My mother suffered an pulmonary embolsim and now she say th

My mother had suffered a pulmonary embolism and her pulmonary capacity diminished. She is in hospital under treatment. Now she says the pressure is to much for her and she cannot breathe with the mask on. Her sleep doctor is out of reach and i do not know what to do.

She is using a philips system one with a nasal mask with the next settings:

mode autob
max ipap 20.0
min epap 6.0
min ps 0.0
max ps 8.0
flex type bi-flex
bi-flex 3

please help because she had not slept in some time and she really needs the rest.

She's exhaling against 6 cm while awake...that's not very much. The BiFlex of 3 is a bit of exhale relief but obviously not enough.
You might try playing with PS minimum...maybe try 2 or 3 and see if the difference between inhale and exhale when using PS at 2 or 3 instead of 0 will help.
Might need try minimum EPAP of 5 if you do that because by adding more PS you will also be increasing IPAP a little.
The doctor needs to be involved ...that's a given.

ino wrote:She is in hospital under treatment. Now she says the pressure is to much for her and she cannot breathe with the mask on. Her sleep doctor is out of reach and i do not know what to do.

I am gonna go out on the limb here and say hopefully that treatment includes a pulmonary specialist as in Doctor.

So discuss with the treating doc dropping her IPAP from 20 to something she can exhale against, if that is where she is having a problem. I think in many cases that might be 10 but can vary w/patient and Hx.

Most doctors in the hospital barley recognize what the machine is for. She is at cardiology and the pulmonary hospital is on the other side of the city. Also the city is small and there is only 1 sleep doctor in it. I will try the setups and let you know how it works... Sorry for bad english.

ino wrote:Most doctors in the hospital barley recognize what the machine is for. She is at cardiology and the pulmonary hospital is on the other side of the city. Also the city is small and there is only 1 sleep doctor in it. I will try the setups and let you know how it works... Sorry for bad english.

See Hospitals in the US would have a doctor of each specialty including pulmonary. In fact, pulmonary and heart docs often work side by side. My sleep doc is a pulmonary doc.

Just curious which country are you writing from?

Romania

Her sleep doctor is also a pulmonary doctor. But is out of reach now and she is at cardiology because she needs anti blood clots treatment.

Changing the IPAP max setting may not help if she isn't ever reaching IPAP anywhere near the 20 max.
The primary difficulty is likely while awake and EPAP won't likely increase while awake and EPAP has to increase to get IPAP to increase and that is usually when asleep when the apneas cause the machine to increase.

Changing PS and/or EPAP is what I would do if it was my mom.

To know if IPAP needed changing I would want to look at the software reports to see how high it was even going.
SleepyHead software will work with the System One bipap.
https://sleep.tnet.com/equipment

Your English is great. We have English speaking people here who do worse..

Pugsy wrote: To know if IPAP needed changing I would want to look at the software reports to see how high it was even going.

While I do agree, we don't even know which make/model bipap she is using. Chances of getting a data report are slim.

I think we all know new & otherwise healthy people who cannot exhale against even 15cm much less 20 - so why give the option to go anywhere near 20?
And I suspect her volume has diminished. When you can't exhale its like you can't breath at all and you can't blow of the CO2

Pugsy wrote:Your English is great. We have English speaking people here who do worse.

Oh and that is for sure. You are doing fine.
To be sure your English is better than my Slovak

Philips System One

So i did like you guys said.

Ipap 10
epap 5
min ps 5
max ps 8

She said exhale is better now but she struggles to inhale like she has to inhale very deeply to get air.

Guest wrote:we don't even know which make/model bipap she is using.

Yes we do..it's either a 750 or 760 and the presence of the PS being variable makes it a 760...the 750 didn't do that.

ino wrote:She is using a philips system one with a nasal mask with the next settings:

mode autob

Reducing IPAP max may not result in any change during exhale if it never goes up very far. Just because it can go to 20 doesn't mean it is going to 20.
If IPAP max is set to 20 and it never goes beyond 12...reducing it to anything 12 or higher is not going to change where IPAP goes.
Won't help at all with awake perceived difficulties.

PS of 0.0 is the starting difference between inhale and exhale...and it's at 6 cm which isn't much. If she is having trouble exhaling against 6 cm then we need to add some sore of extra relief...BiFlex of 3 isn't helping enough probably because it is flow based and I bet she is having trouble breathing forcefully.
PS won't change until the machine sense some obstructive apneas so EPAP won't change either and at 0.0 that means IPAP is also 6 cm.
The machine shouldn't be doing much while awake.

Ino wrote:Ipap 10
epap 5
min ps 5
max ps 8

Those settings pretty much make it a fixed bilevel...5 exhale and 10 inhale...big jump for someone who had been using 6 inhale and 6 exhale.

Change minimum PS to 3 or 4 instead of 5 because 5 is forcing inhale too high for comfort by pushing inhale to 10.

min ps 3...sorry mispelled

she said it has trouble inhale like she is having difficulty pulling air.

ino wrote:min ps 3...sorry mispelled

she said it has trouble inhale like she is having difficulty pulling air.

Try PS of 4 and see if that helps.
Also try minimum EPAP of 4 with PS at all levels...even 1...see what is comfortable for her.

Becareful limiting IPAP max...get the software to see where the machine wants to go while she is asleep. If you limit it too much and it really needs to go up higher it can compromise her apnea therapy.