background info
Note--please see my post which begins with thew words Important new info (found later in the thread) as some of this info has changed and I need comments about the post important now info found below in the thread.
I was supposed to get an autobipap with an IPAP of 15 and an
EPAP of 10 which ranged at IPAP 15-25 and EPAP 10-20..
waited over a week for them to fax prescription,,provider was supposed to come today..been over a month since sleep study.
In trying to get the prescription faxed (Dr is out of town) the provider called me and doctor office saying that the machine cannot be set as doctor ordered as it won't work that way.
Originally, he was putting me on a bipap 18 / 14[/color] (have been using cpap at pressure 15 many years and pressure 20 last month. Still having apneas etc at 16 and 17 they discovered.
I talked him into auto pap but then got him to change it to a autobipap as I was retaining carbon dioxide in lungs.
First he set at IPIA 10 and EPAP 14 which was odd as provider just told me the EPAP can not be lower than the IPAP..also I feel suffocated at pressures under 15..so I got him to relook at it and he changed it to the IPAP 15 and EPAP 10 (with ten point range) as listed above.
But apparently, the machine will not do that according to the provider. I am confused as provider acted like it is like a bipap rather than auto bipap.but later sounded like maybe it was working like I thought it was.
A. Does this pressure she is suggesting to the dr sound right? She is suggesting to him he set it at 20 IPAP 10 EPAP. I think she said something about 7..I think she said it is the range.
I
QUESTIONS Questions are in blue
Does this setting sound good? I am not sure if Dr agreed to it as he called provided when I was on phone with her and she never called back so I don't know if they are coming today still or what pressure will be.
1.Does this mean the machine starts inhale with pressure of 20..is this the same pressure as 20 on a bipap?
and I guess the exhale is 10..
2.If I have no apneas/effects does it stay at 20 all night.?
3.If I have an apnea does it go up and does inhale go up the same span of numbers example-- inhale rises to 22 (from 20) than exhale rises to 12 (from 10)
4. Also does it go up to a high of 27 If 7 is the range and a low of 13 on the inhale (if I should need it)..
Please answer as many questions as you can..thanks I have been at wrong setting 15 years, have multiple symptoms of sleep deprivation despite treatment and anxious to get it fix and at right pressure.
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, CPAP, Prescription, auto
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, CPAP, Prescription, auto
please help confused.New info just added
-
sleepyjane
- Posts: 176
- Joined: Tue Feb 27, 2007 1:43 am
please help confused.New info just added
Last edited by sleepyjane on Fri Apr 13, 2007 4:19 pm, edited 2 times in total.
Depends on WHAT you are trying to fix. But for your machine,
EPAP cannot be higher than IPAP in settings.
1. You have an IPAP Maximum (this is the maximum Inhale pressure).
2. You have an EPAP Minimum (this is the minimum Exhale pressure).
The above is your Minimum and Maximum pressures period.
Between the above you have PS or pressure support. By default it will always keep a minimum of 2cm between these Inhale/Exhale pressures. If you set the PS to 3cm it will keep 3cm pressure between these two. I think the PS range is 3cm to 8cm. Most use 3cm, some labs 4cm. Think of the PS pressure "delta" as a tennis ball between these pressures.
Next understand that IPAP treats certain events and EPAP treats certain events. Some events like Vibratory snore is treated by BOTH pressures.
Here is a breakdown of what each pressure type treats:
IPAP or Inhale Pressure treats:
-Flow Limitation
-Vibratory Snores
-Hypopnea
EPAP or Exhale Pressure treats:
-Vibratory Snores
-Obstructive Apnea
Now understand IF EPAP Minimum is set too HIGH it will prevent the IPAP pressure from dropping down based upon the PS delta (that tennis ball between the IPAP and EPAP pressure settings). IF EPAP Minimum is set to 10cm and using a PS=3, then the lowest IPAP can go is 13cm from ANY Maximum IPAP setting. IF PS=4cm, then the lowest IPAP can drop is 14cm. It cannot drop lower than that because of EPAP's minimum setting of 10cm. So once EPAP drops to the Minimum it stops IPAP from dropping also (again think of the PS as a tennis ball maintaining the delta space between IPAP and EPAP as they move up/down.
Sooo....
If your IPAP Maximum is set to only 15cm, and you are still having apnea that means that IPAP cannot move higher due to the Maximum set limit, which PREVENTS the EPAP pressure from moving up to address the obstructive apnea (i.e. what are you trying to fix).
Here is what you need to do:
1. Set the IPAP Maximum to 20cm.
2. Set the EPAP Minimum to 8cm.
3. Set PS to 3 or 4 (start with 3cm).
This effectively opens your "window" for pressure from 8cm to 20cm.
Now, with those above suggested settings: the maximum IPAP can go is 20cm. It is going to hit that maximum and stop. When it stops it also stops EPAP from coming up. So in essence that IPAP Maximum can control how high IPAP can go and how high EPAP can go (based upon PS settings).
The maximum EPAP can go is 17cm (20cm minus 3cm PS = 17cm). Actually it can go to 18cm but not very long (like tennis ball is squishy but stops at 2cm) it will return to the PS setting of 3 in short order to maintain PS setting.
