EPAP and IPAP

Birdwood · Post by **Birdwood** » Tue Jul 17, 2007 5:08 pm

My polysomnography reports found pressure at 7 and IPAP at 11. I would appreciate if the learned members of this forum could advise what pressures should be set on Bipap Auto.

2 Also how should the rise time be calculated, on Bipap Auto.

An early guidance shall be appreciated.

socknitster · Post by **socknitster** » Tue Jul 17, 2007 5:58 pm

If by rise time you mean ramp? You probably don't need it with a pressure that low, but if you do, I would set it for a little bit longer than it normally takes you to fall asleep.

It is hard to give advice about where to set your bipap range without knowing more about your sleep study.

I'm on bipap too and when I first got my auto I didn't have my sleep report yet and set it from 8 min to 20 max. Then I got my sleep report and found out that my sleep turned into a train wreck at pressures of 18 and above, so I dialed it down to my titrated pressure as my max, which is 16. My titrated pressure is 12/16 and my bipap auto is set at 10-16. This way I spend most of the night a bit lower to decrease aerophagia, but it can go up if it needs to. It rarely does, actually.

Clear as mud? Maybe someone else will have an opinion, but please post any info you have about your polysomnogram data.

jen

Birdwood · Post by **Birdwood** » Tue Jul 17, 2007 6:08 pm

Thanks for the above reply. Rise time, as I understand is the time which it takes for Bipap to change from IPAP to EPAP. The Users manual provide these settings from 0 to 3, which represent the following timings:

0=150msec.
1=200msec.
2=300 msec.
3=400 msec.

I hope some guidance will be available.

socknitster · Post by **socknitster** » Tue Jul 17, 2007 6:16 pm

You must have a different machine from me. Can you list your machine for other members who may be able to help you?

My machine doesn't have this setting.

If you register here, it can be automatically shown in each post.

jen

dsm · Post by **dsm** » Tue Jul 17, 2007 6:16 pm

Jen,

There can be two interpretations of 'risetime' - these are my go at explaining them

Some people can see it as meaning Ramp time (as you mentioned). But with Bilevel machines, risetime usually means the speed with which the machine swaps from epap to ipap.

On Respironics machines risetime is usually a selectable number from 1 to 5.

1 is fastest (swaps very very quickly) this can be to abrupt for many people

5 is slowest & provides more comfort.

Typically people will start at 3 & experiment up & down.

As for setting the values of ipap & epap on a Bipap Auto, that gets complicated - in auto mode you can set a min epap & the machine arbitarily sets ipap to 2 above that. As the machine runs, it can and will adjust epep setting and ipap setting independently (but will always keep a min gap of 2 cms).

You can also set a Max Pressure Support which is the maximum gap you want to allow the machine to go to if it starts to move ipap way above epap.

The absolute max pressure support you can set is capped at 8 CMS (i.e during the night the machine may have started with epap=6 & ipap set to 6+2 = 8 but as the night progresses ipap may move up & if you leave max pressure support set to 8, theoretically the machine could take ipap up to 6 + 8 = 14 (so that would allow epap = 6 & ipap = 14.

By restricting the max pressure support to say 5, then the machine in the above example, would stop raising ipap when it reached 6 + 5 = 11 CMS.

From all the reports we get here, it seems that epap & ipap stay pretty close - I think Rested Gal mentioned seeing her machine spread epap and ipap to a max gap of 5 CMS on one occasion.

Setting these machines is challenging

DSM

socknitster · Post by **socknitster** » Tue Jul 17, 2007 6:27 pm

Going off now to see if I can find a rise setting, thanks DSM!

Jen

socknitster · Post by **socknitster** » Tue Jul 17, 2007 6:32 pm

No rise on my machine. Just biflex. Is that the same?

JEn

cwsanfor · Post by **cwsanfor** » Tue Jul 17, 2007 6:41 pm

"Rise Time" is not available or needed if you are using BiFlex, Socknitser. "Rise Time" will not appear in your menu. Here is a link about that:

viewtopic.php?t=18033&highlight=rise

Good luck with your treatment. I hope you start feeling better.

Snoredog · Post by **Snoredog** » Tue Jul 17, 2007 9:55 pm

as Wally mentioned there is no rise time displayed or settable in "Auto" modes, that only shows up in Biflex or Bilevel mode. Biflex is a comfort setting and separate from rise time, in Auto modes it is automatically detected by digital autotrack feature when in that mode.

For the 7/11 settings in Auto mode, you would set it to:

IPAP Max=11
EPAP Min=7.0
PS=4

When you turn on the machine IPAP will be 2 cm higher than EPAP or at 9cm, EPAP will be at the Minimum of 7cm, IPAP will be free to move up to the 11cm if it sees an event. EPAP will be able to increase on up to 9cm with those settings. PS "minimum" is hard coded in the machine at 2cm and you cannot adjust that setting.

Optionally you can set the EPAP lower and the IPAP higher in Auto mode.

Here are how the different pressures address each type of event:

If the above doesn't seem right, I would set the machine to:

IPAP Max=15
EPAP Min=7.0
PS=4 (range=3-8)

rested gal · Post by **rested gal** » Tue Jul 17, 2007 10:03 pm

Jen, "rise time" on the Respironics M series bipap machines, including the BiPAP Auto, is called "Rise Comfort" in the setup menu.

It's called "rise time" in the resmed VPAP III bi-level machines, but is called "Rise Comfort" in the Respironics M series bi-level machines.

Anyway, you can't use the Bi-flex setting AND the Rise Comfort setting at the same time. It's a "one or the other" choice. As cwsanfor said, if you choose a bi-flex setting, the "Rise Comfort" setting won't even come up as you go on through the menu. That may be why it looked to you as if your machine had no "rise time" setting.

I personally prefer using bi-flex. Feels smoother to me.

birdwood, I'm no doctor, but if it were me, given what you said was your recommended bi-level pressure from your PSG sleep study, I'd probably set the bipap auto with EPAP at 7 and IPAP at 20. I'd set the "Max Press Sup" (PS) as far as it would let me. With those EPAP/IPAP settings, 8 would be what it would let me set the Max Press Sup at.

I wouldn't use a rise time ("Rise Comfort") myself...I'd use bi-flex set at 3.

If I were going to set a rise time though, I'd try the Rise Comfort at all 3 of its settings (as well as at "off") while I was sitting up awake and breathing normally. I'd see how each setting felt. Which felt smoothest...less noticeable during the changes back and forth from exhaling to inhaling to exhaling...over and over again.

If I had to use a rise time, the setting of 2 or 3 feels better to me. But none of the rise time settings feel as natural as bi-flex to me. With bi-flex enabled, it's also good to try the different bi-flex settings while awake and breathing normally. I like bi-flex at " 3 " myself.

Good luck with your machine. You have a good one!

Patrick A · Post by **Patrick A** » Tue Jul 17, 2007 10:13 pm

As RG said the biflex setting of 3 is good. I tried 1 and 2 and went back to 3....

I always used my Pro2 set a 2 cflex, but now on the Bipap auto I like the setting of 3 for biflex.

Machine

EPAP and IPAP

EPAP and IPAP

Rise time.