BiPAP settings

Zack, just to confirm, I take it your settings are as follows? This site can mess up the format sometimes and make it hard to read.

• Mode: S
• IPAP: 25
• EPAP: 17
• Easy-breathe: on
• Ti max 3.5s
• Ti min .3s
• Rise time: min
• Trigger: med
• Cycle: med
• Mask: nasal
• Ramp time: 20min
• Start EPAP 8.0
• Humidity level: 5
• Tube: slimline
• Leak alert: off
• Smart start: off

First off, if you do not have the link, here is one to the technical manual that explains more about what these settings are about.

AirCurve Technical Manual

From the description of your concerns, it seems the machine is working well for you, except for the snoring when on your back. The problem could be the IPAP or EPAP pressure settings are too low. Your IPAP is already at the maximum of 25 cm, so about your only choice would be to increase the EPAP pressure up from 17 about 1 cm at a time to see if that helps. One issue with increasing EPAP is that it will reduce the differential between EPAP and IPAP, which in turn reduces the breathing assistance effect of the machine. There could be consequences to that. So, you would only want to make a small change and try it for a while to see if there is anything negative happening.

The S mode that your machine is in, is quite complicated, and it looks like it has been highly customized to your needs. The S mode also includes a back breathing rate of 10 bpm. You could switch to CPAP mode but then the maximum pressure is limited to 20 cm, which probably is not going to work well at all. You could also switch to the VAuto mode and let the machine adjust the pressure. That could work from a pressure point of view, but you would lose the Easy Breath and Backup Rate feature. There must be a reason why the machine was put in the S mode to give you those features. Switching to VAuto would not be at all advisable without consulting your sleep specialist for advice.

The other option at this point, short of going back to your sleep specialist is to download SleepyHead which is a free software to view your detailed machine data on the SD card. You need a PC or Mac, and a SD card reader. There should be substantial data on the card that will show where you are now, and how it has changed over time. It would also show exactly when you are snoring, and how it has changed over time. Here is a link to a basic manual on how to use the software. If you could post a screen shot of your daily report here, it would be very helpful in understanding in more detail what the issues are. It would also document whether or not you are making any improvement by increasing EPAP.

However, when looking at where you are, unless it is not possible to do, I would consult your sleep specialist for advice even before increasing EPAP.

Hope that helps some,

When you post a screenshot from SleepyHead, it really helps to optimize the layout of the Daily Detail screen first. On a PC, F10 will get rid of that redundant tool bar on the right side. If you go to File, Preferences, Appearance, you can uncheck the box that says Show Event Breakdown Pie Chart. It is kind of redundant too and covers up more important data. In your case it will be important to show the Snore graph. You can click on the title and drag it up the screen. Leave the Events Flag pinned to the top as it should be by default.

To make the screenshot just press F12 on a PC. A message will pop up showing where the screenshot file is saved. Go there with Windows Explorer and left click on the file, and drag it into the body of a message here. Start a new message with the Write a Reply button so you get the full width to display.

EDIT: I forgot one format issue. Click on the triangle beside the date to hide the full month calendar. It also takes up space that hides more important info.

Yes, those leaks look high. I like to see leaks under 25 L/min, and lower is better. SleepyHead is showing you are using a Nasal mask. Is that correct? If you machine is set to Nasal, but you are using a full face mask, that could cause the indicated leaks to be higher than they actually are. What specific mask are you using? A nasal mask may not be the best choice for a pressure of 25 cm. Here is a link to a thread from a few months back about best masks for high pressure. The consensus seemed to be that the F&P Simplus was a good one to try, but pads may be needed to get a good seal.

https://myapnea.org/forum/need-advise-on-a-mask-for-high-pressure

On the snoring, yes there is some, but not what I would consider real bad. But, if it is annoying you then it is a problem. You could try increasing EPAP 1 cm at a time to see if that helps. But, I would watch very carefully to see that clear airway events do not increase. Currently CA is not that high, so you may have room to use more EPAP pressure. The majority of your events appear to be OA. That should improve with increased EPAP.

Your setting is right then. I have heard good things about this mask, but have no experience with it. Perhaps others could give suggestions as to how to adjust for a better fit. As I understand it this DreamWear headgear can be used with inserts that convert it from nasal to nasal pillow and to full face. Possibly the full face might work better at higher pressure, but I have no experience to suggest that. I found this document on the DreamWear Mask System but could see no mention of maximum pressures it is rated for. It does include some tips on fitting it. Also this manual for the nasal version. Still no pressure rating though.

Another possibility here is that you are opening your mouth and air is escaping out. That flat topped leak event that lasted through midnight looks like a mouth leak. I have that issue and have solved it with mouth taping. Sounds bad but really isn't. Perhaps worth a try. 25 cm of pressure might make it hard for the tape to stay in place though.