Initial BiPAP Settings

[Holden4th]

My back up machine, a 'gently used' Respironics DS760 BiPAP auto, will be with me very soon (maybe Monday). I'm going to try it out as my main machine and after some research have decided to set an IPAP minimum of 12 and an EPAP min of 7. This gives me a PS of 5. What should I set the maximums to or should I just leave it at 25/20?

It has BiFLEX and I'm not exactly sure what that is or does. Should I just ignore it or try a simple setting?

As I already have the PRS1 series 60 it will fit with my current humidifier and also heat my hose if needs be.

I'll be interested to see what changes it makes to my sleep.

[robysue]

My back up machine, a 'gently used' Respironics DS760 BiPAP auto, will be with me very soon (maybe Monday). I'm going to try it out as my main machine and after some research have decided to set an IPAP minimum of 12 and an EPAP min of 7. This gives me a PS of 5. What should I set the maximums to or should I just leave it at 25/20?

Are you planning on setting both min PS = 5 and max PS = 5? On the PR S1 760, you have both a min PS and max PS setting, and if they're not the same, the PS can vary through the night.

What's the 90% or 95% pressure level on your current machine?

Personally, I would not leave the max at 25/20 if I were setting the machine up. But I'm prone to aerophagia and in my case, the PR machines seem to increase the pressure in response to flow limitations that get worse as the pressure goes up rather than better. (I don't know why that happens to me, but it's pretty consistent.)

[Holden4th]

My back up machine, a 'gently used' Respironics DS760 BiPAP auto, will be with me very soon (maybe Monday). I'm going to try it out as my main machine and after some research have decided to set an IPAP minimum of 12 and an EPAP min of 7. This gives me a PS of 5. What should I set the maximums to or should I just leave it at 25/20?

Are you planning on setting both min PS = 5 and max PS = 5? On the PR S1 760, you have both a min PS and max PS setting, and if they're not the same, the PS can vary through the night.

What's the 90% or 95% pressure level on your current machine?

Personally, I would not leave the max at 25/20 if I were setting the machine up. But I'm prone to aerophagia and in my case, the PR machines seem to increase the pressure in response to flow limitations that get worse as the pressure goes up rather than better. (I don't know why that happens to me, but it's pretty consistent.)

I'm pleased I've posted this thread as you've already highlighted a couple of misconceptions that I've obviously got. Firstly I assumed that pressure support came from setting your min IPAP and min EPAP. This is obviously not the case so I need some enlightenment here. What you are saying is that there is a separate PS min and max setting that I need to dial in?

My 95% pressure runs between 13 to 14.5% though I do have the APAP set to 13 minimum. I rarely go above 15 though I did have an 18 the other night. When I had the S9 I went quite well on lower settings but upped them on the PR because of my RERA readings. My best nights on the S9 were a minimum of 10.5 and a max of 15.

Thanks for your input and please keep it coming.

[ajack]

it depends what's wrong with you, You're an aussie, go get a titrate on medicare in a public hospital. There are some bulk billing ones, like snore australia in some states. I would be ringing around and talking to your doctor.

[robysue]

I'm pleased I've posted this thread as you've already highlighted a couple of misconceptions that I've obviously got. Firstly I assumed that pressure support came from setting your min IPAP and min EPAP. This is obviously not the case so I need some enlightenment here. What you are saying is that there is a separate PS min and max setting that I need to dial in?

To try to clarify what PS is and how the settings on the PR System One Series 60 BiPAP Auto (i.e. a PR 760 machine) works:

In the clinical settings you have to set the following things:

• Min EPAP
  Max IPAP
  Min PS
  Max PS

When a PR BiPAP Auto is turned on and NO ramp is used, the starting pressures will be:

• Starting EPAP = Min EPAP
  Starting IPAP = Min EPAP + Min PS

The Min PS and Max PS settings allow for a variable PS, which is different than how the Resmed VPAP Autos behave. As an example, lets suppose the settings on a PR BiPAP Auto are:

• Min EPAP = 8
  Max IPAP = 16
  Min PS = 4
  Max PS = 6

Then the possible pressure combinations the machine might use during the night look like this:

• EPAP = 8, 12 <= IPAP <= 14 (since 8+4 = 12 and 8+6 = 14 and 14 <= 16)
  EPAP = 9, 13 <= IPAP <= 15 (since 9+4 = 13 and 9+6 = 15 and 15 <= 16)
  EPAP = 10, 14 <= IPAP <= 16 (since 10+4 = 14 and 10+6 = 16 and 16 <= 16)
  EPAP = 11, 15 <= IPAP <= 16 (since 11+4 = 15 and 16 < 11+6 = 17)
  EPAP = 12, IPAP = 16 (since 12+4 = 16)

Unlike the Resmed VPAP Auto machines, the PR BiPAP Autos adjust the EPAP and IPAP independently of each other as long as the Current PS = Current IPAP - Current EPAP is not equal to either Min PS or Max PS.

