Moving from APap to BiPap - Things to look out for?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Gryphon
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Moving from APap to BiPap - Things to look out for?

Post by Gryphon » Tue Jan 16, 2018 11:22 am

Talked with my Dr. last month and walked through some of my numbers from sleepyhead. noticed that there lots of nights were I was hitting 19.7 maxing out the pressure of my current Resmed Air Sense 10.

I asked about moving to an Auto-BiPap which would have a higher pressure ceiling of 25 and they're ordering me a new machine after a somewhat botched bipap titration sleep study.

"by botched" (I didn't sleep much, They put me in an unbearably hot room after everyone complained about the cold rooms... Sigh... I like it cold, I usually sleep in fleece PJ's with a hood up under the blankets but I was in shorts and a T-Shirt with out even a sheet and I was still sweating. Murphy's law... ) However it looks like the Doc saw something because he's ordering the device.

My question to those who are more familiar with BiPAP would be, which system should I be looking to move to if I want to keep as close an experience as my current AirSence 10 but with a higher pressure cap...

I'm thinking about the "The AirCurve™ 10 VAuto"
https://www.cpap.com/productpage/resmed ... chine.html

I'm going to be looking to set it up at 12.2 to 25 with a epr of 2 I know that "EPR" would be different on the BiPap and can be set independently unlike the limited exhalation relief that is normally offered on an Auto Pap.

I'm hopping to hear from the Technology tech sometime today or tomorrow at the latest to discuss any questions or concerns. I'd prefer to stay with Resmed as I find the breathing algorithm to be more comfortable for me and to my liking. I've tried the older Resperonics and switched to Resmed years ago and hand have an S9 CPAP as well as the AirSence 10 this machine will be replacing - I'll hang onto it as a backup.

Any advice for me moving forward?

Thanks in advance!

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Pugsy
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Re: Moving from APap to BiPap - Things to look out for?

Post by Pugsy » Tue Jan 16, 2018 12:22 pm

Replace the term EPR in your mind with PS (Pressure Support)...ResMed machines don't have EPR on top of PS.
Now Respironics does offer Flex in addition to PS.

I would suggest you stick with your first thoughts of the AirCurve 10 VAuto though.

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Gryphon
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Re: Moving from APap to BiPap - Things to look out for?

Post by Gryphon » Tue Jan 16, 2018 12:49 pm

Thanks for the quick follow up. I went into this all confident thinking that from what I'd heard the AirCurve 10 would be very very much like my AirSence 10 if the correct settings were used but simply allow for a higher pressure threshold.

The Titration study tech was shooting those feelings apart, telling me that a BiPAP doesn't work anything like my APAP. That even if I get a Auto BiPAP it wouldn't respond to changes like my current APAP. Kind of freaked me out... Maybe also not a good idea to shoot my ideas all to bits right before I try to fall asleep in a uncomfortable room when that was the whole point of the study in the first place.

They also insisted on setting up the machine they were running the test with with a inhale of 12 and an exhale of 8. My reason for moving to BiPAP was for the higher pressure capability not for greater "Pressure Support" I really really didn't like the feeling of that and it was driving me crazy. But they insisted it was part of the protocol of titrating me for BiPap.

I was thinking that any Auto system should respond to "Issues" somewhat the same. My current machine to my understanding responds to snores and hypopnias as well as apneas by raising pressure. They Sleep tech told me that the BiPap machine wouldn't raise pressure on detection of obstruction but only hypopnias... (that may still be fine for me as the majority of evens I still have are more flow limitations and not true obstroctuins) I was trying to explain my understanding of BiPAP and use APAP terminology and instead of pointing out what might be the same and helping with what might be different, he kept describing it like they had absolutely nothing in common and didn't really help.

To sum up, I got this feeling "your idea of moving to a BiPAP for higher pressure is a bad idea, because now everything is going to change, good luck getting used to a whole new machine that works nothing like your current APAP toodles, Ummm Ya thanks.

I guess I need a quick refresher on what differences I may expect, and or if needed a tough love confirmation that I really was a dumb bunny, asking to move to a BiPAP simply to get those 5 extra levels of pressure at the high end since I don't need more pressure support then 2.

Thanks, Gryphon

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Pugsy
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Re: Moving from APap to BiPap - Things to look out for?

