Help...Hypopneas with new BiPap Auto

[mesaboog]

Just had my 3rd night on the BiPap Auto since switching from the BiPap Pro 2. I have a few questions and thought I would post my most recent Encore Pro FUll Details report so that you can see the data I am referencing.

http://filecities.com/files/567/SAB%20A ... Report.pdf

As you can see from the report, there are only 3 nights of data. Everything before the 8th was under a different patient name and straight bipap, but my results were consistently similar to the bipap mode results from the 8th. My titrated Bipap pressures were 8/12 and I was having good compliance with AHI's between 3-5 consistently.

Here are my questions:

1) When I switched to Auto, you can see that my hypopnea events have increased dramatically over what I was experiencing on straight bipap. The Obstructive events reduced. I am confused, I thought the auto was supposed to detect these hypopneas and eliminate them. Is there anything I can do to reduce these?

2) If you look at the data, you will see that no matter whether I am on straight bipap, or auto mode, a large part of the obstructive events are happening when I am awake and settling. For instance, right when I turn on the machine and when I return from a restroom break. Should I be concerned about this data, and why is the machine picking this up? has anyone else experienced this?...it really increases my AHI.

3) Any additional thoughts/recommendations based upon my sample data is appreciated.

Thanks in advance,

Scott

[-SWS]

When I switched to Auto, you can see that my hypopnea events have increased dramatically over what I was experiencing on straight bipap. The Obstructive events reduced. I am confused, I thought the auto was supposed to detect these hypopneas and eliminate them. Is there anything I can do to reduce these?

Scott, I personally have no experience with that model. However, you may have simply traded more severe obstructive apneas for less severe hypopneas. That isn't necessarily a bad thing either. I believe with that particular model you also have the option of trying: 1) straight BiPAP with BiFlex, as well as 2) BiPAP Auto without BiFlex. That would be two additional modalities of BiPAP operation you can try that just may yield even better results for you. If I were running that machine with those charts, I would personally be inclined to also experiment with a PS max setting of 3 in your current operational mode of "BiPAP Auto with BiFlex" (keeping all other settings for that particular experiment identical as well).

There are others in this forum who use that same model and can very likely give you their own very keen hands-on analysis. Good luck!

[Snoredog]

I'd wait for Moggy to chime in, she has some experience with that machine. But your pressures have appeared to "flip" from your bipap pro.

My guess is the auto will reveal events previously masked out by straight bipap pressures. But it looks like the auto found the same pressures you previously used of 12/8, your AHI is really not that bad.

Your auto's Min pressure appears to be 8/6 where on straight bipap you would have been at 12/8, so those OA, HI events wouldn't have been seen resulting in a lower appearing score.

If you can tolerate the pressure, bump the Min. IPAP and EPAP pressures up, try 9/7 and see what happens. I would stop where you feel the best the next day.

[Moogy]

I agree with SWS that it looks like you have traded obstructive events for hypopneas. That is actually an improvement, since hypopneas are less damaging. The auto will try to correct them, but it only ramps up a few cm at a time, so some of them will sneak through.

Your OA pattern is very interesting. Those clusters right after a break are mysterious. It appears that you had such a cluster of apparent apneas on straight bipap as well as on the auto. Is that how you interpret your charts also?

Is it possible you are doing something while you are still awake that the machine interprets at apneas. Any breath holding? Any messing with the mask in a way that might block the air flow?

Are you already back to sleep when these OAs occur? It looks like these are happening when you pressure is at the lower levels, so I would bump my lower pressure to 8 now. That shouldn't be a problem since you are accustomed to straight bipap exhale pressure of 8.

Just my opinion. Let us know what you decide to try and if it works.

Good Luck,

Moogy

[rested gal]

It looks like these are happening when you pressure is at the lower levels, so I would bump my lower pressure to 8 now. That shouldn't be a problem since you are accustomed to straight bipap exhale pressure of 8.

I agree that setting the EPAP up on 8 would be a good thing to try.

[mesaboog]

Thanks for the suggestions everyone. Setting Min EPAP of 8 tonight and see if I can't bring those hypos down.

Will reply back tomorrow.