First BiPAP Night - Pretty Rough

Hi - Last couple of months got my 2 sleep studies required by Medicare (even though I've been on CPAP for over 10 years...) Without the machine on the first study, I was about 75 events per hour. Then they did a BiPAP tritrataion study, and reduced the events to about zero between pressures of 14-18. Even though they did not go above 19 on the study, the doctor doing the report recommended: Maximum IPAP = 25 cwp, Minimum EPAP = 9, Minimum PS = 8 cwp, Minimum PS = 4 cwp, Bi-Flex - 3. Don't really know what all that means.

The Sleep Doctor wrote the prescription as Max IPAP of 20, Min EPAP of 9, and a Pressure Adj. of 5. She said she thought the 25 was too high. I don't understand how the Max PS, and Min PS, and the Bi-Flex correlates to a single "pressure adjustment" of 5?

So the first night my AHI was 7.79 which is higher than the 4-7 I was averaging on the APAP machine. I was struggling to breathe and kept feeling like I was hyperventilating - it was really scary. I guess it is normal to have a lot of problems getting used to the BiPAP? of the 7.79, 4.32 was clear airway, and on the APAP I was averaging only 1 or 2. Looking at the results on the machine (ResMed Aircurve VAuto), it showed an AHI of 3.9 - using the Sleepyhead software, it shows the 7.79. I don't remember seeing those differences on the ResMed S9 Autoset. Sleepyhead usually showed the same as the machine.

The Machine also has setting of TI Max - 2.0s/TI Min - 0.3s/Trigger - Med/Cycle - Med. I guess those are default settings? I don't know what they mean.

I know 7.79 is not horrible, but I was hoping for some really good numbers for a change. I really struggled - tossing and turning, and had to change masks (my favorites result in bad rainout), and felt like I was fighting the machine the whole night. Woke up with heart racing and very anxious. In the past my average pressure would be around 13-14, and I'm not really sure why they think I need a BiPAP - they just said they thought I would be more comfortable and it would bring the AHI's down.

Should I keep the machine as set for a few days and see if things improve, or do any of the settings seem "out of whack" to those that use the BiPAP machines? I do have the Clinician manual and know how to make any changes.

Thank you for reading my post and for any advice you might have for a BiPAP Newbie.

I'm sure someone with an intricate knowledge of bilevel settings will come along soon. I was lucky in that my original settings worked fine for me. I'm guessing yours will too with a bit of tweaking. I'll be reading to see what you're advised as I am trying to learn more about bilevel treatment.

What were your settings when you were using the APAP? Minimum, maximum and if using EPR at what setting?
Exactly what are the settings now on your new machine?

Did you at some point turn the machine off and back on during the night? If you did that would likely explain the discrepancy in the AHI as what you were seeing on the screen was simply the AHI for the second session.

You slept poorly last night with a lot of tossing and turning most likely and I wouldn't be surprised if the bulk of those centrals/Clear Airway events were some awake breathing getting flagged by mistake. Over half your AHI amounts to centrals and if most of those were awake breathing getting flagged by mistake they really aren't all that alarming.

Can you post the detailed report image from last night so we can see where the flags were happening?

What is it about the breathing with the new machine that is different or uncomfortable for you?

Thank you for your response. I was using a ResMed S9 Auto with a minimum of 9 and a maximum of 16 and a flex of 1.

The ResMed Aircurve VAuto is set to Maximum IPAP of 20, Minimum EPAP of 9, and Pressure Support of 5. (The report recommended a high of 25, but the Sleep Doctor felt that was too high for me). The Timax is 2.0s, TiMin is 0.3s, Trigger is Med, Cycle is Med.

I do turn the machine off and on when I get up to use the restroom at night - is it wrong to do that? I thought it would mess it up to just keep it running, but I've never thought about that.

I was awake a Lot last night struggling and tossing and turning. The way the BiPAP seems to be "forcing" me to breathe just doesn't feel right, but maybe I just have to get used to it. The old Auto seemed to "react" to my breathing whereas the BiPap seems to have its ideas about how I "should be" breathing. I alternate between feeling like I'm not getting enough air and feeling like it's blowing too hard.

I have to go into town for a couple of hours and I will try to post an image from Sleepyhead from last night when I return - I'm really bad at it, and still struggling to figure it out. Please let me know what I need to do differently when I post it later - I'm getting confused about getting it from Imgur to post on the forum.

Again, thanks so much and I will post further details later this evening.

There's a pretty big difference in PS (pressure support) of 5 and EPR of 1. EPR at 1 is pretty much PS of 1.
So not surprised that you aren't comfortable with the machine's way it is wanting you to breathe. It's out of sync with your body because your body isn't used to it.

Your settings aren't all that different except for the PS. Why not go in and change the PS from 5 to 2 or 3 and see if that is more comfortable for you.
Or heck, change it to 1 and it should feel like the S9 felt.

Don't worry about turning the machine off if you get up during the night...that's fine. Just remember that when you do the LCD screen is going to reflect the most recent session and it might be a bit off from the overall nightly data especially if you have a lot of awake flags happening.

Don't worry about the recommended high vs the doc limiting the IPAP to 20. It's only a factor if for some reason you see the maximum pressure line wanting to max out at 20.

Thank you, Pugsy, for your suggestions. I was wondering the same about the Pressure Adjustment. I remember having a hard time with setting my EPR at 3 on the AutoSet. I will change it tonight to a 3 from the 5, to equal the 3 suggested by the Sleep Study report and see how it feels. If still difficult, I will reduce to 2 and then 1 as you suggest. If I still feel something's not right, I will post a description of the problem and a Sleepyhead graph. I feel more optimistic and will make an effort to approach tonight more positively. (Last night I was very reluctant to use the BiPAP for the first time...). So appreciate your taking the time to help me.

I think you also posted on another site, you have an auto machine, I don't think it matter if the max is 25, the machine will only use what it needs. so reducing the max to 20 won't mean anything unless your machine is going over 20 on a regular basis. AFAIK the resmed Vauto doesn't have a variable PS only a variable epap. I've been caught on that before. It also doesn't have a flex. I think these are the Philips

your lab at a fixed pressure 14-18 would translate to an auto pressure on min epap 12 max epap 20 (or 25) with a PS;4
It is a shock to the system and you will get use to the pressure in a couple of weeks...or you can start with min epap8, limit the max to 12, then 13, then 14 etc. and PS still at 4, PS:4 will make it easier to breathe out., PS:5 will make it even easier. The only thing is new use pressure induced CA may crop up for a while.

Time will tell, but I think you are making a mistake reducing your PS and it would be better working on epap till you are use to it and then raise it as you go and be back to your prescribed max in a couple of weeks to a month

your sleepyhead chart will tell you when you have your pressures right and members who can help you understand them.

I started using the Aircurve VAuto a week ago, and have changed my profile information now. This first week has been about like the APAP was - AHI 4-8 - not great, not awful. I got used to the BiPap after reducing the Pressure Support from 5 to 3 the VAuto does have one. I do think my EPAP needs to be higher than 9, and will bump that up to 10 for a few nights and then a little higher if needed. When breathing, it does feel like I might need to go down to 2 on the Pressure Support. Right now the IPAP seems about right - the average pressures seem to be running about 13-15.

Under a new post a few minutes ago, I asked about mouth breathing, because I suspect that may be one of my main problems. Will be working on that.

Thanks for your post, ajack - I think in the end you will be correct with an EPAP of 12 and not 9 as on the prescription.