Tonite is first night on CPAP (BIPAP)--few questions please

[Jason7]

Hi All,
I've posted before as a guest but my equipment finally arrived today. Thanks to you folks for educating and helping me get what I needed. This forum is truly awesome, as only the really lucky ones have easy access to sleep MD, RT, good DME, etc.
I hope my equipment shows up below my post, but if not here's what I'm using:
--PR System One Bipap Auto Biflex set at 13/8 (not using AUTO yet) with humidifer
--Resmed Mirage Softgel Nasal Mask (also have Mirage Micro tthat I used for my sleep test)
--Will get software and oximeter as the next step.

I was just trying out the unit now, and I have a few questions please...
1. I thought it would make a constant sound -- but most of the sound is during inhalation, I guess because higher pressure is needed then. Is this sound pattern normal?
2. It's pretty hard to breathe out -- of course much easier with Ramp on -- guess I have to get used to that? Ramp is set to 20 mins, will probably have to increase to 45 mins.
3. How will I know when there is a mask leak? I'll hear it, or feel it, right? (Sorry stupid question)

Any hints for my first night would be appreciated. I did a split study but don't remember much about those 4 hours on the mask!

Thanks so much!
Jason

[Blrfl]

1. I thought it would make a constant sound -- but most of the sound is during inhalation, I guess because higher pressure is needed then. Is this sound pattern normal?

Yep. I'm on an APAP with EPR, and it pretty much follows my breathing pattern. If you're on a fixed CPAP, it will run continuously.

2. It's pretty hard to breathe out -- of course much easier with Ramp on -- guess I have to get used to that?

Pretty much. I sat for a few minutes with mine in the leak test mode (10 cmH2O) and found the same thing. If your doctor prescribed auto and didn't recommended fixed for the first few nights, I'd start with auto. It will be a lot easier to deal with the lower pressures at first so you don't have to get used to as many things at once. You'll only get blasted when the machine thinks you need it.

3. How will I know when there is a mask leak? I'll hear it, or feel it, right? (Sorry stupid question)

Yep. One thing you can do is fiddle around with your headgear to make a sloppy fit and induce leaks. Under pressure, you'll notice it.

Any hints for my first night would be appreciated. I did a split study but don't remember much about those 4 hours on the mask!

Expect it to be an unusual night, and don't plan on getting huge amounts of sleep. I did two or three hours the first night and shut down after waking up and not wanting to deal with it and needing to at least get some sleep for work the next day. Even with just a few hours, I noticed a difference the next morning. The next night I went longer and after ten days I'm running it all night.

On the other hand, if you don't remember the four hours during your sleep study, maybe you don't have anything to worry about.

Good luck, Mr. Gorsky.

--Mark

[cflame1]

2. It's pretty hard to breathe out -- of course much easier with Ramp on -- guess I have to get used to that? Ramp is set to 20 mins, will probably have to increase to 45 mins.

I have an older version of your machine...

Do you have BiFlex enabled? If you don't and choose to, 3 is the most and 1 is the least. BiFlex is the exhale relief on this machine.

[Janknitz]

Yep, that's what the "flex" is for--it's the equivalent of "exhalation pressure relief" on ResMed machines. You should definitely try it as long as they have not locked you out of that option. It should not affect the efficacy of your therapy at all.

[Jason7]

Thanks birfli, cflame1, Janknitz for your help.
I am indeed set up for biflex.
Hoping for a good night, we'll see!
Jason

[Jason7]

Hi, and thanks Birfl, cflame1 and Janknitz for your help.
My first nite wasn't bad (13/8 on biflex #3), had 5+ hours on the machine, then woke around 4 pm and when I had trouble falling back asleep I just left mask off to make sure I would get some more sleep for work.
I am disappointed though my AHI was 13, but that's actually a great improvement from the sleep study, so I'll take it for my first night.
I don't have any other stats at the moment except no major leaks.
I'm looking forward to night #2.
Thanks for your support.
Jason

[cflame1]

keep in mind that it'll take some getting used to... and your AHI should start to come down.

How were your leaks?

[Jason7]

keep in mind that it'll take some getting used to... and your AHI should start to come down.

How were your leaks?

I had a small leak maybe 3 or 4 times -- fixed it by readjusting one of the lower velcro straps...

[jweeks]

1. I thought it would make a constant sound -- but most of the sound is during inhalation, I guess because higher pressure is needed then. Is this sound pattern normal?
2. It's pretty hard to breathe out -- of course much easier with Ramp on -- guess I have to get used to that? Ramp is set to 20 mins, will probably have to increase to 45 mins.
3. How will I know when there is a mask leak? I'll hear it, or feel it, right? (Sorry stupid question)

Jason,

Sound - yes, the sound follows your breathing with a BiPAP. While it sounds annoying at first, my plan is to sleep when using the machine, and I don't hear it when I am sleeping. I keep my machine below the level of my bed, so most of the sound ends up being absorbed by my mattress. Also, keeping the machine low keeps water from running into my nose.

Leaks - you can get a leak number on your screen. All masks have a built in leak level. You don't want to go above it by too much. This is where software helps in that you can get a graph, and find out if you had any "large leak" events (where the machine was not able to compensate for the leak).

Breathing out - that is a bummer when you first get started. I found it really hard to just breathe normal, and I would end up with funny breathing patterns. Breathing out is something that you will get used to over time. Your chest cavity is not used to breathing against pressure like this. It actually has to build up some muscle tone and get a bit stronger. You will notice a big difference by day 10. After 6 months, I no longer notice the pressure at all, and I am on 14/20.

I wouldn't use BiFLEX for the long haul. BiFLEX reduces the bottom number, but for BiPAP users, that bottom number is pretty important. For example, if you are on 8 exhale, 13 inhale, a BiFLEX of 3 makes that effectively 5 exhale, 13 inhale. That might significantly affect your treatment, and might have something to do with the high AHI that you saw. I'd suggest trying to wean yourself off of BiFLEX and off of the ramp function as soon as you can, preferably over the first 60 days.

The key thing right now is for you to build up some time on the machine, let your chest and diaphragm build up a bit of tone, and get used to breathing with the machine. I wouldn't worry too much about numbers right now, rather, I'd focus on getting to the point where you can sleep through the night. Getting the software is a great goal, too, so you can start watching your leaks more closely and building up a bit of data to track how you are doing.

-john-

[cflame1]

John... Biflex doesn't work like EPR. A Biflex of 3 does not equate to a 3 cm H2O drop. That's not how Respironics works.

[jweeks]

John... Biflex doesn't work like EPR. A Biflex of 3 does not equate to a 3 cm H2O drop. That's not how Respironics works.

Hi,

It is my understanding that BiFLEX drops the pressure during transitions between exhale to inhale and inhale to exhale. On the inhale to exhale transition, the pressure drops below the normal exhale pressure by up to 3 cm. While the software attempts to minimize issues caused by this lowering of pressure, we do know that not every person responds perfectly to every software algorithm in these machines. As an example, note the number of people who report that they do far better on CPAP than on APAP.

-john-

[cflame1]

I'm just saying it's not a measurable drop... not like EPR being 1 cm for each value