EPAP Minimum: This is set to 8cm (again it goes back to what are you trying to fix, if you want lower pressure set this lower). Just as the IPAP Max prevents IPAP from going higher, EPAP minimum prevents EPAP from going lower, with PS delta maintained, it also prevents IPAP from going lower than EPAP Minimum +PS delta. So if PS=3cm, and you set EPAP Min to 8cm, the lowest IPAP can go is 11cm.
So the range for IPAP =11cm to 20cm
So the range for EPAP =8 to 17cm (+/- 1cm)
Now on a EncorePro report, the items I listed above being addressed by each pressure type is listed on your Bipap Auto Daily report table at the bottom. On the left is the OSA event listed and which pressure addressed it.
So if you want to kill OA's you let EPAP go higher making SURE that any IPAP Maximum is not preventing that from happening.
You should always try and kill OA's first then pick up the pieces of Hypopnea, Flow limitation and snore after that. For snores, don't worry about any settings, the machine will try and eliminate those on its own.
Biggest mistake you can make on this machine is squeezing down your IPAP Max and EPAP Min pressures. Give yourself a taller "window" to work in. IPAP and EPAP go up/down together with a space between. If you increase PS you make that space or tennis ball delta wider between the two pressures. That means you bump up against your Max or Min settings sooner than using a lower PS setting.
How it works (with above settings):
When you first turn on the machine EPAP will be at the Minimum of 8cm pressure. IPAP will be at EPAP pressure +PS setting or (8cm +3cm = 11cm). If an Hypopnea is seen it will increase IPAP by 1cm (IPAP now =12cm). EPAP will follow it up going from 8cm to 9cm.
Now if an obstructive apnea is seen it will increase EPAP by 1cm, going from 9cm to 10cm. EPAP moving up will also push up IPAP by 1cm so IPAP goes from 12cm to 13cm. All along PS is maintained between them.
EPAP cannot be higher than IPAP in settings.
1. You have an IPAP Maximum (this is the maximum Inhale pressure).
2. You have an EPAP Minimum (this is the minimum Exhale pressure).
The above is your Minimum and Maximum pressures period.
Between the above you have PS or pressure support. By default it will always keep a minimum of 2cm between these Inhale/Exhale pressures. If you set the PS to 3cm it will keep 3cm pressure between these two. I think the PS range is 3cm to 8cm. Most use 3cm, some labs 4cm. Think of the PS pressure "delta" as a tennis ball between these pressures.
Next understand that IPAP treats certain events and EPAP treats certain events. Some events like Vibratory snore is treated by BOTH pressures.
Here is a breakdown of what each pressure type treats:
IPAP or Inhale Pressure treats:
-Flow Limitation
-Vibratory Snores
-Hypopnea
EPAP or Exhale Pressure treats:
-Vibratory Snores
-Obstructive Apnea
Now understand IF EPAP Minimum is set too HIGH it will prevent the IPAP pressure from dropping down based upon the PS delta (that tennis ball between the IPAP and EPAP pressure settings). IF EPAP Minimum is set to 10cm and using a PS=3, then the lowest IPAP can go is 13cm from ANY Maximum IPAP setting. IF PS=4cm, then the lowest IPAP can drop is 14cm. It cannot drop lower than that because of EPAP's minimum setting of 10cm. So once EPAP drops to the Minimum it stops IPAP from dropping also (again think of the PS as a tennis ball maintaining the delta space between IPAP and EPAP as they move up/down.
Sooo....
If your IPAP Maximum is set to only 15cm, and you are still having apnea that means that IPAP cannot move higher due to the Maximum set limit, which PREVENTS the EPAP pressure from moving up to address the obstructive apnea (i.e. what are you trying to fix).
Here is what you need to do:
1. Set the IPAP Maximum to 20cm.
2. Set the EPAP Minimum to 8cm.
3. Set PS to 3 or 4 (start with 3cm).
This effectively opens your "window" for pressure from 8cm to 20cm.
Now, with those above suggested settings: the maximum IPAP can go is 20cm. It is going to hit that maximum and stop. When it stops it also stops EPAP from coming up. So in essence that IPAP Maximum can control how high IPAP can go and how high EPAP can go (based upon PS settings).
The maximum EPAP can go is 17cm (20cm minus 3cm PS = 17cm). Actually it can go to 18cm but not very long (like tennis ball is squishy but stops at 2cm) it will return to the PS setting of 3 in short order to maintain PS setting.
EPAP Minimum: This is set to 8cm (again it goes back to what are you trying to fix, if you want lower pressure set this lower). Just as the IPAP Max prevents IPAP from going higher, EPAP minimum prevents EPAP from going lower, with PS delta maintained, it also prevents IPAP from going lower than EPAP Minimum +PS delta. So if PS=3cm, and you set EPAP Min to 8cm, the lowest IPAP can go is 11cm.
So the range for IPAP =11cm to 20cm
So the range for EPAP =8 to 17cm (+/- 1cm)
Now on a EncorePro report, the items I listed above being addressed by each pressure type is listed on your Bipap Auto Daily report table at the bottom. On the left is the OSA event listed and which pressure addressed it.
