Switched to BiPAP last week after years on CPAP. Aerophagia was a problem on CPAP, but is much better on BiPAP. Subjective experience: much improved sleep quality. Also improved duration. Still, my numbers are sub-optimal. Ideally, I would like to lower AHI and flow limitation.
This screenshot from last night is typical.
Current settings: PS4 over 7-21. Trigger and Cycle at medium. Using VPAP auto mode as this initial stage.
I use a cervical collar to reduce chin tucking (it helps) and I sleep with a small backpack to reduce back-sleeping (also helps).
I've tried increasing the EPAP minimum to 10, but aerophagia was a problem and sleep quality suffered. I'm afraid I may not be suitable for S mode, since I seem to benefit from having a low EPAP, but at the same time need periodic high IPAP to resolve obstructions.
It's all a bit overwhelming and medical support is the usual gaslighting ("AHI<5, you're fine!"). Any advice is appreciated.
Hello UKU353 :)
What you’re seeing here is pretty classic “good leak control + low flow limits, but residual OAs because baseline EPAP is just a touch too low at the wrong moments.” This isn’t a “crank PS” problem and it’s not a “leave the ceiling at 21 and let VAuto go wild” problem either, because that’s exactly how you end up back in aerophagia land. The clean fix is to raise the floor enough to splint the airway, and simultaneously clamp the ceiling so the algorithm can’t chase events into stomach-inflation pressures. So let's please keep you in VAuto, keep PS = 4, raise Min EPAP to 9.2 cmH₂O to address the OAs, and cap Max IPAP at 15 cmH₂O (which effectively caps EPAP around ~11 with PS4). That tight band (roughly EPAP 9.2–11 / IPAP 13.2–15) usually drops OA clustering while staying much more aerophagia-friendly. Run it unchanged for 3 nights, then reassess and post the data please, if OAs drop and you still feel better, you’re done; if aerophagia flares at 9.2, that’s your personal EPAP ceiling and we solve the remainder with positional mechanics (collar fit/height, pillow geometry, and hard anti-supine).
Many thanks RL. Your explanation is so helpful. I will do as you suggest.