Question regarding Bipap P.S. setting

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GTOJim
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Question regarding Bipap P.S. setting

Post by GTOJim » Sat Aug 01, 2015 12:54 pm

Feeling more comfortable with my new sleep doc I started tweaking my settings a bit. Changed my P.S. to 2 and my numbers were supper. But my new doc wants a bigger separation, he states high pressure with P.S at 2 can cause airway damage, he want's more separation which means increasing IPAP which means more CA events. My numbers will still look very good but for some reason I seem feel best when my AHI is below 2, the lower my AHI the better I feel.

I would love to hear how others feel about this?

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JDS74
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Re: Question regarding Bipap P.S. setting

Post by JDS74 » Sat Aug 01, 2015 4:59 pm

Hi Jim:
Its good that you are able to keep your AHI below 2.0 and feel better when that happens. Keep up the good work!

However, without additional information, your question just hangs there and is difficult to answer.

So ... Please post your equipment using the User Control Panel ( upper left of screen ) and select Text mode for clarity.
Also, could you also post as part of this thread, your actual CPAP settings? It sounds as if you have a Respironics BiPap machine and that your doctor is concerned that your EPAP pressure is too close to your IPAP pressure. Having them too close like that makes the machine more like an plain CPAP (single pressure machine) than a BiPap (dual pressure machine).

BTW, I'm having difficulty finding the P.S. parameter in the settings for Respironics BiPap machines. Perhaps it is different brand??? Or you have used a different label for some other parameter???

For example, if, instead of just increasing the Pressure Support from 2.0 cm H2O to 4.0 cm H2O and letting it go at that, you could at the same time decrease the minimum EPAP down by 2.0 cm H2O thus increasing the separation but not increasing the maximum pressure and causing pressure related difficulties. It all depends on the actual settings and that's the reason for posting them.

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xyz
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Re: Question regarding Bipap P.S. setting

Post by xyz » Sat Aug 01, 2015 7:18 pm

> Changed my P.S. to 2 and my numbers were super.
> my new doc wants a bigger separation

If you use an auto bipap with full data, the machine will determine what you actually need, and when you make a change you can see the effect.

That would eliminate opinions and guesses.

Unless a doctor has SA they often know less than an experienced patient.

GTOJim
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Re: Question regarding Bipap P.S. setting

Post by GTOJim » Sat Aug 01, 2015 7:27 pm

I updated my profile as you suggested with my current machine and settings. I was using a RemStar BiPAP Auto with Bi-Flex (760P) for a couple years but switched to an S9 VPAP Auto two months ago, also changing sleep doctors. With the RemStar my settings were Min EPAP 14.5 Max IPAP 25.0 PS 2.0-5.0, AHI averaged 1.74. With the change in doctors I decided to tweak things a bit using the S9. Got my average AHI down to .54 for over a period of 3 weeks with settings of PS 2.0 over 14.0-19.0.

My new doctor doesn't like the PS at 2, states it can damage my airway. Is the doctor correct, using the setting PS 2 will or can cause damage?

With my RamStar using a Max IPAP 25, every night my IPAP was over 20. I made changes to my old doctors prescription and left the Max IPAP at 25 as wasn't sure how he would react to changing every one of his settings.

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Pugsy
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Re: Question regarding Bipap P.S. setting

Post by Pugsy » Sat Aug 01, 2015 9:37 pm

I have never heard of a too low of a pressure support causing damage to the airway.
If it did there's a whole lot of people on regular cpap/apap machines that don't have any pressure support offered getting damage and I just don't see it causing a problem unless there is some sort of unusual health condition going on.

What PS does he want you to use?
I prefer PS if 4 over 2 myself but that is just a comfort personal thing.

If increasing IPAP to get more PS causes centrals...maybe split the difference and lower EPAP by 1 and increase IPAP by 1 and see what happens..that would give you PS of 4 which is probably where a lot of people do very well with.

