Man switches to BiPAP from CPAP and struggles

[Mike_Snodgrass]

Ok - here's the scenario. Been on CPAP for almost a year, severe OSA, full face mask (mouth breather), titration at 14. Is really helping but want to get lower AHI.

Doctor gives me BiPAP to try. Titrated at 14/6 gets me to 0 AHI - in the sleep center of course. However, the pressure drop from 14 to 6 is very hard to handle with the Liberty hybrid mask. I can't go to sleep with it - feels like really forced breathing. So, we set the ramp to the lowest setting, which if you know biPAP machines, is kinda confusing. We set the lowest setting to 4, but with the 14/6 setting (which is a delta of , I start each night with a 12/4 i/e ratio, which is still too much for me to get used to. Too hard to comfortably fall asleep.

The DME tells me to then try the other mask I have (regular full face mask not a hybrid), which will not feel as up/down with the pressure, but I don't like that mask. So, I cheat, change my BiPAP settings to 14/10, JUST SO I CAN get my starting ramp pressure to be low and go to sleep (starts off with 8/4). However, I don't feel rested in the morning. And of course the new BiPAP machine does not read my AHI's, so I don't really know how well I did.

Hope this all makes sense to someone out there!!

Here's my question. Is BiPAP of 14/14 the same as CPAP of 14? If I set the inhale/exhale ratio to 14/14, isn't that the same as a CPAP of 14? Or am I missing something here with BiPAP? If my optimal setting was 14/6, why wouldn't 14/7, 14/8, 14/9, etc., be just as good? It's enough pressure to keep my throat from closing, right?

How do I keep the setting low enough to go to sleep with the mask I prefer (can't fall asleep at a 12/4 starting pressure), yet still get to the DME recommended setting at the end?

Any suggestions on what to do in this situation would be appreciated! Thanks!

[Wulfman]

Ok - here's the scenario. Been on CPAP for almost a year, severe OSA, full face mask (mouth breather), titration at 14. Is really helping but want to get lower AHI.

Doctor gives me BiPAP to try. Titrated at 14/6 gets me to 0 AHI - in the sleep center of course. However, the pressure drop from 14 to 6 is very hard to handle with the Liberty hybrid mask. I can't go to sleep with it - feels like really forced breathing. So, we set the ramp to the lowest setting, which if you know biPAP machines, is kinda confusing. We set the lowest setting to 4, but with the 14/6 setting (which is a delta of , I start each night with a 12/4 i/e ratio, which is still too much for me to get used to. Too hard to comfortably fall asleep.

The DME tells me to then try the other mask I have (regular full face mask not a hybrid), which will not feel as up/down with the pressure, but I don't like that mask. So, I cheat, change my BiPAP settings to 14/10, JUST SO I CAN get my starting ramp pressure to be low and go to sleep (starts off with 8/4). However, I don't feel rested in the morning. And of course the new BiPAP machine does not read my AHI's, so I don't really know how well I did.

Hope this all makes sense to someone out there!!

Here's my question. Is BiPAP of 14/14 the same as CPAP of 14? If I set the inhale/exhale ratio to 14/14, isn't that the same as a CPAP of 14? Or am I missing something here with BiPAP? If my optimal setting was 14/6, why wouldn't 14/7, 14/8, 14/9, etc., be just as good? It's enough pressure to keep my throat from closing, right?

How do I keep the setting low enough to go to sleep with the mask I prefer (can't fall asleep at a 12/4 starting pressure), yet still get to the DME recommended setting at the end?

Any suggestions on what to do in this situation would be appreciated! Thanks!

Yes. Virtually all bi-level machines should be able to be set to CPAP mode in that way..

I don't think I can answer your last question......that's something you're going to have to experiment with.
Your EPAP setting SHOULD be set to where it eliminates almost all of your Apnea events.......and the IPAP setting is supposed to be for eliminating your Hypopnea events.