So if you want to kill OA's you let EPAP go higher making SURE that any IPAP Maximum is not preventing that from happening.
You should always try and kill OA's first then pick up the pieces of Hypopnea, Flow limitation and snore after that. For snores, don't worry about any settings, the machine will try and eliminate those on its own.
Biggest mistake you can make on this machine is squeezing down your IPAP Max and EPAP Min pressures. Give yourself a taller "window" to work in. IPAP and EPAP go up/down together with a space between. If you increase PS you make that space or tennis ball delta wider between the two pressures. That means you bump up against your Max or Min settings sooner than using a lower PS setting.
How it works (with above settings):
When you first turn on the machine EPAP will be at the Minimum of 8cm pressure. IPAP will be at EPAP pressure +PS setting or (8cm +3cm = 11cm). If an Hypopnea is seen it will increase IPAP by 1cm (IPAP now =12cm). EPAP will follow it up going from 8cm to 9cm.
Now if an obstructive apnea is seen it will increase EPAP by 1cm, going from 9cm to 10cm. EPAP moving up will also push up IPAP by 1cm so IPAP goes from 12cm to 13cm. All along PS is maintained between them.
someday science will catch up to what I'm saying...
-
cohodependent
- Posts: 30
- Joined: Fri Nov 17, 2006 2:06 am
Again I totally agree with Snoredog. I generally try to keep the PS setting at around 4cm difference between Ipap and Epap. If I am treating Central events or even CSR I will increase the PS setting. The most I have had to go was a 7cm difference, but 6cm is usually good.
In our lab, the max pressure for a Bipap is 24/20, and it is the very rare patients that needs that, or can even tolerate it. Generally 20/16 is the max that I will go to.
In our lab, the max pressure for a Bipap is 24/20, and it is the very rare patients that needs that, or can even tolerate it. Generally 20/16 is the max that I will go to.
-
rested gal
- Posts: 12881
- Joined: Thu Sep 09, 2004 10:14 pm
- Location: Tennessee
Jane, I'm not a doctor, but I do have a Respironics BiPAP Auto.
Your provider is correct that it cannot be set the way the doctor phrased his prescription.
If the machine is going to be used the way I use mine... operating as a bipap with auto-titration turned on and bi-flex turned on....I would set it like this:
If it is not an M series BiPAP Auto:
AbFLE mode
10.0 Min EPAP
20.0 Max IPAP
8.0 Max PS (or 7, if that's what the doctor and provider want to use for "PS", which would be fine.)
3 Flex (softens the transition between inhale/exhale)
0:00 Ramp (no ramp)
0:00 Start (this MUST be set for 0:00 or machine will use "split night" therapy mode, which you do not want.)
0 Patient (leak alert Off)
1 Light (button lights stay On when machine is not being used)
___ nights (leave whatever number is showing as is)
If it is an M series BiPAP Auto:
Auto Bilevel mode
20.0 Max IPAP
10.0 Min EPAP
8.0 Max Press Sup (or 7, if that's what the doctor and provider want to use for "PS".)
3 Bi-Flex (softens the transition between inhale/exhale)
0:00 Ramp (no ramp)
0:00 Start (no starting ramp pressure)
0 Mask Alert
0 Auto-off
0:00 Split Night Time - this should always be set for zero to keep "Split Night" turned off.
1 Show AHI/Leak - lets you bring up AHI, leak info and 90th percentile pressures used, shown as weekly or monthly averages in the M machine's
0 Patient reminder
To answer a couple of your questions, Jane...
After that, the EPAP/IPAP pressures will do what they need to do independently of each other...never getting closer than 2 cms together, and never getting farther apart than whatever the "PS" (Pressure Support) setting is set for. Setting the PS at 7 is probably what the provider has in mind when she mentioned "range" of 7 to you.
The "PS" can be set to as much as 8 cms apart, IF there is at least 8 cm's difference in the EPAP/IPAP settings in the first place. Which they would be with an EPAP 10 / IPAP 20 setting.
Jane, here is a link where I gave a "dogs on a yoked leash" description of my understanding of what the PS (Pressure Support) setting on the BiPAP Auto is for:
viewtopic.php?t=15666
Dec 08, 2006 subject: Question for BiPap users - UPDATED 12/14/2006
EPAP and IPAP will each do what's needed independently of each other...but can't get closer than 2 cm's to each other, or farther apart than 8 cm's (or whatever number of cm's the "PS" is set at.)
Jane, it sounds like your DME understands quite well the settings for using the machine in Auto Bilevel mode. The settings of EPAP 10 / IPAP 20, and PS "7" that the DME is suggesting to the doctor sound fine to me.
I'd ask that the DME also set the machine to use Bi-Flex at "3". To me, anyway, using bi-flex is much more comfortable than using a "rise time". One or the other can be chosen during setup...can't use both bi-flex AND a rise time together. I'd opt for "bi-flex."
Your provider is correct that it cannot be set the way the doctor phrased his prescription.