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Re: Question regarding Bipap P.S. setting

Post by GTOJim » Sun Aug 02, 2015 1:47 am

I was thinking the same thing regarding people using CPAP or Auto CPAP with out pressure support. I've been away from this forum for a very long time and thought possibly there was new information regarding PS.

I'm not sure but my impression is this doc likes PS 5. I tried PS 4 and AHI went over 2 with CA events. On paper the numbers look great but how I feel isn't so great as I also have PLM. I will try the suggestions of lowering my EPAP and see how it works.
'

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GTOJim
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Re: Question regarding Bipap P.S. setting

Post by GTOJim » Sun Aug 02, 2015 10:06 am

Last nights AHI .84 after lowering my EPAP 1 and increasing pressure support 1, pressure support is now 4. I should feel more alert with a lower AHI and PS 4 will make my doc happy. This looks like a win, win for me, I'll continue to monitor but don't expect much variation in my AHI. Thanks a bunch for your suggestions.

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xyz
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Re: Question regarding Bipap P.S. setting

Post by xyz » Sun Aug 02, 2015 12:17 pm

> I made changes to my old doctors prescription

Not _doctor's_ prescription.
What exactly was the bipap prescription from your _sleep study_?

> Min EPAP 14.5 Max IPAP 25.0

I have never heard of a difference between min and max of that much. It seems huge.

I set my min at 2 below and my max at 2 above my bipap sleep study prescription.

The actual pressures that I see during the night never get to the min (except briefly at start up) and almost never get to the max setting.

I'm a little vague on "pressure support" for bipap. It seems to me that that's the very reason that bipap exists. And thus seems to be redundant. If I misunderstand something, someone please explain.

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Re: Question regarding Bipap P.S. setting

Post by GTOJim » Sun Aug 02, 2015 11:58 pm

In that example the doctor prescribed Minimum EPAP 8, Max IPAP 25, Minimum PS 2.0, max PS 5.0, CPAP in Auto mode. My sleep study at that time recommended a pressure setting of 10 but that said the sleep labs have always gotten my pressure wrong, I've had 4 or 5 sleep studies.

My first sleep study recommended a pressure of 12. The DME provided a basic CPAP which I used every single night for 1 1/2 years and I was actually feeling worse than when I started. Short version, I purchased an auto CPAP and the next morning I woke up feeling refreshed for the fist time in 20 years, pressure of 12 was to low. That Auto CPAP was the best purchase I've ever made in my life, it was amazing how much better I felt with proper treatment, truly life changing.

Seems to me you have a good understanding of Pressure Support, better than I do for sure.

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GTOJim
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Re: Question regarding Bipap P.S. setting

Post by GTOJim » Mon Aug 03, 2015 12:45 am

xyz
I just reread you post so I'll add a little more information how max pressure works for me. No matter how high my max is I hit it or come very close every night, so normally I limit my max pressure just as you have done by going 2 points above the max recommended pressure from your sleep study. I've only had one sleep study which recommended a max pressure setting and it was 16, the same study when the doc prescribed a max IPAP 25, that was 2 years ago when I first started using BiPAP. I had to change the doc's minimum pressure but left the max pressure as I concerned how the doc would react if I also changed his Max IPAP prescription.

I think it's great you never hit your maximum.

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Pugsy
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Re: Question regarding Bipap P.S. setting

Post by Pugsy » Mon Aug 03, 2015 7:24 am

Jim you may be one of a small minority of people who have centrals develop with bilevel pressures and it might not be the IPAP setting itself. Sometimes it can happen with just a little bilevel difference (even simple EPR on the ResMed cpap machines) and sometimes it is happens with too much pressure support like when people use 6 to 10 pressure support. That's a really small minority but you might be in it or on the edge of it.

If this latest change keeps you happy and keeps your doc happy...that's great, I would keep using it if it works well for you. It probably would be futile to try to educate the doctor about PS too low causing damage. Seems like once they get an idea in their head it's hard to remove it.

