Okay, to report back I ended up deciding to go all the way back up to a "Max PS" (I don't have anything called IPAP) of 15 in order to feel comfortable and not deprived of full breaths during sleep. Now I feel good.JohnBFisher wrote:I tend to agree with the recommendations. An EPAP of 5 seems pretty low. You might want to try to increase that to an EPAP of 8. It would tend to help better splint open the airway. If it works well, I would leave it at that. If that doesn't help as much as you would like, try switching EPAP back to 5 and then let it settle for a bit. Then try an IPAP of 13 instead of 11. Split the difference approach. If that does not help as much as you like, which back to EPAP of 5 and IPAP of 11 and let it settle a bit. Then try combining the two. Try an EPAP of 8 and an IPAP of 13. See how that does. It's possible you need both to get better results. In fact, I suspect that the combination of the low EPAP and lower IPAP contribute to how poorly you feel. By moving up EPAP we will better splint open the airway and the IPAP of 13 will help better maintain the open airway during inhalation, but not leave you feeling as if you are breathing against a Category 5 hurricane.
So, that's several tests:
Give each setting at least three to five days. That should give you a good baseline to see which of those seems to help the most.
- Try EPAP of 8 and IPAP of 15
- Settle back with EPAP of 5 and IPAP of 15
- Try EPAP of 5 and IPAP of 13
- Settle back with EPAP of 5 and IPAP of 15
- Try EPAP of 8 and IPAP of 13
Hope that helps.
Now I am considering the suggestions made to move my bottom number up, which you and others have referred to as EPAP, presumably in an effort to perfect a low AHI score by further reducing apneas and thereby further enhance my quality of sleep and rest.
Before doing so, I want to make doubly sure that I am working with the right setting, as I have a setting for "EPAP" currently of 5 as noted above, but I also have a setting for something called "Min PS" which is set to 3.
About EPAP, the manual says:
EPAP and Pressure Support
(ASV mode) EPAP can be adjusted to maintain upper airway patency.
Pressure Support (PS) is defined as the difference between the peak pressure at the end of inspiration,
and the minimum pressure at the end of expiration (ie, the amplitude of the pressure waveform
delivered).
The pressure support trigger points (Inspiration:Expiration and Expiration:Inspiration) are set automatically
based on measurement of the patient respiratory flow. ASV mode automatically adjusts pressure support
between Max PS and Min PS to keep the patient’s respiratory flow even.
ResMed recommends maximum pressure support to be greater than or equal to 10 cm.
…and for menu parameters says:
Default 5 cm H2O
Sets the pressure which will be delivered to the patient when the device is cycled into expiration.
About ASV Mode, which I'm set to, the Manual says:
ASV mode
Treats central sleep apnea and/or mixed apneas and periodic breathing by
automatically adjusting the pressure support (PS). In ASV mode, the expiratory
positive airway pressure (EPAP) is adjusted by the clinician to maintain upper
airway patency, while Min PS and Max PS restricts the range of automatically
adjusted pressure support.
(There were also references in this thread/discussion to "IPAP" but I don't have any setting called IPAP referred to in my manual or settings guides.)
So I just would like to make sure: We are talking about raising the EPAP not the "Min PS" right?
Thanks, Nate