If the machine is going to be used the way I use mine... operating as a bipap with auto-titration turned on and bi-flex turned on....I would set it like this:
If it is not an M series BiPAP Auto:
AbFLE mode
10.0 Min EPAP
20.0 Max IPAP
8.0 Max PS (or 7, if that's what the doctor and provider want to use for "PS", which would be fine.)
3 Flex (softens the transition between inhale/exhale)
0:00 Ramp (no ramp)
0:00 Start (this MUST be set for 0:00 or machine will use "split night" therapy mode, which you do not want.)
0 Patient (leak alert Off)
1 Light (button lights stay On when machine is not being used)
___ nights (leave whatever number is showing as is)
If it is an M series BiPAP Auto:
Auto Bilevel mode
20.0 Max IPAP
10.0 Min EPAP
8.0 Max Press Sup (or 7, if that's what the doctor and provider want to use for "PS".)
3 Bi-Flex (softens the transition between inhale/exhale)
0:00 Ramp (no ramp)
0:00 Start (no starting ramp pressure)
0 Mask Alert
0 Auto-off
0:00 Split Night Time - this should always be set for zero to keep "Split Night" turned off.
1 Show AHI/Leak - lets you bring up AHI, leak info and 90th percentile pressures used, shown as weekly or monthly averages in the M machine's
0 Patient reminder
To answer a couple of your questions, Jane...
Yes, the pressure settings the DME is suggesting to the doctor sound right for using the BiPAP Auto as a BiPAP Auto, not just as a BiPAP.sleepyjane wrote:A. Does this pressure she is suggesting to the dr sound right? She is suggesting to him he set it at 20 IPAP 10 EPAP. I think she said something about 7..I think she said it is the range.
You are guessing right about how the exhale pressure will start. But the inhale pressure will not start at 20. The inhale pressure will start at two cm's above the exhale pressure. The EPAP will start at 10 and the IPAP will start at 12.sleepyjane wrote:1.Does this mean the machine starts inhale with pressure of 20..is this the same pressure as 20 on a bipap?
and I guess the exhale is 10..
After that, the EPAP/IPAP pressures will do what they need to do independently of each other...never getting closer than 2 cms together, and never getting farther apart than whatever the "PS" (Pressure Support) setting is set for. Setting the PS at 7 is probably what the provider has in mind when she mentioned "range" of 7 to you.
The "PS" can be set to as much as 8 cms apart, IF there is at least 8 cm's difference in the EPAP/IPAP settings in the first place. Which they would be with an EPAP 10 / IPAP 20 setting.
Jane, here is a link where I gave a "dogs on a yoked leash" description of my understanding of what the PS (Pressure Support) setting on the BiPAP Auto is for:
viewtopic.php?t=15666
Dec 08, 2006 subject: Question for BiPap users - UPDATED 12/14/2006
No. For that matter, the IPAP is not necessarily ever even going to hit 20 at all.sleepyjane wrote:2.If I have no apneas/effects does it stay at 20 all night.?
This is a greatly oversimplified answer, but No, they will not necessarily use the same span of numbers as one or the other goes up/down.sleepyjane wrote:3.If I have an apnea does it go up and does inhale go up the same span of numbers example-- inhale rises to 22 (from 20) than exhale rises to 12 (from 10)
EPAP and IPAP will each do what's needed independently of each other...but can't get closer than 2 cm's to each other, or farther apart than 8 cm's (or whatever number of cm's the "PS" is set at.)
No.sleepyjane wrote: 4. Also does it go up to a high of 27 If 7 is the range and a low of 13 on the inhale (if I should need it)..
Jane, it sounds like your DME understands quite well the settings for using the machine in Auto Bilevel mode. The settings of EPAP 10 / IPAP 20, and PS "7" that the DME is suggesting to the doctor sound fine to me.
I'd ask that the DME also set the machine to use Bi-Flex at "3". To me, anyway, using bi-flex is much more comfortable than using a "rise time". One or the other can be chosen during setup...can't use both bi-flex AND a rise time together. I'd opt for "bi-flex."
ResMed S9 VPAP Auto (ASV)
Humidifier: Integrated + Climate Control hose
Mask: Aeiomed Headrest (deconstructed, with homemade straps
3M painters tape over mouth
ALL LINKS by rested gal:
viewtopic.php?t=17435
Humidifier: Integrated + Climate Control hose
Mask: Aeiomed Headrest (deconstructed, with homemade straps
3M painters tape over mouth
ALL LINKS by rested gal:
viewtopic.php?t=17435
According to the Resprionics Bipap Auto Simulation program;sleepyjane wrote: 3.If I have an apnea does it go up and does inhale go up the same span of numbers example-- inhale rises to 22 (from 20) than exhale rises to 12 (from 10)
On an apnea, it is taken care of by an increase in EPAP pressure. As EPAP increases it in turn pushes IPAP pressure UP by same amount as EPAP moved up. So YES, IPAP would increase from 20cm to 22cm.
When the apnea goes away, EPAP would drop bringing IPAP down with it. Always maintaining a 2cm Minimum delta or the PS setting spacing.
The IPAP and EPAP move together like a string tied together. The length of that string is what the PS setting is (3-8cm) never getting closer than 2cm.
someday science will catch up to what I'm saying...