In general, the IPAP (and only the IPAP) is increased in response to flow limitations, clusters of Hs that do not have OAs mixed in, and the PR Search algorithm. And the EPAP (and only the EPAP) is increased in response to snores, clusters of OAs, and clusters of OAs mixed with Hs.

If the machine wants to increase the IPAP and Current PS = Max PS, then the machine is forced to increase both the IPAP and EPAP at the same time. If the machine wants to increase the EPAP and Current PS = Min PS, then the machine is forced to increase both the IPAP and EPAP at the same time.

My 95% pressure runs between 13 to 14.5% though I do have the APAP set to 13 minimum. I rarely go above 15 though I did have an 18 the other night. When I had the S9 I went quite well on lower settings but upped them on the PR because of my RERA readings. My best nights on the S9 were a minimum of 10.5 and a max of 15.

Your signature seems to indicate that you've been using a PR System One APAP. Do you use A-Flex on your machine?

Given what you've said about your pressure numbers and why you upped the pressure setting on the PR relative to the S9, this is what I'd suggest as a starting guess for the PR S1 Series 60 BiPAP Auto settings:

• Min EPAP = 13 OR Min EPAP = 11 if you use A-Flex and you intend on turning Bi-Flex OFF
• Max IPAP = your current Max Pressure on your PR S1 APAP. If the AHI winds up being higher than you'd like, you can bump the Max IPAP to your current Max Pressure + Min PS setting on the BiPAP. But only do this if you have no problems with aerophagia.
• Min PS = 2 if you use A-Flex. If you don't use A-Flex, you might consider setting Min PS = 0 or 1 instead. If you want a bit more pressure relief than A-Flex provides, bump the Min PS up to 3.
• Max PS = 5. That will keep force the machine to increase the EPAP as well as IPAP if the pressures look like 18/13 and IPAP needs to be increased, but since you seldom hit 18cm on the APAP, you probably won't see much of an IPAP > 18 on the BiPAP unless its snoring and OAs that cause your APAP to increase all the way to 18cm.

If the results aren't what you want in terms of comfort or the AHI is way to high, you can always tweek once you know what you like or dislike about the the 760 machine.

A final comment: Bi-Flex adds a small additional amount of pressure relief in addition to the drop from IPAP to EPAP. If Bi-Flex is turned on and IPAP = 14 and IPAP = 8, the pressure might drop to as low as 6cm at the beginning of a very forceful exhalation, but it will return to 8cm by the middle of the exhalation. The pressure will go back up to 14 when the start of the inhalation is detected. The speed that it returns to 14cm depends on the Bi-Flex setting. Lower setting = faster return to full IPAP.

If you don't like Bi-Flex, it's possible to turn it off in the clinical menu. Then you wind up with a RiseTime setting. The higher the RiseTime setting, the slower the machine increases the pressure to full IPAP.

[Holden4th]

RobySue, I didn't realise how complicated this process is so thanks again for your feedback

I do use APAP set at 2 on my PRS1 560. Occasionally I've woken up feeling starved for air and wondered if a lack of pressure relief was an issue.

Given what you've said about your pressure numbers and why you upped the pressure setting on the PR relative to the S9, this is what I'd suggest as a starting guess for the PR S1 Series 60 BiPAP Auto settings:

Min EPAP = 13 OR Min EPAP = 11 if you use A-Flex and you intend on turning Bi-Flex OFF
Max IPAP = your current Max Pressure on your PR S1 APAP. If the AHI winds up being higher than you'd like, you can bump the Max IPAP to your current Max Pressure + Min PS setting on the BiPAP. But only do this if you have no problems with aerophagia.
Min PS = 2 if you use A-Flex. If you don't use A-Flex, you might consider setting Min PS = 0 or 1 instead. If you want a bit more pressure relief than A-Flex provides, bump the Min PS up to 3.
Max PS = 5. That will keep force the machine to increase the EPAP as well as IPAP if the pressures look like 18/13 and IPAP needs to be increased, but since you seldom hit 18cm on the APAP, you probably won't see much of an IPAP > 18 on the BiPAP unless its snoring and OAs that cause your APAP to increase all the way to 18cm.

If I turn BiFlex on (and A-Flex off) should I set BiFlex to 1? I like the idea of a rapid return to the optimal pressure.

