BPAP settings for IPAP and EPAP

Being new to BPAP (6 nights of data), I have some questions concerning the prescribed settings. When I did my sleep study, I started out on CPAP at +4 cm H20 and titrated to BiPAP +23/18 cm H20. My pulmonologist prescribed settings are 22 IPAP/18 EPAP. My AHI was 52.2.

Out of curiosity more than anything else, relying on experience here, do the settings sound right - 22/18? With no experience, my thoughts would be that they would be farther apart. I just did an internet search, and did find out that a separation of 4 seems about right.

For anyone providing their informed opinions/speculation, I am not asking for this information in order to change settings, etc., and I promise that won't happen. Nor will it be to form an opinion of my medical team — for learning purposes only. Besides, I only have 6 nights worth of data, 2 of which were battling mask leaks, and I know it takes much more data to use it informatively. Yes, I use OSCAR, but I am just learning the ropes with that app.

My AHI has dropped significantly, averaging less than 5, but I suspect much of that is due to not being able to sleep well — how can I have apneas when I am awake?

Any information will be greatly appreciated. Thanks in advance.

Mel0806 wrote: ↑

Fri Aug 19, 2022 6:58 pm

how can I have apneas when I am awake?

You can have apneas when you're awake. An apnea is an interruption in your breathing, and wakeful breathing can be disordered, and interrupted, with episodes the machine reports as "apnea" (literally "non-breathing"). When you suffer from sleep apnea, (or "sleep disordered breathing") it is the state of sleep that causes disruption in your breathing, and the most common disruption is obstructive sleep apnea - when the relaxation of sleep causes your upper airway to collapse and the airflow is obstructed. With proper therapy, most of those disruptions do not happen. Normal sleep breathing is very orderly (to be seen in Oscar's flow chart). If your airway collapses while you're asleep, the order is disrupted, and -- given certain criteria -- the disruption is identified and reported by the machine. As best we can, we should focus on the apneas that appear when your breathing is otherwise very orderly.

Mel0806 wrote: ↑

Fri Aug 19, 2022 6:58 pm

When I did my sleep study, I started out on CPAP at +4 cm H20 and titrated to BiPAP +23/18 cm H20 [...] My pulmonologist prescribed settings are 22 IPAP/18 EPAP.

There's no way of knowing if "the setting are right". The IPAP EPAP difference it there to help you get the therapy you need with the maximal comfort possible - and which is best is a personal thing. Assuming your titration was done professionally - and let's assume that until proven otherwise - they found the minimum pressure needed to keep your airway from collapsing is 18 when you exhale and 23 when you inhale. The pulmonologist set your pressure at one less than the maximum they found optimal in the titration -- I assume the titration report gave him information to justify that. Maybe the gain in results from 22 to 23 wasn't very high. Maybe the results at an EPAP of 22 were reasonable, and the pulmonologist wanted to let you have a somewhat lower more, comfortable IPAP. I don't think he/she was focusing on the differential and "correcting" it.

He ha essentially set your machine up as a single pressure machine. He is limiting what the machine can do. The only way to know if this setting is right for you is to look at the data. What is your AHI when using the machine? My machine is set for MIN EPAP 16, MAX IPAP 25 and PS of 4. With this setting, my IPAP can vary from 20 to 25, and my EPAP from 16 to 21.

Mel0806 wrote: ↑

Fri Aug 19, 2022 6:58 pm

Being new to BPAP (6 nights of data), I have some questions concerning the prescribed settings.

Get a copy of your sleep study, that should answer some of your questions. Your doc, DME, and the sleep lab will all have a copy, why shouldn't you?