Post by Pugsy » Tue Jan 16, 2018 1:37 pm

The sleep tech is an idiot. The AirCurve 10 VAuto is pretty much the AutoSet with higher maximum pressures and the ability to have higher than 3 (if you want it) EPR. I have no idea what he was thinking of.
With the AIrCurve 10 VAuto you can have a PS of 0, 1, 2 or 3 or 4 or 5 or whatever up to the max PS whatever it is.
The PS of 4 (the 12 inhale 8 exhale) thing is pretty much the starting titration protocol but it doesn't mean you have to use PS of 4 if you don't want to.
It will respond to the same stuff the AutoSet responds to. It just does it maybe higher than 20 if it senses the need and the setting parameters will allow it.

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Re: Moving from APap to BiPap - Things to look out for?

Post by Gryphon » Tue Jan 16, 2018 2:20 pm

That's what I thought going in. But ya... sleep tech had a nice mix of professionalism mixed with "I have sleep apnea too and use a machine etc etc... mixed with "what the hell are you talking about" that it made me question everything I thought I knew about BIPAP.

Sometimes when you assume (even when you know better) that people should know what they're talking about given the position they hold you get thrown under the bus.

I'll make sure to request the BIPAP I linked earlier in my post when I speak with the technology tech. Thanks again for responding so quickly.

Gryphon

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Re: Moving from APap to BiPap - Things to look out for?

Post by jnk... » Tue Jan 16, 2018 3:42 pm

Pugsy wrote:I would suggest you stick with your first thoughts of the AirCurve 10 VAuto though.
+1
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Accounts to put on the foe list: Me. I often post misleading, timewasting stuff.

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Gryphon
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Re: Moving from APap to BiPap - Things to look out for?

Post by Gryphon » Tue Jan 16, 2018 5:07 pm

Just got done talking with the technology tech at my doctor's office... looks like my new machine will be an air curve like I want. Though the surprise is in the script for its setup. They want me at 16 with support pressure of 10 to start. With 25 over 19 as my max. I managed 15 min of REM sleep during my test and about 1 hour of normal sleep. So we'll. See how that goes.

If I don't like it I'll be making calculated tweaks till I can deal with it and then work from there. I don't like "ramp" and don't use it... but now I'm wondering if there is such a thing as a ramp for the pressure support. A setting that would let me start the night at like 16 over 14 but then slowly widen the pressure gap so after I'm sleeping I'd have a pressure support difference of the prescribed 6 instead of the 2 I'm at now.

Overall if the wide PS is really needed and makes me feel better I'm all for it especially as it makes an even better case for medical need for my insurance to cover it.

I'm just wondering how hard its going to be to tolerate such a wide gap between inhale pressure and exhale. If a exhalation relief of 3 was mildly annoying and the 4 with the Resperonics machine was maddening. I will be in my house with my own bed etc... so I think I can handle big changes like that much better in the long term. We'll just have to see.

Rest well, Gryphon

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Re: Moving from APap to BiPap - Things to look out for?

Post by TedVPAP » Tue Jan 16, 2018 5:29 pm

Gryphon wrote:Talked with my Dr. last month and walked through some of my numbers from sleepyhead. noticed that there lots of nights were I was hitting 19.7 maxing out the pressure of my current Resmed Air Sense 10.

I asked about moving to an Auto-BiPap which would have a higher pressure ceiling of 25 and they're ordering me a new machine after a somewhat botched bipap titration sleep study.

"by botched" (I didn't sleep much, They put me in an unbearably hot room after everyone complained about the cold rooms... Sigh... I like it cold, I usually sleep in fleece PJ's with a hood up under the blankets but I was in shorts and a T-Shirt with out even a sheet and I was still sweating. Murphy's law... ) However it looks like the Doc saw something because he's ordering the device.

My question to those who are more familiar with BiPAP would be, which system should I be looking to move to if I want to keep as close an experience as my current AirSence 10 but with a higher pressure cap...

I'm thinking about the "The AirCurve™ 10 VAuto"
https://www.cpap.com/productpage/resmed ... chine.html

I'm going to be looking to set it up at 12.2 to 25 with a epr of 2 I know that "EPR" would be different on the BiPap and can be set independently unlike the limited exhalation relief that is normally offered on an Auto Pap.

I'm hopping to hear from the Technology tech sometime today or tomorrow at the latest to discuss any questions or concerns. I'd prefer to stay with Resmed as I find the breathing algorithm to be more comfortable for me and to my liking. I've tried the older Resperonics and switched to Resmed years ago and hand have an S9 CPAP as well as the AirSence 10 this machine will be replacing - I'll hang onto it as a backup.

