Switched to ASV

[KatieW]

Hello everyone. I have been using CPAP since 2008, very successfully, and was quite active on this forum for a few years, then faded away around 2012.

Recently, I had an episode of food poisoning which led to a visit to Urgent Care; dehydration pushed me into Atrial Fib, and then the IV fluids led to Acute Pulmonary Edema. Close call, but I am fine now.
Part of the treatment was a Bi-PAP Machine, set at 10 inhale, 5 exhale, and a full face mask, which I used several hours during the day, and during sleep. I went from 15 liters of oxygen to 2 liters, at discharge after 6 days in hospital. I have now been home 2 weeks, and am recovering well. Am down to 1.5 liters of oxygen, which I also bleed into my CPAP at night. I still have fluid in my lungs, which is slowly dissipating with diuretics. And am being monitored by a cardiologist (who claims no knowledge of CPAP and will refer to a Pulmonologist).

Currently using ResMed Air Sense for Her, which I love, set on APAP 9-13, EPR 3. I have always been my own respiratory therapist, and my AHI is .5, with maybe .1 Obstructive Apnea, no Centrals, most nights. I currently use the Philips Respironics Pico Nasal Mask.

A friend has given me a barely used DreamStation Auto BiPAP, with Humidifier. Searching on-line, I have located the User Manual and Clinical Manual, and am washing and drying the parts of the machine. And I have ordered a heated hose and new filters. Meanwhile I am researching what would be the best settings. 9-13 works well for me, but even EPR 3 is difficult for me right now, (difficult to exhale and accumulation of gas) so I am thinking the the Bi-Pap would make it easier to exhale. Should I stay at 9-13, with an EPAP of 5?

Any advice would be appreciated.

Thank you.
Katie

Edited to add:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4244615/ Positive airway pressure therapy for heart failure.

[jnk...]

Bilevel in the long term is mostly about comfort and possibly about helping out with work of breathing. But how bilevel/autobilevel relates to your particular lung-fluid issues is a question for a pulmonologist with your particulars in hand.

Sorry to hear about what you went through. Glad things are getting better. Wish you all the best.

[KatieW]

Thank you for your reply. I don't expect BiPap to help with fluid in lungs. It is for comfort while exhaling.

[palerider]

Bilevel in the long term is mostly about comfort and possibly about helping out with work of breathing. But how bilevel/autobilevel relates to your particular lung-fluid issues is a question for a pulmonologist with your particulars in hand.

Sorry to hear about what you went through. Glad things are getting better. Wish you all the best.

Actually, bilevel is about helping people who are in pulmonary distress... (in the ER, anyway).

https://www.youtube.com/watch?v=A-SlO2dU8Og

[palerider]

9-13 works well for me, but even EPR 3 is difficult for me right now, (difficult to exhale and accumulation of gas) so I am thinking the the Bi-Pap would make it easier to exhale. Should I stay at 9-13, with an EPAP of 5?

Your *EPAP* is what keeps your airway open, so if you drop the EPAP, you'll end up with more apneas, and worse treatment.

So what you'll have to do is maintain your EPAP and increase the PS, thus ending up with higher IPAP.

If you're using a pressure of 9-13 on an autoset, then those pressures work out to 9/6 to 13/10 on a bilevel, or minepap 6, ps 3. so you can start with minepap of 6 or 7, and crank up the PS. keep in mind that the respironics won't be as responsive as the autoset.

[jnk...]

Actually

Perhaps you missed the words "longterm," "mostly," and "work of breathing" in my post? I don't think she lives in the ER.

[jnk...]

Thank you for your reply. I don't expect BiPap to help with fluid in lungs. It is for comfort while exhaling.

Then personally I would consider the ResMed APAP with an EPR of 3 to be more comfortable than a Respironics autobilevel at any PS. Your mileage may vary.

[palerider]

Actually

Perhaps you missed the words "longterm," "mostly," and "work of breathing" in my post? I don't think she lives in the ER.

But it might help her in the short term with the work of breathing until she gets the rest of the

fluid in my lungs,

out of her lungs...

It's a maybe.

[LSAT]

Thank you for your reply. I don't expect BiPap to help with fluid in lungs. It is for comfort while exhaling.

Then personally I would consider the ResMed APAP with an EPR of 3 to be more comfortable than a Respironics autobilevel at any PS. Your mileage may vary.

