I think my BiPAP is still speeding

[Perchancetodream]

Is it me or is my machine doing strange things? Once again it is hitting the max IPAP and staying there until I manually hit the Ramp button.

Any ideas?

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[Wulfman]

Susan,

I'm not a Bi-PAP guru, but I have a feeling from looking at your report that it's a combination of your Hybrid mask and the wide range of settings on your machine. It appears that snores and leaking are driving up your pressures.

Den

[curtcurt46]

It's just a guess, but it looks like the machine may be chasing the snores. I feel your range may be to great 5 or 6 to 20. Maybe you can narrow the range based on your PSG titration study. There are many opinions on the procedure but I would start a couple of cm below the titration cm and then go above that number by about 5 or 6 cm. Try this for a week and look at your numbers. You may be able to get by with less pressure and achieve about the same results. The PS setting in my opinion should be set at the largest setting up to 8cm. Remember this is only my best guess.

[Goofproof]

Until you get a mask with a low enough leak rate, so you can maintain the pressure to reduce your snore rate, your pressure is going to go to as high as you set it.

Sure the Ramp lowers the pressure again, and also stops you from getting treatment. Get your leak rate between 32 and 35 LPM and then find the pressures you need, the Hybreed, isn't going to cut it. a FF mask would be the better option if you have one that seals. Jim

[Perchancetodream]

Thanks for looking at it guys.

I used the Hybrid without any silicone putty last night which contributed to the high leak rates, but I don't understand why the pressure didn't go down after I stopped snoring, until I hit the ramp button.

My titrated pressure resulted in the Rx of 20/18 which is higher than what I normally need, which is why I am running in auto BiPAP mode. I did reduce the PS to 6, but it doesn't seem to have changed anything.

I may try taping my lips for a night or two to see it that will cut down on the snoring. If that doesn't help I'll try setting it to an min of 13 and max of 22.

Thanks again for your input!

Susan

[Guest]

Now that we know your titration pressure, I can only say the machine is right on. Maybe a couple of recommendations to consider will help.
Try to get your mask leak down to the expected leak rate for the pressure your using. You are not far off. Maybe just some fine tuning.
You might want to lower the max IPAP to say 18 cm or even 16 cm and see if you are able to get about the same AHI results. The lower pressure will also help with the leaks. Also, there is nothing wrong with the Hybrid if it seals correctly. Many folks use this mask successfully. In fact it was so good that Resmed developed a very similiar mask the Liberty.

[Perchancetodream]

Thanks, Curtcurt. Normally I use sillicone putty to get a better seal on the oral cushion but last night I didn't.

I would hate to give up the Hybrid because it allows me to read in bed before I fall asleep. I rarely have a problem with the nasal pillows unless the pressure goes to the max and then there might be a small leak. Most leakage is from the oral cushion.

I like the thought of lowering the max IPAP to 18 or even 16. I seem to do better overall at those pressures or lower.

Thanks for your help!

Susan

[Perchancetodream]

So, I tried reducing the IPAP to 18 but that didn't help any. The pressure went up to 18 and stalled there until I hit the ramp.

About a week ago I changed the PS back to 8 and increased the Max IPAP to 22. Since then my IPAP has never exceeded 19 and is usually between 16 and 18. My AHIs are down to 3 and below. Last night was the first night I did not use the silicone putty and the leak rate went up some, but the pressure and the AHI stayed as low as they had all week.

Anyone have any idea why increasing the IPAP would result in lower pressures? (The min EPAP is still 6.)

Susan

[rested gal]

(The min EPAP is still 6.)

Looks to me (and I'm sure no doctor!) like the minimum EPAP definitely needs to be set at about 12 or 13, not any lower, when using the machine in auto bi-level mode. Especially considering how high your prescribed titrated bipap settings were. Might even need the EPAP up around 15.

Whether you use the machine in autotitrating bi-level mode or just in bi-level alone, that EPAP needs to be up where it will prevent apneas from the get-go, imho.

People tend to think of "EPAP" as simply being a comfortable reduction in pressure for exhaling, but the EPAP pressure serves a much more important purpose than just "relief."

EPAP -- the pressure coming in -- is extremely important after the exhalation is over and there is that pause, however brief, before we start to inhale again. If an apnea slams the throat shut during the pause, we can't even START to inhale again.

A bi-level machine (not talking about bi-level S/T machines...just talking about "regular" bi-levels and the bipap auto) is going to sit there and sit there and sit there...forever... steadily blowing the low EPAP pressure...waiting for you to START to inhale again before it can give you the higher IPAP pressure.

The bipap auto's EPAP pressure will adjust itself upward, yes, but auto-titrating is designed to work gradually, checking the air flow as it goes. Looks like your machine is having to play catchup way too much with such a low EPAP setting.

It's important to have EPAP set up at a pressure than prevents apneas in the first place. The IPAP pressure can then take care of handling what IPAP is for -- knocking out snores and the partial closures (limited flows) that could deteriorate into hypopneas.

EPAP is for preventing apneas.
IPAP is for everything else.

I'd set it for auto bi-level, EPAP 13, IPAP 20. I'd put the PS setting for as much as it will allow...which will be 7 with that range of EPAP/IPAP. Bi-flex turned on at whatever bi-flex setting feels nice and smooth to you. I like Bi-Flex "3", myself.