So based on the above (and hopefully I've understood it properly) these should be my starting settings

Min EPAP 13
Max IPAP 20
Min PS 1 (maybe 0)
Max PS 5
BiFlex 1

[robysue]

If I turn BiFlex on (and A-Flex off) should I set BiFlex to 1? I like the idea of a rapid return to the optimal pressure.

The most rapid return to full IPAP pressure will be achieved by turning BiFlex OFF and setting RiseTime = 1.

Min EPAP 13
Max IPAP 20
Min PS 1 (maybe 0)
Max PS 5
BiFlex 1

I'd suggest starting with Min PS = 2, BiFlex = Off, RiseTime = 1 since you want a rapid increase back to IPAP.

[Holden4th]

If I turn BiFlex on (and A-Flex off) should I set BiFlex to 1? I like the idea of a rapid return to the optimal pressure.

The most rapid return to full IPAP pressure will be achieved by turning BiFlex OFF and setting RiseTime = 1.

Min EPAP 13
Max IPAP 20
Min PS 1 (maybe 0)
Max PS 5
BiFlex 1

I'd suggest starting with Min PS = 2, BiFlex = Off, RiseTime = 1 since you want a rapid increase back to IPAP.

The machine arrives tomorrow so I'll set it up with those settings. One thought did creep into my mind. Could a rapid increase back to IPAP be something that might disturb my sleep or is it not a problem? Once again, thanks for your expert input.

[robysue]

The machine arrives tomorrow so I'll set it up with those settings. One thought did creep into my mind. Could a rapid increase back to IPAP be something that might disturb my sleep or is it not a problem? Once again, thanks for your expert input.

Only you can answer that question.

We're all sensitive to different things when it comes to CPAP therapy. The only way to tell if a rapid change back to IPAP winds up being a problem is to try RiseTime = 1 for a while.

One thing that is nice on the 760 machine is that it has a test Bi-Flex/Rise Time setting feature. If Bi-Flex is set to On, you can test the difference between Bi-Flex = 1, 2, 3 in real time while you know which setting you are using. If Bi-Flex is set to Off, you can test the difference between Rise Time = 1, 2, 3 in real time while you know which setting you are using. When I first got my 750 BiPap Auto, I used the test feature to figure out (within 15 minutes) that Bi-Flex was definitely NOT for me. I then turned Bi-Flex off and ran through the Rise-Time test to figure out (within 15 minutes or so) that Rise Time = 3 was the one that my body seemed to prefer.

[Holden4th]

The machine arrives tomorrow so I'll set it up with those settings. One thought did creep into my mind. Could a rapid increase back to IPAP be something that might disturb my sleep or is it not a problem? Once again, thanks for your expert input.

Only you can answer that question.

We're all sensitive to different things when it comes to CPAP therapy. The only way to tell if a rapid change back to IPAP winds up being a problem is to try RiseTime = 1 for a while.

One thing that is nice on the 760 machine is that it has a test Bi-Flex/Rise Time setting feature. If Bi-Flex is set to On, you can test the difference between Bi-Flex = 1, 2, 3 in real time while you know which setting you are using. If Bi-Flex is set to Off, you can test the difference between Rise Time = 1, 2, 3 in real time while you know which setting you are using. When I first got my 750 BiPap Auto, I used the test feature to figure out (within 15 minutes) that Bi-Flex was definitely NOT for me. I then turned Bi-Flex off and ran through the Rise-Time test to figure out (within 15 minutes or so) that Rise Time = 3 was the one that my body seemed to prefer.

Thank you Robysue, that's what I'll do. It could be an interesting evening trying it all out as I love playing with new gadgets. Will I have time for sleep I wonder?

[Holden4th]

Machine has arrived and is set up

I tested the BiFlex and Rise Time features and because I prefer a longer exhale went with the BiFlex. That could change.

The machine has no odours or smells. It looks to be in quite good condition apart from a couple of nicks in the plastic at one point. After I took the protection plate off the side it fitted perfectly into the humidifier that came with my PRS1 560. I'll add some water and see what happens.

I'm interested to see how many hours the machine has done but in the clinical settings mode it shows blower hours as zero. I'm not sure that's correct as it's supposedly 'gently used'. Could the supplier wipe the info somehow? Is there another way I can access true blower hours?

My settings are:

EPAP MIn = 12
IPAP Max = 20
PS Min = 2
PS Max = 5
Biflex = 1

..and now to bed.