Any advice for me moving forward?

Thanks in advance!
Have you posted any of your data?

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Pugsy
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Re: Moving from APap to BiPap - Things to look out for?

Post by Pugsy » Tue Jan 16, 2018 5:43 pm

Gryphon wrote:They want me at 16 with support pressure of 10 to start. With 25 over 19 as my max.
That's a physical impossibility...can't have 16 with PS of 10 because that would give you EPAP of 16 and IPAP of 26 and the machine won't go that high.

I am sitting here scratching my head as to why they want you to have such a high PS...
Pressure support is the difference between inhale and exhale...PS of 10 is a really high PS.
Be careful...that much PS can trigger centrals. So be sure to check your data after the first night.

Unfortunately there is no ramp for PS...with ResMed it's fixed PS.

Do you have any lung issues that you know of like COPD or something?

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Gryphon
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Re: Moving from APap to BiPap - Things to look out for?

Post by Gryphon » Tue Jan 16, 2018 6:28 pm

PS support of 6 So inhale pressure for me would be 16 and exhale pressure of 10.

Sorry still getting my terms correct for BiPAP

If I went to the machines max of 15 the exhale pressure would be 19 etc...

Ya I'm not 100% sure where the prescribed pressure came from. Doc only got about 1 hours worth of real sleep data to work with. So I'm going to take the initial settings with a grain of salt and go from there. Quickly or slowly depending on how badly the first few nights are.

Gryphon

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Re: Moving from APap to BiPap - Things to look out for?

Post by Pugsy » Tue Jan 16, 2018 6:45 pm

That makes more sense
10 EPAP with PS of 6 makes IPAP 16 and if it wants to go to 25 IPAP then it will drag EPAP up to 19.
I doubt it will want to go that high or if it does it won't stay up there very long.

Did you by chance mainly see more hyponeas on your software reports? Sometimes they use more PS so that IPAP is a bit higher in an effort to ward off hyponeas.

6 PS isn't as likely to trigger centrals as 10 would but watch your reports that first night anyway.

Did you go get the manual?
Request it from here so you can read up on all its features.
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

It also has some additional comfort features for the timing of that PS but usually those are left to the factory defaults unless someone has a problem.
Most people do very well with the factory defaults for those settings. If you feel too rushed with the breathing or that the machine is taking too long then those can be adjusted. Ti min and max and something else I forget what. You will see it in the setup menu.
Don't forget to changes "Essentials" from usage to Plus so the data will be available on the LCD screen at a quick glance.
If you use SleepyHead there is no need to do anything special. SleepyHead will just show it under your usual profile as a change in prescription.
Not a bit deal.

No need to lock the SD card either...that's really just a warning for S9 users who happen to have Windows 8.xx or higher and some Macs.

It's a pretty sweet little machine. It does seem to use just a bit more water than the S9 did at approx the same humidity settings. I still don't know why but then maybe the settings aren't as similar as I first thought.
I like the heated hose...I set the humidity to one thing and don't ever have to change it for the seasons or whatever. All I do is change the hose air temp because I like cooler air in the summer and warmer in the winter (my house gets quite cold at night) and my nose likes nice consistent humidity so I don't have to worry about making the nose unhappy. The default is for auto which is both humidity and hose air temp but they can be set separately if you wish.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

TedVPAP
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Re: Moving from APap to BiPap - Things to look out for?

Post by TedVPAP » Tue Jan 16, 2018 7:29 pm

TedVPAP wrote:
Gryphon wrote:Talked with my Dr. last month and walked through some of my numbers from sleepyhead. noticed that there lots of nights were I was hitting 19.7 maxing out the pressure of my current Resmed Air Sense 10.

I asked about moving to an Auto-BiPap which would have a higher pressure ceiling of 25 and they're ordering me a new machine after a somewhat botched bipap titration sleep study.

"by botched" (I didn't sleep much, They put me in an unbearably hot room after everyone complained about the cold rooms... Sigh... I like it cold, I usually sleep in fleece PJ's with a hood up under the blankets but I was in shorts and a T-Shirt with out even a sheet and I was still sweating. Murphy's law... ) However it looks like the Doc saw something because he's ordering the device.

