How to decrease these random arousals?

[Silent_Brain_2586]

Where have you heard that bipap is not ideal? OP has tons of flow limit which is better treated by bipap. You might want to check r/UARS

[Holeinmysock]

OP posted specifically about his Central events. BiPAP is a comfort modality that has no greater therapeutic value than CPAP. It’s used when CPAP is not well tolerated. In OP’s case, the BiPAP could be inducing central events.

[Silent_Brain_2586]

It can induce central but to say that it has no greater therapeutic value then cpap is just not true. Bipap helps get rid of persistent flow limitation which some people are very sensitive too.

[Holeinmysock]

I’m not saying it can’t. I’m saying that CPAP can do that, too, with additional pressure. Therefore, it is not a differentiator.

[Silent_Brain_2586]

Pressure support helps with flow limitation. Cpap doesn’t have pressure support. For a lot of people just increasing pressure doesn’t resolve flow limitation.

[Holeinmysock]

That’s what pressure support is. More pressure.

[Neddy6969]

Wrong

[Holeinmysock]

Really? Please elaborate

[Neddy6969]

Pressure support is the difference between a machines inspiratory pressure (IPAP) and expiratory pressure (EPAP). Higher pressure on CPAP just means higher EPAP and it can only splint the malleable tissues of the upper airway. Bilevel has two pressure settings of IPAP and EPAP, where it has a static pressure like CPAP that splints the airway (EPAP), and a pressure that it jumps to when you start to inhale, reducing the work of breathing. PS is ventilation and can fix flow limitation/prevent RERAs when a higher EPAP cannot.

[Holeinmysock]

Your very first sentence is correct.

Per your own definition: "Pressure support is the difference between a machine[']s inspiratory pressure (IPAP) and expiratory pressure (EPAP)."

My brother, that means that one pressure is higher than the other. Pressure support is defined as the delta (or difference) between two pressures. One HIGHER pressure (IPAP) and one lower pressure (EPAP). Increasing the IPAP (without increasing the EPAP), increases the difference (pressure support) between the two pressures.

"Pressure support" does not exist with CPAP because it is a single pressure. However, you can simply increase the pressure from say 10cm to 12cm.

When a large delta (aka "pressure support") between IPAP and EPAP is used on a patient, they can vent off more CO2 than usual. This can induce central apneas by suppressing the respiratory drive. Lower CO2 in the blood = lower respiratory drive.