Am I not understanding sleepyhead or a bipap machine settings?

[Sleepygal1]

Hi All,

I'm trying to understand my settings on the Dreamstation AutoBipap on basic Fixed BIPAP mode. Sorry for not setting up all the graphs the right way but I just want you to notice the "Fixed Bi-Level" and EPAP 11, IPAP 18, then notice the pressure graph. I am not getting it. The IPAP line is static at 18 as I expect, but the EPAP is ramping up from 11 -> 13 (when 11 is selected as EPAP!). I checked all the settings and see nothing related to PS, Ramp, Flex is turned off, nothing obvious. Can anyone tell me what is going on???

odd_bipap.png (88.58 KiB) Viewed 950 times

[Pugsy]

That is weird. I wonder if it is a SleepyHead bug with this version.

I suggest you try version 1.1 and see what it shows.
https://www.apneaboard.com/sleepyhead/

[Pugsy]

Also....go look in the machine's clinical setup menu for verification of settings.
Sometimes the Settings part of SH is buggy so always look at the machine itself also.

[Sleepygal1]

Huh, that's interesting, didn't know there was a new version. Same thing though. i actually set the EPAP pressure down to 9 to try to get it around where I want it at 11->11.5. I've been relying on this data for a while so I went from auto Bipap to using the statistics in SH to select 11 and 18. Now I'm not sure what to do! I'm assuming if its a bug, then it should be down around 9ish instead of 11 if its always off by 2? Hard to know.

I did look through all the settings on the clinical menu, that's what is so baffling to me. Does 9 and 18 sound like a safe BiPAP level or is the EPAP and IPAP too far apart for normal?

odd_bipap2.png (142.22 KiB) Viewed 940 times

[palerider]

. I am not getting it. The IPAP line is static at 18 as I expect, but the EPAP is ramping up from 11 -> 13 (when 11 is selected as EPAP!). I checked all the settings and see nothing related to PS, Ramp, Flex is turned off, nothing obvious. Can anyone tell me what is going on???

biflex. it causes the EPAP to wander some.

[Sleepygal1]

biflex. it causes the EPAP to wander some.

I turned off Flex, so there shouldn't be any problems from that. Here's a pic to prove it: And even so, wouldnt that show lower pressure than my set pressure, not higher? This is 2cmH2O higher than I set!

20190217_205729.jpg (420.63 KiB) Viewed 932 times

[Pugsy]

biflex. it causes the EPAP to wander some.

Yes it does cause some roaming but she says Flex is turned off.
And when Flex is used it sort of causes some bouncing around a little...not one straight line and certainly not what is shown on this EPAP graph.

[Pugsy]

I actually don't like to advise using PS over say 6...too much PS can cause problems unless the person has some specific ventilation needs for some reason.

My own personal preference for PS...4 or 5 to start with.

If you don't have issues with your lungs or problems breathing for some reason...I wouldn't go over 6 PS.

[palerider]

biflex. it causes the EPAP to wander some.

Yes it does cause some roaming but she says Flex is turned off.
And when Flex is used it sort of causes some bouncing around a little...not one straight line and certainly not what is shown on EPAP.
It's mostly going to show up on inhale if I remember right.

I'm pretty sure *flex shows up on exhale only.. it used to not show up at all, then that changed.

If I'm wrong, then I've got no idea.

[Pugsy]

I'm pretty sure *flex shows up on exhale only.. it used to not show up at all, then that changed.

I changed what I said because I just don't remember and I am looking for some of my old bilevel reports from the 760 to confirm or not.
Going to take me a while...they are way old..
I seem to remember it showing up on inhale but I can't swear to it. I am old and forgetful and we are talking years here.

But shouldn't matter...here with this OP....Flex is obviously off so can't blame that weird EPAP line on Flex.

[Pugsy]

This might be where I might like to run the data through Encore Pro for verification as to is SH buggy or not.

[Sleepygal1]

I actually don't like to advise using PS over say 6...too much PS can cause problems unless the person has some specific ventilation needs for some reason.

My own personal preference for PS...4 or 5 to start with.

If you don't have issues with your lungs or problems breathing for some reason...I wouldn't go over 6 PS.

Thanks Pugsy for the info. I've been using it in Auto bipap mode for quite a while, and this is what the 90% EPAP/IPAP results were from Sleepyhead. I am quite obese and I probably suffer from Obesity Hypoventilation syndrome, but not clinically diagnosed.

I was mostly just surprised the PS was so large, and then after questioning the pressure levels that SleepyHead is showing me for fixed bipap mode last night, where I felt like it was giving me way too much air, I'm kinda questioning all its results now.

My best results were when i was running at: MinEPAP: 11, MaxIPAP 20, PS 5-8, so I was targetting what looked best in there.

[Sleepygal1]

This might be where I might like to run the data through Encore Pro for verification as to is SH buggy or not.

I am not familiar with that program, is it something I can download?

[Pugsy]

90 % numbers aren't necessarily what you should be using for fixed numbers.

It's it NOT where you were at for 90% of the night...people think this but it isn't.

90/95 % number are where we were AT OR BELOW for 90/95% of the night...people don't often know about the "or below" part of the definition.

I prefer to maybe start with the median average numbers if I am going to go with fixed mode.
What was the auto mode median numbers??

What kind of operating system is on your computer? Encore Pro is Windows only.

[Sleepygal1]

90 % numbers aren't necessarily what you should be using for fixed numbers.

It's it NOT where you were at for 90% of the night...people think this but it isn't.

90/95 % number are where we were AT OR BELOW for 90/95% of the night...people don't often know about the "or below" part of the definition.

I prefer to maybe start with the median average numbers if I am going to go with fixed mode.
What was the auto mode median numbers??

What kind of operating system is on your computer? Encore Pro is Windows only.

I am on Windows 10.

As you can see I've been trying to dial it in for some time I also found it strange that SH shows 95% value for IPAP but not EPAP, so I aimed around the average. I tried 11.5, that was too much air, so I moved down to 11, and that still seemed like too much air so that's where I noticed the strange graph. I also think I had Biflex on so it was even wierder that the pressure showed so high! Anyways, this is why I settled on 11 and 18. I could reduce the IPAP if you think the PS is too high though to maybe 16.5.