[Holden4th]

I've had my first night on the BiPAP and the results are mixed. AHI was 0.71 but I didn't sleep that well and was a bit tired today. Looking at my settings I'm wondering if I need to make changes. Here are my settings according to SH


Machine Settings

PAP ModePAP Device Mode Auto Bi-Level (Variable PS)
Min EPAPLower Expiratory Pressure 12.00 cmH2O
Max EPAPHigher Expiratory Pressure 20.00 cmH2O
Min IPAPLower Inspiratory Pressure 14.00 cmH2O
Max IPAPHigher Inspiratory Pressure 20.00 cmH2O
PS MinPressure Support Minimum 2.00 cmH2O
PS MaxPressure Support Maximum 5.00 cmH2O

Now I didn't set a minimum IPAP but it seems to have come out at 14. No problems I can handle that.

Stats for last night:

Statistics
Channel Min Med 95% Max
EPAPExpiratory Pressure (cmH2O)
W-Avg: 12.01 12.00 12.00 12.10 12.10
IPAPInspiratory Pressure (cmH2O)
W-Avg: 14.41 14.00 14.00 16.60 17.10
PSPressure Support (cmH2O)
W-Avg: 2.41 2.00 2.00 4.50 5.00

It's early days and I hope that as I get used to this new form of xPAP therapy that I will get improved sleep. Here is the screenshot

http://imageshack.com/a/img923/7871/8EvhA7.png

[Pugsy]

Now I didn't set a minimum IPAP but it seems to have come out at 14. No problems I can handle that.

IPAP minimum is always going to be tied to EPAP plus PS so there's no need to make an official setting choice.
Since your EPAP minimum is 12 and your PS minimum is 2...IPAP is 14 and it can't go lower because of the EPAP minimum...but it could go higher if the machine either wants to increase EPAP or PS or IPAP (which could maybe drag EPAP up).
I think that a lower EPAP minimum might be worth trying at some point in your experimentation process.

It doesn't look like the machine needed or wanted to increase EPAP last night but it did play around with PS a bit.
I never could find any documentation as to what PS works best in certain situations to give us an idea where PS needs to be for whatever situation. For me it was more of a trial and error thing.

Whatever you decide to do....you have to stick with it for a period of time to be able to best evaluate the results.
When I was first trying to use auto bilevel and trying to figure out suitable settings I tried several different settings over a period of 4 or 5 nights...then I chose the settings that seemed to give me the best AHI (I was starting out using the bare minimum pressures needed whereas you are using much more than bare minimum) and allowed me to sleep comfortably for the most part.
Then I kept those settings for 6 weeks...had some good nights and bad nights during those 6 weeks but slowly the good nights started to outweigh the bad nights and by the end of the 6 weeks the AHI average had been cut in half and time asleep had increased 45 minutes on average. There is a lot of truth to the "give it time" thing for your body to get used to the new way of doing things.

[Holden4th]

Thanks Pugsy, that's cleared up a few things for me.

When I was on APAP, in an effort to reduce my RERAs I upped the minimum pressure and instead of seeing a flattening out of my pressure levels, everything tended to go up proportionately, including 90% pressure.

My starting EPAP min on my first night gave me 90% pressure highs I rarely see and once I learned how this was tied in to IPAP and PS I've decided to take the route you suggest and lower my EPAP pressure and set a PS 0-5. Last night I dialed down the EPAP min and everything else came down with it. Tonight I am going to set my EPAP min at 8 and see what happens. Looking at two nights of graphs, I love the way that BiPAP attacks events. I'll then leave it as is (unless things are really bad over a few nights) and post data for the good folks on this forum to comment on.

Off topic, when I went into the clinical menu settings it had the blower hours as zero despite the machine being 'gently used' Have Secondwind found a way of resetting the data or have I not found the way to access true blower hours?

[Pugsy]

Off topic, when I went into the clinical menu settings it had the blower hours as zero despite the machine being 'gently used' Have Secondwind found a way of resetting the data or have I not found the way to access true blower hours?

Not everything at secondwind is "gently used", Some are new open box specials which would mean zero hour. I don't know hneeow they get their "new" zero hour machines but it might be they purchased some left over discontinued machines from some place since the PR S1 760 was replaced by the DreamStation BiPap Auto.
There's no way at all to reset the hours of use unless the machine goes to the factory and even if there was a way for secondwind to do it....I know Mark who owns it and I just can't see him doing that sort of stuff.

I am thinking you just got lucky and got a new open box special zero hour machine.

There's therapy hours and blower hours...if you see the same number of hours in each then you got a zero hour machine.
Oh...sometimes those "gently used" hours are really gently....I know a guy who got a machine from them "gently used" and it only had 8 hours of use.