God, the incline version is absolute death on my elbows... And I've never really gotten anything out of it for some reason.
I can do them lying flat just fine though (bar comes down behind head, upper arms stop the rep at an incline rather than perpendicular to the floor, yadda-yadda).
With a single DB, holding the 'bell works best for me if...
a) seated (upper back against preacher bench or so): both hands with fingers intertwined around the handle of the DB (while straightening the elbows, I try to have them point forward). Holding the innermost plate instead of the DB just doesn't work with my tiny hands and short finger... Ends up with the plat digging too much into my wrists and causing numbness.
b) lying on a flat bench, PJR pullover+extension... I just use 2 DB's here now... I can't do the intertwining thing here with my arm length, that just makes the 'bell bump into my head.