Are you using some "Auto" settings or just straight Bi-PAP settings? (I'm trying to figure out why their settings worked in the sleep lab, but not in your home environment)

Do you have the Encore software? (Pro or Viewer)


Den

[cflame1]

what Bipap did you get Mike?

[Mike_Snodgrass]

Thanks folks.

I have a Respironics BiPAP plus M series, but with no card that records data. I do have Encore software and the card reader, for the other machine (CPAP). Just straight BiPAP on the new machine - no auto settings.

I guess I should keep trying the machine with the BiPAP setting of 14/6. Maybe I'll try the other mask that I don't like as much, just to keep experimenting. I'm just not sure why BiPAP is necessarily better than CPAP.

[Wulfman]

Thanks folks.

I have a Respironics BiPAP plus M series, but with no card that records data. I do have Encore software and the card reader, for the other machine (CPAP). Just straight BiPAP on the new machine - no auto settings.

I guess I should keep trying the machine with the BiPAP setting of 14/6. Maybe I'll try the other mask that I don't like as much, just to keep experimenting. I'm just not sure why BiPAP is necessarily better than CPAP.

The "Plus" won't record any data other than hours used. I take it from your first post that this is just a "loaner" from your doctor.......I wonder how he is supposed to know how it's working for you without any data. (he's probably one of those who doesn't believe in the data from these machines)

Good luck trying to find the right settings.


Den

[unadog]

What about trying a BiPap Auto?

I was titrated on CPAP at 13.0. I had my BiPap Auto set at: EPAP 8.0, IPAP min 11.0, IPAP max 16.0. It averaged 12.4 for IPAP. The spread from 8 to 11 was very subtle. I sometimes had IPAP min at 10.

If you let your breating settle before you put it on, an Auto should start out at lower pressures. Hopefully you would fall asleep before it had a chance to hit higher pressures.

I don't recall if the BiPap Auto had a "Rise" setting. My BiPap ASV does. That controls how quickly IPAP scales up to the working pressure from EPAP. That further "buffers" the transition so that it is less noticible. Easiest, "softest" xPAP machine I have used. I often can't tell if it is on.

A BiPap is supposed to be titrated so that EPAP controls apneas, IPAP controls other events. So if you had a BiPap Auto with data, you could use the data to dial it in.

I loved BiPap over CPAP.

[Mike_Snodgrass]

Thank you - I am going to call the DME today and suggest the Auto BiPAP - great idea. Tried the other mask last night and that "drop" between exhalation and inhalation is just too great to get to sleep. The mask sucks into my face, then forceably blows back off. Very annoying. Sounds like the Auto features will fix that.

[GumbyCT]

The mask sucks into my face, then forceably blows back off. Very annoying. Sounds like the Auto features will fix that.

Without knowing the rest of your machine settings this is just a WAG (Wild A** Guess) but it sounds like you need to increase the low pressure. My guess is auto will NOT fix that.

Maybe you need to get used to a fixed pressure first - then increase it each week until you get where you need to be.

[Mike_Snodgrass]

Without knowing the rest of your machine settings this is just a WAG (Wild A** Guess) but it sounds like you need to increase the low pressure. My guess is auto will NOT fix that.

Maybe you need to get used to a fixed pressure first - then increase it each week until you get where you need to be.

Thanks Gumby, but that was one of my original points. I increased the lower pressure to deal with the e/i pressure gap, but I didn't feel any better. And I went on to say that a BiPAP at 14/14 is really just a CPAP at 14 I assume, so what's the point in using a BiPAP? I'm totally used to fixed CPAP, but I don't get below say 8-10 AHI. BiPAP is the next step to get closer to 0, but I can't get used to the initial pressure differences. So, an AutoBiPAP might start me with some better sleeping pressure then just adjust to something I can get used to (once I'm konked out).

Make sense?