-
rested gal
- Posts: 12881
- Joined: Thu Sep 09, 2004 10:14 pm
- Location: Tennessee
Jane, the BiPAP Auto operating in both modes at the same time is a very different animal than just a bi-level (BiPAP) machine.
Setting a Pressure Support range of a 3 or 4 cm difference between IPAP/EPAP as has been suggested is not necessary, in my non-medical opinion, when using the BiPAP Auto in auto-titrating bi-level mode.
Unless there is a medical reason in your case for the PS to be set for a close range of 3 or 4, I'd set the PS for as much as it will allow when using auto bipap mode together.
With IPAP set for 20 and EPAP set for 10, I'd set the PS at " 8 " (the maximum "range" it will allow at those settings. Or PS 7, if the DME wants to use 7. I'd not set the PS at 3 or 4. There's no need to have IPAP dragging the EPAP up unnecessarily, imho. I'd give the "PS" a wide "leash" to work with:
viewtopic.php?t=15666
Dec 08, 2006 subject: Question for BiPap users - UPDATED 12/14/2006
Setting a Pressure Support range of a 3 or 4 cm difference between IPAP/EPAP as has been suggested is not necessary, in my non-medical opinion, when using the BiPAP Auto in auto-titrating bi-level mode.
Unless there is a medical reason in your case for the PS to be set for a close range of 3 or 4, I'd set the PS for as much as it will allow when using auto bipap mode together.
With IPAP set for 20 and EPAP set for 10, I'd set the PS at " 8 " (the maximum "range" it will allow at those settings. Or PS 7, if the DME wants to use 7. I'd not set the PS at 3 or 4. There's no need to have IPAP dragging the EPAP up unnecessarily, imho. I'd give the "PS" a wide "leash" to work with:
viewtopic.php?t=15666
Dec 08, 2006 subject: Question for BiPap users - UPDATED 12/14/2006
ResMed S9 VPAP Auto (ASV)
Humidifier: Integrated + Climate Control hose
Mask: Aeiomed Headrest (deconstructed, with homemade straps
3M painters tape over mouth
ALL LINKS by rested gal:
viewtopic.php?t=17435
Humidifier: Integrated + Climate Control hose
Mask: Aeiomed Headrest (deconstructed, with homemade straps
3M painters tape over mouth
ALL LINKS by rested gal:
viewtopic.php?t=17435
It works exactly as shown on a Daily EncorePro report. When you put PS up too high it may "limit" how much those pressures can move between the upper IPAP Max and the lower EPAP min.rested gal wrote:Jane, the BiPAP Auto operating in both modes at the same time is a very different animal than just a bi-level (BiPAP) machine.
Setting a Pressure Support range of a 3 or 4 cm difference between IPAP/EPAP as has been suggested is not necessary, in my non-medical opinion, when using the BiPAP Auto in auto-titrating bi-level mode.
Unless there is a medical reason in your case for the PS to be set for a close range of 3 or 4, I'd set the PS for as much as it will allow when using auto bipap mode together.
With IPAP set for 20 and EPAP set for 10, I'd set the PS at " 8 " (the maximum "range" it will allow at those settings. Or PS 7, if the DME wants to use 7. I'd not set the PS at 3 or 4. There's no need to have IPAP dragging the EPAP up unnecessarily, imho. I'd give the "PS" a wide "leash" to work with:
viewtopic.php?t=15666
Dec 08, 2006 subject: Question for BiPap users - UPDATED 12/14/2006
For example:
IF using:
20=IPAP Max
10=EPAP Min
8=PS (maximum)
When machine is turned on IPAP will be at 12cm (minimum), EPAP will be at 10cm.
If Flow Limitation or Hypopnea or snore is seen IPAP will increase by 1cm. EPAP will stay at 10cm. EPAP will not move up until the PS setting is reached (or OA is seen), If those events continue until IPAP reaches the Max at 20cm, EPAP will still only be at 12cm using a PS=8 setting.
If an apnea then occurs needing more splint pressure, EPAP will move up to 13cm, IPAP is at 20 maxed out, it stays there until PS = min of 2cm is reached.
If a PS=4 setting WAS used; EPAP would have increased from starting 10cm much sooner (it would have started moving sooner when IPAP reached 16cm instead of 18cm) than using a PS=8 setting. Overall, it may have resulted in a lower pressure for the patient while accomplishing the same thing. Set too high you seem to increase the risk of the IPAP maxing out before any movement of EPAP is seen.
On the flip side, if OA's are seen first EPAP would move up by 1cm, IPAP would also move up by 1cm. EPAP now 11cm, IPAP 13cm. Lets say EPAP moved on up to 16cm, IPAP would still only be at 18cm. Now things clear up and it drops pressure, EPAP moves down to 15, 14, 13, 12, 11, and finally 10cm. IPAP is still up at 18cm because of PS=8. If PS=4 it would have been brought down much sooner and only be at 14cm instead of 18cm.
So setting PS too high is not good either.
someday science will catch up to what I'm saying...
-
sleepyjane
- Posts: 176
- Joined: Tue Feb 27, 2007 1:43 am
thank you both for all your help..I will have to reread when I am not so sleepy and can better understand it as it seems complex.
I am though hoping to get your opinion on this. They are coming to bring machine this afternoon but I am not sure if doctor approved her recommendation.
