomed to it and to see what my levels are naturally . I can fall asleep easily however going back to sleep after I wake up in the middle of the night (like I usually do) takes longer.

- Also I've experienced some drooling from my mouth and bloating which I think is a sign that I should increase the pressure

For now I haven't experienced any improvement in how tired I feel after waking up.
Should I change the settings ? I'm hearing that UARS is treated better on S mode. By how much should I change?



Thanks

Welcome to the forum

Gilgamesh wrote: ↑

Thu Jul 16, 2020 5:41 am

lso I've experienced some drooling from my mouth and bloating which I think is a sign that I should increase the pressure

No...the drooling as nothing to do with the pressure needs and the bloating is because the air is sneaking past your LES Lower Esophageal Sphincter and getting into your stomach and then your gut. It has nothing to do with how much pressure you need to stent the airway open and more pressure will just make the bloating worse.

Now you might need more EPAP to deal with UARS...most UARS people do but I would suggest going about it differently.
The machine isn't going to do a good job auto adjusting for UARS because it was never designed to deal with UARS. None of the auto adjusting machines were designed to deal UARS. They were designed to deal with OSA stuff...not UARS stuff. UARS stuff is different and not part of the auto adjusting algorithm.

Since you are having bloating issues...we call that aerophagia..
We are careful with the pressures because we don't want to make it worse.

My suggestion....increase your EPAP to 6.6 but decrease your PS to 3...see how that goes. The max IPAP isn't going to matter. The machine is never going to very high or move much because you don't have the OSA stuff that would drive it up.
Your FL statistic is low...so not much in Flow Limitations to drive it either.

UARS...you have to go more on how you feel than what the data off the machine shows. Your data is never going to be all that remarkable because the data is driven mainly for OSA stuff.

S mode or Auto mode...probably not critical at this point because it's not going to move much anyway in terms of variable pressures.

Your bloating/aerophagia issues are going to complicate things a bit. Now sometimes that fades away with time and experience but for now we have to always keep that in mind with the pressure experiments...any form of more pressure will make it worse so we want to be careful. With current 6 plus 5 PS...you are having 6 cm on exhale and 11 on inhale...
What I propose is a modest increase increase in EPAP to 6.6 but reducing PS so that on inhale you are only doing 9.6. I am hoping more EPAP helps stent the airway open better and less IPAP doesn't cause the aerophagia stuff to rear up.

EPAP or exhale pressure...that is going to be your most critical setting to worry about.

Okay thank you I'm going to try increase the EPAP, you are a legend in this forum I read so many of your posts . I thought drooling had to do with the pressure because the first 2 nights I used the machine at ipap 8 and epap 4 s mode I didn't have any drooling or bloating. After I changed the settings to auto 20 max 6 min I started feeling them and I read that it could be because my pressure is too low or too high. Also I'm using nasal pillows if that can mean anything

The drooling just means the mouth is opening a bit and saliva is leaking out. Has nothing to do with the pressure. Some nights I do it a lot and some nights I don't. It's annoying but changing the pressure one way or the other won't change it.

UARS ...not a quick fix by any means. We don't have any of the usual markers or data to guide us. You really have to rely more on subjective feelings or how you sleep and feel than what the machine is going to show you.

What I usually tell UARS suspected people...keep a detailed log of how you slept and how you feel...be extremely patient and don't get in a rush to go changing stuff. Overnight miracles rarely happen with UARS patients.
Play with the EPAP setting...but keep a log so you can return to it and compare results. Give each pressure change a full 2 weeks to give yourself time to adjust to things. There is a lot of truth to the "give it time" adage.
So you have to titrate yourself based on how you feel. It sucks but that's really all you have to go on.
So small increases in EPAP for a couple of weeks at a time. Keep a log...if you start having belly issues very much then back off for a while and maybe try more later. All the while keep a log as to how you sleep and feel. There isn't a magic pressure for UARS people. Everyone is different but historically they always seem to need a lot more than what the machine will want to deliver with the auto adjusting algorithm. Once you have 2 to 3 months worth of logs and pressures...go back and see if anything stands out as being better or worse than something else.

I've changed the settings for 3 nights now. To EPAP 6.6 and PS 3. Im happy to say that the bloating is gone and im feeling let's say 10% more refreshed when I wake up.
I changed the location of the machine from besides the bed to just above my head, this is causing more leaks than before, should I be worried?

Unless the leaks are waking you up...they are NOT big enough to cause a problem with the therapy itself.
It's normal and expected to have some leak...it's just going to happen. Your machine can handle up to around 35 L/min excess leak very decently...won't even flag a large leak until you hit 24 L/min...and even if you do that as long as it isn't for a prolonged period of time...not a big deal.

Now any leak that wakes a person up is unwanted even if it is a tiny leak but because it is disturbing our sleep. Anything that disturbs our sleep is unwanted.