My question to those who are more familiar with BiPAP would be, which system should I be looking to move to if I want to keep as close an experience as my current AirSence 10 but with a higher pressure cap...

I'm thinking about the "The AirCurve™ 10 VAuto"
https://www.cpap.com/productpage/resmed ... chine.html

I'm going to be looking to set it up at 12.2 to 25 with a epr of 2 I know that "EPR" would be different on the BiPap and can be set independently unlike the limited exhalation relief that is normally offered on an Auto Pap.

I'm hopping to hear from the Technology tech sometime today or tomorrow at the latest to discuss any questions or concerns. I'd prefer to stay with Resmed as I find the breathing algorithm to be more comfortable for me and to my liking. I've tried the older Resperonics and switched to Resmed years ago and hand have an S9 CPAP as well as the AirSence 10 this machine will be replacing - I'll hang onto it as a backup.

Any advice for me moving forward?

Thanks in advance!
Have you posted any of your data?
The reason I ask is because it seems to me that your treatment has not yet been adequately set so your doctor is reacting (aware of a poor sleep study, and saw that you were bumping up against 20) so he prescribed more power. If your treatment was well tuned and you needed more pressure than that would be a strong argument. Instead he is just throwing more technology at you. Poor settings will cause the machine to respond more than what is needed. You may not need to go above 20. Regardless, your new machine is a great machine but I think you need to be more involved in managing your treatment. Nothing personal as I tell everyone who is not completely satisfied with their therapy that they need to become more involved. This forum is proof.

So to answer the question in your topic, look out for moving for the wrong reasons.

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Machine: DreamStation Auto CPAP Machine
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Humidifier: DreamStation Heated Humidifier
Additional Comments: AutoPAP 16-20, Ultimate Chin Strap http://sleepapneasolutionsinc.com/
Use data to optimize your xPAP treatment:
how to see your data https://sleep.tnet.com/resources/sleepyhead
how to present your data https://sleep.tnet.com/resources/sleepyhead/shorganize
how to post your data https://sleep.tnet.com/reference/tips/imgur

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Re: Moving from APap to BiPap - Things to look out for?

Post by Holden4th » Wed Jan 17, 2018 2:29 am

I can't see any issues in setting your IPAP max to 25 just in case you need it. As Pugsy and others have been saying, your EPAP min setting along with PS is what's going to have the major effect on your treatment. What is making it hard for the aficionados on this forum is a lack of data. You talk about going up to 19.5 but what is your 90% pressure for IPAP. If you can post some charts it would help.

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Gryphon
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Re: Moving from APap to BiPap - Things to look out for?

Post by Gryphon » Wed Jan 17, 2018 2:42 pm

For one of my counts... 16 out of 20 days my 95% was 19 or higher on pressure. none were lower then 17.
EPAP 95% appears to be averaging 17+ of a max of 18 with my current setup. In the past my numbers were a bit lower but I have gained some weight lately and thing are tracking higher right now. My goal is to loose the weight with in the year but in the mean time I don't want to have my treatment suffer if my numbers were trending higher.

My system right now is setup to start at a pressure of 12.2 and move up from there to 20 if needed. With my exhalation relief set to 2.

Looks like what they want to set me on now... to put it into APAP terms... is a starting pressure of 16 to 25 if needed... with "exhalation relief" set to 6. For an inhale pressure of 16 and an exhale pressure of 10 to start me off.

Still learning the new terms. I get to pick up my new machine tomorrow mid day. So we'll see how it goes. I'm also going to be moving to a new DME who according to my Doc is much better and they have had far fewer complaints then my current DME who has been annoying me a lot lately.

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Gryphon
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Re: Moving from APap to BiPap - Things to look out for?

Post by Gryphon » Thu Jan 18, 2018 11:56 pm

Using my new machine right now with one if the new hybrid masks. So far so good. I think the ResMed algorithm is what I was missing the night of the study. Even though I have a PS of 6 it's no where as annoying as the PS of 4 on the titration macine they used on me the night of the study. There other settings in there I'll need to learn about like Ti min and Max.

I tweaked a few very minor things like ramp and auto start etc... set the info to plus. Nothing to make any one wag their finger at me yet.

Thanks again for all the support. I'm back to learning new stuff cause I have the equipment. So want to learn all the details. Take what I learn and pass it on.

I'll be changing my gear on the site soon.

Take care All!

Gryphon