When they did my sleep study, they started it at 10 (I had been at 15 which was high as my old cpap went for years and at 20 for one month.
I could not breathe at all at 10..felt suffocated and like chest as crushing..they upped it to 12 same thing 14 same at 15 I could breathe again.
I think the reason he set it at ten was I said I could not breathe under 15 when I was awake (cause he first set autopap 10i/14e)..but apparently he didn't understand the machine.
The practicer said it would start at 20 but it sounds like this is incorrect. It seems it will start at 12 (2 above the epap)..this will make it hard to breathe, no??
It won't go higher at that point as I will be awake trying to sleep and I am assuming it only goes higher if you have apnea or something. Now I am worried as sometimes it takes 30 minutes to fall asleep will I feel suffocated the whole time? how can I sleep if I feel like that.
Now I dont know what to do..suggestions??
I am though hoping to get your opinion on this. They are coming to bring machine this afternoon but I am not sure if doctor approved her recommendation.
When they did my sleep study, they started it at 10 (I had been at 15 which was high as my old cpap went for years and at 20 for one month.
I could not breathe at all at 10..felt suffocated and like chest as crushing..they upped it to 12 same thing 14 same at 15 I could breathe again.
I think the reason he set it at ten was I said I could not breathe under 15 when I was awake (cause he first set autopap 10i/14e)..but apparently he didn't understand the machine.
The practicer said it would start at 20 but it sounds like this is incorrect. It seems it will start at 12 (2 above the epap)..this will make it hard to breathe, no??
It won't go higher at that point as I will be awake trying to sleep and I am assuming it only goes higher if you have apnea or something. Now I am worried as sometimes it takes 30 minutes to fall asleep will I feel suffocated the whole time? how can I sleep if I feel like that.
Now I dont know what to do..suggestions??
[quote="sleepyjane"]thank you both for all your help..I will have to reread when I am not so sleepy and can better understand it as it seems complex.
I am though hoping to get your opinion on this. They are coming to bring machine this afternoon but I am not sure if doctor approved her recommendation.
When they did my sleep study, they started it at 10 (I had been at 15 which was high as my old cpap went for years and at 20 for one month.
I could not breathe at all at 10..felt suffocated and like chest as crushing..they upped it to 12 same thing 14 same at 15 I could breathe again.
I think the reason he set it at ten was I said I could not breathe under 15 when I was awake (cause he first set autopap 10i/14e)..but apparently he didn't understand the machine.
The practicer said it would start at 20 but it sounds like this is incorrect. It seems it will start at 12 (2 above the epap)..this will make it hard to breathe, no??
It won't go higher at that point as I will be awake trying to sleep and I am assuming it only goes higher if you have apnea or something. Now I am worried as sometimes it takes 30 minutes to fall asleep will I feel suffocated the whole time? how can I sleep if I feel like that.
Now I dont know what to do..suggestions??
I am though hoping to get your opinion on this. They are coming to bring machine this afternoon but I am not sure if doctor approved her recommendation.
When they did my sleep study, they started it at 10 (I had been at 15 which was high as my old cpap went for years and at 20 for one month.
I could not breathe at all at 10..felt suffocated and like chest as crushing..they upped it to 12 same thing 14 same at 15 I could breathe again.
I think the reason he set it at ten was I said I could not breathe under 15 when I was awake (cause he first set autopap 10i/14e)..but apparently he didn't understand the machine.
The practicer said it would start at 20 but it sounds like this is incorrect. It seems it will start at 12 (2 above the epap)..this will make it hard to breathe, no??
It won't go higher at that point as I will be awake trying to sleep and I am assuming it only goes higher if you have apnea or something. Now I am worried as sometimes it takes 30 minutes to fall asleep will I feel suffocated the whole time? how can I sleep if I feel like that.
Now I dont know what to do..suggestions??
someday science will catch up to what I'm saying...
Fixed BiPAP vs Auto BiPAP
I haven't followed the BiPAP Auto threads very closely to be perfectly honest. I don't use or have a BiPAP Auto. However, I'm interested in what BiPAP Auto users are actually seeing in their data with respect to maximum IPAP/EPAP spread that is actually delivered. I've seen and understand the algorithm description offered by the manufacturer. So that's not what I'm personally interested in.rested gal wrote:After that, the EPAP/IPAP pressures will do what they need to do independently of each other...never getting closer than 2 cms together, and never getting farther apart than whatever the "PS" (Pressure Support) setting is set for. Setting the PS at 7 is probably what the provider has in mind when she mentioned "range" of 7 to you.
The "PS" can be set to as much as 8 cms apart, IF there is at least 8 cm's difference in the EPAP/IPAP settings in the first place. Which they would be with an EPAP 10 / IPAP 20 setting.
An explanation of the basis for my interest in what users are actually seeing on their own reports with respect to IPAP/EPAP spread: I recall having read many times that clinicians titrating traditional spontaneous BiLevel machines most often titrate a 3cm or 4 cm IPAP/EPAP spread. My understanding is that central dysregulation in at least some purely obstructive patients can happen when the IPAP/EPAP spread becomes too vast (stretch-receptor based central skewing in some cases perhaps). And paradoxically, the IPAP/EPAP spread is sometimes widened beyond that 3 or 4 cm spread for centrally-dysregulated patients as mentioned in a post above (greater peak-reated pressure transitions between cycles amount to more ventilatory support). This is the basis for my wanting to know what "real world" data results people are seeing on this machine with respect to an automatically maintained IPAP/EPAP spread.
