A question (or several) for BiPAP users...

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
IllinoisRRT
Posts: 73
Joined: Mon Nov 29, 2004 10:08 am
Location: central Illinois

A question (or several) for BiPAP users...

Post by IllinoisRRT » Fri Jan 07, 2005 10:27 pm

1. What are your current settings?
2. Had you tried CPAP before being changed to BiPAP? Was it for your comfort that the change was made or was it always BiPAP due to your diagnosis?
3. If you are on BiPAP because you can't tolerate CPAP, have you ever tried something like C-Flex (which is supposed to help with CPAP tolerance)?

The reason behind my questions: I have a patient who is on BiPAP of 18/11, and I have an order to increase him to 18/13. He also has O2 bled into this. His oximetries (which we do as a free service- he's had one done with every pressure change) haven't improved, even from when he was on 12/8 or something like that, much lower. He's on a dinosaur of a machine (the old Respironics BiPAP S-T/D) and while it's supposed to go up to 20 on IPAP, I have a feeling I won't be able to go much higher than 19. What I would like to do is go back to trying him on just CPAP, perhaps with a CFlex mode, so that I can go higher on his EPAP and improve his oxygenation. I'm interested to hear if anyone here has similar experience.
Christine RRT

BetterBreathinBob
Posts: 69
Joined: Wed Dec 29, 2004 12:40 pm
Location: Mount Prospect IL

Bipap vs CPAP

Post by BetterBreathinBob » Fri Jan 07, 2005 10:53 pm

Hi Christine,

Your pt. should be thankful that they have a knowledgable therapist looking after them! Was the EPAP being changed because the sats were dropping at noc and was this confirmed with a full nocturnal oximetry study?
Is the pt on o2 because of a lung and or heart condition or because of extreme obseity and they returned from the sleep lab with those settings.

You have a complex pt here and you need to troubleshoot very systemically. If the pt isn't having any obstructive events on the EPAP of 11 then going to 13 is not necessary and a better solution is to increase the o2 to raise the sats. Also remember that a low sat could be caused by a leaking mask when the pt hits REM and they're in the supine position, I see this occur sometimes in the lab on higher BIpap settings.

Take your time and adjust each or fix one goal at a time. Open and stabilze the airway then correct oxygenation. Better sleep should return and if not maybe a retest in the lab is warranted.

Good Luck
Bob

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LDuyer
Posts: 1332
Joined: Sat Nov 06, 2004 9:26 pm
Location: Maryland

Christine

Post by LDuyer » Fri Jan 07, 2005 11:11 pm

Christine,

I haven't a clue what half of what's written above means.
All I know is for two months I've had the Resprionics bipap PRO with bi-flex. My settings are 17/14. Started adding oxygen last week. Doctor says I've got apnea and hypo ventilation. Claims bipap is good for both (I don't really understand this, though). This is the only machine I've had. I just went back to the doctor complaining about adjusting to it, he said it should take time. I asked about autopap and c-flex. And while he explained them (and it went over my head), he still insisted the bipap was better. He said something about not being able to get or simulate the 17/14 with an autopap with c-flex, that it only provided a lower pressure number of one or no more than one pressure point lower than the higher inhale pressure number. Sorry, I don't talk technical. And sorry if it doesn't help your questions.

Linda

BetterBreathinBob
Posts: 69
Joined: Wed Dec 29, 2004 12:40 pm
Location: Mount Prospect IL

Adjusting to Bipap

Post by BetterBreathinBob » Fri Jan 07, 2005 11:28 pm

Why is the oxygen being added now? Did they do an all night pulse-oximetry study to determine that you need oxygen while wearing the BIpap? I wonder if you are having obstructive events on your settings now because you're using the BIflex.

Biflex and C-flex should only be used if you were titrated with it in the lab. This is very important because many people only think that it is used as a comfort feature, which it does help but if not used correctly a pt could be having obstructive events occuring during the slight pressure drop which happens while using the C or BI-flex option.

Knowledgeable sleep techs and physicians are aware of this and that's the reason you should work closely with your doc. Ask questions and learn to improve your health.

Bob

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LDuyer
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Location: Maryland

Bob

Post by LDuyer » Fri Jan 07, 2005 11:37 pm

I assume you mean me.

Oxygen was added during my sleep study. In fact, it was added shortly after starting with the first mask. Even before the sleep test the doctor knew my oxygen was very low. He debated whether or not to start me with the bipap with oxygen right off. But he waited. After first 3 or 4 weeks of using it, the doctor said there was no change in my oxygen level and ordered oxygen. I'm now up to 97 which he happily said was normal. (sorry, off hand I plum forget my lowest level, I'd have to look it up again, but it dangerously low he said). Not sure if I can answer the other questions, at least not now. I'm only guessing that the bipap was part of the test. The graph showed no apneas/snoring at 17, and the pressure was even tested at 18.

Linda

IllinoisRRT
Posts: 73
Joined: Mon Nov 29, 2004 10:08 am
Location: central Illinois

Re: Bipap vs CPAP

Post by IllinoisRRT » Sat Jan 08, 2005 12:08 am

BetterBreathinBob wrote:Hi Christine,

Your pt. should be thankful that they have a knowledgable therapist looking after them! Was the EPAP being changed because the sats were dropping at noc and was this confirmed with a full nocturnal oximetry study?
Is the pt on o2 because of a lung and or heart condition or because of extreme obseity and they returned from the sleep lab with those settings.

Thanks Bob,
The EPAP has been changed because his O2 sats were dropping quite low on his previous settings. However, we have gone from 9 to 11 to 13 to now 15 and there's been very little if any improvement. They haven't ordered a change in the O2 flow since it was increased to 3.5 from 2, but that was at the initial increase. The sats have been confirmed by our overnight oximetry only (just wearing a pulse ox, no other info regarding actual obstructions). The lab that's done his sleep studies in the past doesn't typically do studies with BiPAP, I'm told. Whatever that means! I don't know how he got on it in the first place, to be honest. I've only been taking care of him for about 6 months, he's been on this for years.
As far as his diagnosis, I know that his O2 is ordered for continuous use but he is only wearing it at night. I know he has heart issues but I don't know if it's all boiling down to his obesity. As I said also, he has some delays as well- I don't know if there's a congenital thing going on or what (I miss being in the hospital where I could actually read charts! I have such little information!).
All I know is, I am going to try to push for another sleep study because like I said, I'm pushing the limits with my equipment and it doesn't seem to be doing much good anyway. Thanks for all of your help- do you work in this profession as well, I assume?
Christine RRT