[OCSleeper]

Based on your 14/6 setting, your 'Pressure Support' (PS) would be set at 8. A setting of 12/4 would also imply a PS of 8. This is probably too much!

I'm told by sleep doc that a PS of great than 5 means you're being 'ventilated'. Unless you have some lung disfunction, I'd tweak that setting way down to 3 or 4. My DME set mine initially to IPAP 15 / EPAP 10 on FIXED (i.e. PS=5). I couldn't sleep at all until I changed the setting to MAX IPAP 12 / MIN EPAP 10 on AUTO with PS=3.

[dsm]

Mike

Just trying to figure out if I have this right ...

1) You are titrated for 14 CMs - so a CPAP machine or mode would be set to 14 CMs

2) Dr says try this & gives you a Bipap set with epap=6 & Ipap = 14
(or is this epap=14 & ipap = (14 + 6 ps) = 20 CMs --- My confusion here is trying to figure out precisely what you mean by "12/4 i/e ratio" is that ipap=12 & ps=4 or is that ipap=12 & epap=4 ?

3) Machine is not in auto mode but straight bipap


If you are titrated at 14 for cpap & they gave you a bipap set epap=6 & ipap=14 that would seem to me to be bizarre (a formula for serious sleep events).

If they gave you a bipap where epap=14 & ipap= (14+6) thus 20 CMs that would seem to me to be equally as bizarre.

Can you spell out what those numbers actually relate to else some of us will be guessing & may get it wrong ?

Good luck - lots of folk here who can help

Cheers

DSM

[Mike_Snodgrass]

My confusion here is trying to figure out precisely what you mean by "12/4 i/e ratio" is that ipap=12 & ps=4 or is that ipap=12 & epap=4 ?

Can you spell out what those numbers actually relate to else some of us will be guessing & may get it wrong ?

Sorry if I wasn't clear. BIPAP settings are IPAP = 14, EPAP = 6, starting ramp pressure is 4. The difference between the EPAP and the IPAP is 8, so when you have a starting ramp pressure of 4, the machine will initially set the EPAP to 4 and then maintain that IPAP/EPAP difference of 8, making the IPAP = 12. So, I start off the night lying down with a blast of 12 IPAP and then a drop to 4 EPAP, which if you've ever tried this, is hard to comfortably fall asleep with. After 25 mins it ramps all the way up to 14/6.

That's kinda my point here. I can't fall asleep with the BiPAP machine with the way the settings are and the way the machine works.

Let me know if you need any more info. I'm talking to the DME either today or Monday as well. Thanks!

[Wulfman]

At least........

Turn the Ramp OFF or don't use it.


Den

[Mike_Snodgrass]

At least........
Turn the Ramp OFF or don't use it.
Den

Not an option on this machine I believe. Not using the ramp makes it even worse - more pressure to start with - and 4 is the lowest ramp pressure you can set it to. I even changed the EPAP to be 10, making an IPAP=14/EPAP=10/difference being 4, just so that my initial ramping pressure would be IPAP=8/EPAP=4, which I can breathe with. However, it ramps to IPAP=14/IPAP=10, which is not the setting the DME recommended and I didn't feel good the next morning.

Going to try that AutoBiPAP option someone suggested - another sleep study with that - and see if it is better.

[Wulfman]

At least........
Turn the Ramp OFF or don't use it.
Den

Not an option on this machine I believe. Not using the ramp makes it even worse - more pressure to start with - and 4 is the lowest ramp pressure you can set it to. I even changed the EPAP to be 10, making an IPAP=14/EPAP=10/difference being 4, just so that my initial ramping pressure would be IPAP=8/EPAP=4, which I can breathe with. However, it ramps to IPAP=14/IPAP=10, which is not the setting the DME recommended and I didn't feel good the next morning.

Going to try that AutoBiPAP option someone suggested - another sleep study with that - and see if it is better.

Of course it is. But, then, this is "your call"......and YOUR therapy.


Den