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Shin Ryoku
Unread post  Post subject: " An optimal minimum IPAP-EPAP differential is 4 cm H2O"  |  Posted: Sat Nov 11, 2017 9:07 am
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Joined: Sat Nov 11, 2017 9:04 am
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Hi all, new member here, recently self-diagnosed with OSA and finding my way with the help of great info from here and some of the other forums.


I was reading these guidelines: http://jcsm.aasm.org/articles/040210.pdf

And noticed that my current APAP settings of 15-20 cm H20 put me at a pressure level where consideration of a change to BPAP is recommended:

"If there are continued obstructive respiratory events at 15 cm H2 O of CPAP during the titration study, the patient may be switched to BPAP."


Furthermore, there is this comment regarding BPAP:

" An optimal minimum IPAP-EPAP differential is 4 cm H2O"


The level evidence provided for those recommendations has not been graded, nor has the evidence been summarized in any detail, so I am left wondering whether I should spring for a BPAP machine (I am doing this all out of pocket), and whether I would be better off with PS 4 than I am now with EPR 3.


Here is my data from last night as an example. I feel great and have no residual OSA symptoms to speak of.

Image


Those early in the night clusters of OAs seem common for me. I'm guessing that they correlate with REM sleep.

I have only been on CPAP for a few weeks total now and have been working on optimal gear and improving sleep hygiene as well as weight loss (the eternal struggle), so it's possible that my results will improve over time without further increasing my pressure settings.


I really don't mind buying a BPAP if there is a good reason to do so. Fwiw, comfort has not been an issue for me. I am very comfortable at the current settings.


I guess my question boils down to this: Are the two recommendations I quoted based solely on achieving comfort, or is there some health benefit to having a higher PS when working with larger pressures? I have no asthma, COPD, or anything like that.


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Pugsy
Unread post  Post subject: Re: " An optimal minimum IPAP-EPAP differential is 4 cm H2O"  |  Posted: Sat Nov 11, 2017 12:44 pm
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Joined: Wed Aug 02, 2017 8:01 pm
Posts: 612
PAP Mask: ResMed AirFit P10 or DreamWear Gel nasal pillows
PAP Machine: ResMed AirSense 10 AutoSet for Her
Humidifier: ResMed AirSense 10
Pressure Setting: Depends on the machine as I actually have more than one

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The higher PS is mainly from a comfort standpoint at the higher pressures.
The difference between 4 cm and 3 cm PS is very minimal and you might not be able to feel much difference. I have used both...and own bilevel and regular apap machines....so I have actually tried both 3 and 4 and while I can barely feel or sense the difference it isn't that big of an issue for me.

There is a bit of therapy value with PS of 4 in that it lets a person use a little more IPAP but that would mainly be of benefit maybe if a person was having a lot of stubborn hyponeas.

Mainly though it's a comfort thing. If you are sleeping good and feeling good and since you are self pay....maybe not a big urgent need to go down the bilevel road. If you ever run across a really good deal on a bilevel machine for maybe a back up machine you could consider getting one to play with it and see if you like it better than what you are using now.

I rather like PS of 4 myself. But then I don't hate PS of 3....


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Shin Ryoku
Unread post  Post subject: Re: " An optimal minimum IPAP-EPAP differential is 4 cm H2O"  |  Posted: Sun Nov 12, 2017 6:56 am
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Thanks, Pugsy. If I decide to spring for the BPAP, is the ResMed AirCurve Vauto widely considered to be a good choice?


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Pugsy
Unread post  Post subject: Re: " An optimal minimum IPAP-EPAP differential is 4 cm H2O"  |  Posted: Sun Nov 12, 2017 10:28 am
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Joined: Wed Aug 02, 2017 8:01 pm
Posts: 612
PAP Mask: ResMed AirFit P10 or DreamWear Gel nasal pillows
PAP Machine: ResMed AirSense 10 AutoSet for Her
Humidifier: ResMed AirSense 10
Pressure Setting: Depends on the machine as I actually have more than one

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Yes, the AirCurve 10 VAuto would be what I would look at if I was in the market for a bilevel device.
Of the 2 main brands for bilevel (ResMed and Respironics) I tend to lean toward the ResMed but if I found a killer hot deal on similar machine in the Respironics line I would seriously consider it.

In your situation especially so because you have been using the ResMed algorithm and the Respironics algorithm is a bit different.

Alternately don't totally discount the prior ResMed model in the bilevel department...the S9 VPAP Auto if you find a really good deal on one. The insides and how they do things didn't really change with the cosmetic new model.


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Shin Ryoku
Unread post  Post subject: Re: " An optimal minimum IPAP-EPAP differential is 4 cm H2O"  |  Posted: Tue Nov 14, 2017 1:05 pm
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I found a good deal on the Aircurve 10 VAuto and pulled the trigger. Will keep my Airsense as a backup.

If you're in the market, I can vouch for Sistemma having bought from them before, and they are selling a variety of used and new Aircurve 10 VAuto devices at different price points here: https://www.amazon.com/gp/offer-listing ... 917&sr=8-1


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Karen
Unread post  Post subject: Re: " An optimal minimum IPAP-EPAP differential is 4 cm H2O"  |  Posted: Tue Nov 14, 2017 8:18 pm

Joined: Mon Aug 28, 2017 3:50 pm
Posts: 20
Location: Buffalo, NY
PAP Mask: Amara ViewFFM, Dreamwear nasal, Brevida nasal cushions, Resmed N20 nasal mask
PAP Machine: Resmed AirCurve 10 VAUTO
Humidifier: Built in humidifier
Pressure Setting: Changing- Right now 10-20/6 BIPAP auto

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Congrats Shin. That is the machine I will be getting tomorrow. Will be interested in seeing how you do!


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Shin Ryoku
Unread post  Post subject: Re: " An optimal minimum IPAP-EPAP differential is 4 cm H2O"  |  Posted: Tue Nov 14, 2017 9:03 pm
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Thanks, Karen. I never thought I'd be excited about a PAP device, but I sure am :).


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