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Re: Question regarding Bipap P.S. setting

Post by GTOJim » Mon Aug 03, 2015 12:44 pm

Pugsy

I'm happy to report that lasts nights AHI was 0.83.

I think you might have nailed it regarding my centrals. Thinking back when using an AutoSet it was very rare that I had a central, with BiPAP my centrals defiantly increased. The reason I tried PS 2 it's closer to my old Autoset settings 14 - 16. I just took a close look at the PS 2 data and to my surprise several nights my IPAP Minimum pressure of 16, stayed at 16 the entire night, never varied, quite a few nights had very little fluctuation with most events being centrals. Not many centrals as my AHI remains low so at least for me it's not a problem. But the lower my AHI the better I feel, even a slight change in AHI can be a very good thing for me. PS 2 might be the sweet spot for me, although so far my current settings are very close. A big thank you as I never would have tried these settings and honestly I expected my AHI to go up, not down, plus this will make my doctor happy.

XYZ This is a bit embarrassing because I just stated every night I hit or came very close to my Max pressure setting. I incorrectly made an assumption based on past experience when I closely monitored my data and again after first starting BiPAP. My AHI doesn't vary much so I haven't been taking a close look at my data and made an incorrect assumption.

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palerider
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Re: Question regarding Bipap P.S. setting

Post by palerider » Mon Aug 03, 2015 2:13 pm

GTOJim wrote: The reason I tried PS 2 it's closer to my old Autoset settings 14 - 16.
I'm not sure if you're still under this misimpression, but I feel that it's important to clear up.

your ps of 2 has nothing at all to do with your autoset settings of 14-16.

the autoset settings of 14-16 means that your basic pressure varied, over minutes of time, between 14 and 16, depending on what your needs were.

a PS of 2 means that on every breath, your pressure goes from 14 to 16. it's completely different.

a PS of 2 would be like having an EPR of 2 on your autoset. which would give you a difference of 2cm between inhales and exhales, whatever the pressure is.

does that make sense?

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Re: Question regarding Bipap P.S. setting

Post by GTOJim » Mon Aug 03, 2015 2:44 pm

Makes perfect sense, completely understand. My intention was a poor attempt of making a comparison of max pressures of 16 between my old AutoSet, VPAP and centrals or CA events between the two types of machines. I always maxed out the AutoSet (14-16) pressure at 16 which I didn't' include in my previous post, and when using the VPAP at PS 2 (14-19) I had some nights when the pressure stayed at 16 or very close to it. With the AutoSet centrals were rare and with the VPAP centrals are a lot more common. AutoSet exhale was set for three (proper name escapes me right now) but as you point out it's not exactly the same inhale pressure between the two machines. Guess it's apples to oranges.

Thanks for pointing it out.

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palerider
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Re: Question regarding Bipap P.S. setting

Post by palerider » Mon Aug 03, 2015 6:18 pm

GTOJim wrote:Makes perfect sense, completely understand. My intention was a poor attempt of making a comparison of max pressures of 16 between my old AutoSet, VPAP and centrals or CA events between the two types of machines. I always maxed out the AutoSet (14-16) pressure at 16 which I didn't' include in my previous post, and when using the VPAP at PS 2 (14-19) I had some nights when the pressure stayed at 16 or very close to it. With the AutoSet centrals were rare and with the VPAP centrals are a lot more common. AutoSet exhale was set for three (proper name escapes me right now) but as you point out it's not exactly the same inhale pressure between the two machines. Guess it's apples to oranges.

Thanks for pointing it out.
ok, the three on the autoset was epr. and a 3 EPR is very very very similar to a PS of 3 on the vpap auto.

if you had 14-16 on your autoset, with epr of 3, the corresponding settings on the vpap auto would be:
min epap 11,
max ipap 16
ps 3.

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