Again, anyone who cares to may repost the manufacturer's algorithmic description. But I'd really like to know how often or seldom people see their IPAP/EPAP automatically widenining beyond say a 3 cm or 4 cm spread. Is it often? Seldom? When it does happen on your own data set is that vast IPAP/EPAP spread sustained or of short-duration? Thanks in advance to anyone who cares to share their real world observations about this BiPAP Auto model's self-adjusting IPAP/EPAP pressure spread! .
Central Hypopneas?
Thanks, Snoredog! I haven't opened my PMs yet, but I'll head there next.Snoredog wrote:that is the way I understood it also SWS. If centrals were seen you increased the PS setting.
I sent you a PM, let me know if you want it.
As far as putting that PS=3 or PS=4 "leash" on the Auto BiPAP: I don't know that it's usually or even often necessary. But I bet wanting to manually impose a PS limit that way is a very intuitive thing for many of us who have used traditional APAP machines (non-BiLevel variety).
But, I'm wondering just how rare or how common it is in the "real world" for a PS=8 setting to result in an 8 cm delivered spread between IPAP and EPAP on these machines. So this model likes to increase EPAP for residual apneas and it likes to increase IPAP for residual hypopneas and such. Right? Doesn't that hint that those rare patients who end up receiving a rare whopping IPAP/EPAP spread of 8 cm might be predominately hypopnea patients? At least for those periods that precipitated IPAP going up, up, up while EPAP did not?
And if this algorithm finds a hypopnea patient who thrives with that whopping IPAP/EPAP spread of 8 cm, doesn't that hint at a good candidate for central hypopneas? So recapping the logic of my own ponderings about this machine: 1) wide IPAP/EPAP spreads tend to treat central disorders more so than obstructive disorders, 2) this machine raises IPAP for hypoponeas but EPAP for apneas, 3) succesfully treating a patient with a whopping but automatic 8 cm IPAP/EPAP pressure spread on this machine thus hints at a patient who may be both central and hypopneic.
None of the above is fact. It's merely conjecture and pondering on my part. But it's compelling logic, is it not?
Re: Central Hypopneas?
-SWS wrote:Thanks, Snoredog! I haven't opened my PMs yet, but I'll head there next.Snoredog wrote:that is the way I understood it also SWS. If centrals were seen you increased the PS setting.
I sent you a PM, let me know if you want it.
As far as putting that PS=3 or PS=4 "leash" on the Auto BiPAP: I don't know that it's usually or even often necessary. But I bet wanting to manually impose a PS limit that way is a very intuitive thing for many of us who have used traditional APAP machines (non-BiLevel variety).
But, I'm wondering just how rare or how common it is in the "real world" for a PS=8 setting to result in an 8 cm delivered spread between IPAP and EPAP on these machines. So this model likes to increase EPAP for residual apneas and it likes to increase IPAP for residual hypopneas and such. Right? Doesn't that hint that those rare patients who end up receiving a rare whopping IPAP/EPAP spread of 8 cm might be predominately hypopnea patients? At least for those periods that precipitated IPAP going up, up, up while EPAP did not?
And if this algorithm finds a hypopnea patient who thrives with that whopping IPAP/EPAP spread of 8 cm, doesn't that hint at a good candidate for central hypopneas? So recapping the logic of my own ponderings about this machine: 1) wide IPAP/EPAP spreads tend to treat central disorders more so than obstructive disorders, 2) this machine raises IPAP for hypoponeas but EPAP for apneas, 3) succesfully treating a patient with a whopping but automatic 8 cm IPAP/EPAP pressure spread on this machine thus hints at a patient who may be both central and hypopneic.
None of the above is fact. It's merely conjecture and pondering on my part. But it's compelling logic, is it not?
someday science will catch up to what I'm saying...
Thanks, Snoredog. I've had this program in the past via manufacturer download an analyzed it. Now that I've lost/misplaced/deleted the program I'm glad to get it again.
I'm intrigued at: 1) the etiological implications of just what may be happening when delivered IPAP-EPAP=8 cm (at PS=8 cm) in this algorithm, 2) the fact that this pressure-spread possibility is quite deliberately placed in the algorithm, and 3) just how frequently (or very infrequently likely) this whopping 8 cm IPAP/EPAP spread is required and thus algorithmically delivered in the real world.
Of course, the algorithm's pressure strategy can never textually describe the underlying etiological nuances encountered. It can only imply patient-based pattern response as if the patient were a mysterious and biological "black box" relative to the algorithm's various pattern-based strategies of delivered pressure.
PS=8 in an Auto BiLevel machine designed to treat obstructions. To me this designed pressure-delivery feature hints at etiologically and epidemiologically intriguing possibilities that are either downright profound or downright obscure. And if they're downright obscure, I have to wonder why the designers went to all that trouble to put it in the algorithm. I'm thinking along the lines of etiologically-unique hypopneic central possibilities---which are potentially profound.
Thanks again, Snoredog!
I'm intrigued at: 1) the etiological implications of just what may be happening when delivered IPAP-EPAP=8 cm (at PS=8 cm) in this algorithm, 2) the fact that this pressure-spread possibility is quite deliberately placed in the algorithm, and 3) just how frequently (or very infrequently likely) this whopping 8 cm IPAP/EPAP spread is required and thus algorithmically delivered in the real world.
Of course, the algorithm's pressure strategy can never textually describe the underlying etiological nuances encountered. It can only imply patient-based pattern response as if the patient were a mysterious and biological "black box" relative to the algorithm's various pattern-based strategies of delivered pressure.
PS=8 in an Auto BiLevel machine designed to treat obstructions. To me this designed pressure-delivery feature hints at etiologically and epidemiologically intriguing possibilities that are either downright profound or downright obscure. And if they're downright obscure, I have to wonder why the designers went to all that trouble to put it in the algorithm. I'm thinking along the lines of etiologically-unique hypopneic central possibilities---which are potentially profound.
Thanks again, Snoredog!
-
sleepyjane
- Posts: 176
- Joined: Tue Feb 27, 2007 1:43 am
Important new info-
All questions will be in red print, new settings for machines are in blue print. and stuff in large print is stuff I need to know if I am understanding it correctly as written.
OK..I called the provider and found they set the autobipap at 20IPAP and 10EPAP since getting hold of the doctor but now I have gotten that changed again as listed below since I told them that would make my starting IPAP at 12 and since I could not breathe under 15 without suffocation feelings, this needed to be changed.
They said it was hard but they got it changed again. thankfully.
Here is what I wound up with. Please give me your opinions if this sounds helpful in light of the facts that I have hypopneas and such at 17 and I can't breath under 15, and I was retaining CO2 in my lungs on old cpap pressure of 15 (through 20)
I got a bipapauto m series. They set the EPAP at 15 which puts my starting IPAP at 17. It ranges from 15 min to 25 max (I think it is epep min 15 and IPAP max 25 (though it starts at IPAP 17)
It has a ps of 7. It has a biflex of 3.
Also got the resmed ultra mirage full face mask (from respironics profile light nasal) due to mouth breathing.
If I understand it correctly, it never goes below 15 EPAP and 17 IPAP. The spread between the IPAP can be anywhere from 2 to 7 depending on what machine decides based on my breathing and such. It can go as high as 25 IPAP and 23 EPAP (but EPAP may be lower)
Please tell me if the words in the larger print are all correct. Am I understanding any parts of it wrong?
Finally does this sound like good settings based on info I gave you above about my case?
I definitely appreciate all the people who have got me here and changed my stuff from the nasal mask and bipap of 18/14 I would have wound up with had I not came here and been advised.
I think this more improved equipment and settings will really help and for the first time in years I feel hope. I do still need to figure out how to fix my PLMD as I am not too open to taking the brain altering drugs yet.
How long might it take for me to get used to the full face mask and machine and should I try it with my old nasal mask and new machine a few days before starting with the full face mask..this is what my provider suggested.
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, resmed, bipap, mirage, CPAP
All questions will be in red print, new settings for machines are in blue print. and stuff in large print is stuff I need to know if I am understanding it correctly as written.
OK..I called the provider and found they set the autobipap at 20IPAP and 10EPAP since getting hold of the doctor but now I have gotten that changed again as listed below since I told them that would make my starting IPAP at 12 and since I could not breathe under 15 without suffocation feelings, this needed to be changed.
They said it was hard but they got it changed again. thankfully.
Here is what I wound up with. Please give me your opinions if this sounds helpful in light of the facts that I have hypopneas and such at 17 and I can't breath under 15, and I was retaining CO2 in my lungs on old cpap pressure of 15 (through 20)
I got a bipapauto m series. They set the EPAP at 15 which puts my starting IPAP at 17. It ranges from 15 min to 25 max (I think it is epep min 15 and IPAP max 25 (though it starts at IPAP 17)
It has a ps of 7. It has a biflex of 3.
Also got the resmed ultra mirage full face mask (from respironics profile light nasal) due to mouth breathing.
If I understand it correctly, it never goes below 15 EPAP and 17 IPAP. The spread between the IPAP can be anywhere from 2 to 7 depending on what machine decides based on my breathing and such. It can go as high as 25 IPAP and 23 EPAP (but EPAP may be lower)
Please tell me if the words in the larger print are all correct. Am I understanding any parts of it wrong?
Finally does this sound like good settings based on info I gave you above about my case?
I definitely appreciate all the people who have got me here and changed my stuff from the nasal mask and bipap of 18/14 I would have wound up with had I not came here and been advised.
I think this more improved equipment and settings will really help and for the first time in years I feel hope. I do still need to figure out how to fix my PLMD as I am not too open to taking the brain altering drugs yet.
How long might it take for me to get used to the full face mask and machine and should I try it with my old nasal mask and new machine a few days before starting with the full face mask..this is what my provider suggested.
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, resmed, bipap, mirage, CPAP