She said she is using an APAP with EPR 3 and it is NOT comfortable. She should try the BIPAP as long as she has one to use. (I understand YMMV).

[KatieW]

9-13 works well for me, but even EPR 3 is difficult for me right now, (difficult to exhale and accumulation of gas) so I am thinking the the Bi-Pap would make it easier to exhale. Should I stay at 9-13, with an EPAP of 5?

Your *EPAP* is what keeps your airway open, so if you drop the EPAP, you'll end up with more apneas, and worse treatment.

So what you'll have to do is maintain your EPAP and increase the PS, thus ending up with higher IPAP.

If you're using a pressure of 9-13 on an autoset, then those pressures work out to 9/6 to 13/10 on a bilevel, or minepap 6, ps 3. so you can start with minepap of 6 or 7, and crank up the PS. keep in mind that the respironics won't be as responsive as the autoset.

Thank you, I haven't learned the terminology yet, and this is the information I am seeking. I will try it for a nap and see how it feels. I appreciate that respironics is different, and maybe it's not the solution, or maybe it's a temporary solution for what I hope is a temporary problem.

[KatieW]

Bilevel in the long term is mostly about comfort and possibly about helping out with work of breathing. But how bilevel/autobilevel relates to your particular lung-fluid issues is a question for a pulmonologist with your particulars in hand.

Sorry to hear about what you went through. Glad things are getting better. Wish you all the best.

Actually, bilevel is about helping people who are in pulmonary distress... (in the ER, anyway).

https://www.youtube.com/watch?v=A-SlO2dU8Og

Thanks for the video. Very informative, and that was my experience with BiPap in the hospital.

[raisedfist]

Considering there is fluid in your lungs, and 10/5 seemed to be helping you, why not just set the BiPAP to 10/5 in the fixed spontaneous mode for now? The EPAP keeps your airway open, and the IPAP helps with the work of breathing and augments your spontaneous ventilation. By supporting your breathing it gives your body more energy to more easily carry out its necessary functions like maintaining a proper fluid balance.

[KatieW]

Considering there is fluid in your lungs, and 10/5 seemed to be helping you, why not just set the BiPAP to 10/5 in the fixed spontaneous mode for now? The EPAP keeps your airway open, and the IPAP helps with the work of breathing and augments your spontaneous ventilation. By supporting your breathing it gives your body more energy to more easily carry out its necessary functions like maintaining a proper fluid balance.

Yes, I had thought of this. But I was concerned that fixed 10 would not treat my apneas, since my average pressure for the week on apap was 12.7. I have no idea if I had apneas on a 10/5 in the hospital, and probably that was not their primary concern.

Thank you for your suggestion. And it will be the next thing I try.

[raisedfist]

Considering there is fluid in your lungs, and 10/5 seemed to be helping you, why not just set the BiPAP to 10/5 in the fixed spontaneous mode for now? The EPAP keeps your airway open, and the IPAP helps with the work of breathing and augments your spontaneous ventilation. By supporting your breathing it gives your body more energy to more easily carry out its necessary functions like maintaining a proper fluid balance.

Yes, I had thought of this. But I was concerned that fixed 10 would not treat my apneas, since my average pressure for the week on apap was 12.7. I have no idea if I had apneas on a 10/5 in the hospital, and probably that was not their primary concern.

Thank you for your suggestion. And it will be the next thing I try.

You can download OSCAR sleep software and check your data after a night of sleep if you have an SD card reader. If you post your OSCAR charts here there are members here that can recommend what changes to make to the settings if any. Once there is a general idea of how things are, someone here can tell you how to set up the parameters in the auto mode.

[Pugsy]

Yes, I had thought of this. But I was concerned that fixed 10 would not treat my apneas, since my average pressure for the week on apap was 12.7. I have no idea if I had apneas on a 10/5 in the hospital, and probably that was not their primary concern.

Using bilevel with a substantial IPAP with the aid of PS might be enough to do a better than you thought job at reducing the obstructive stuff.
When using apap you are using a single pressure and it takes a while to go anywhere.
With bilevel and IPAP happening with every breath...it might help more than we first think it would even if it is less than what we normally see on apap. Probably not ideal but given the situation here which is rather unique...I think it would be worth trying at least one night just so you see what it can or can't do.

Or just do auto mode with a small range and make the IPAP max 13.
Minimum EPAP 5 and PS of 5 to give you the 5/10 but it could go up to 8/13 if needed.

The DreamStation Auto BiPap is compatible with SleepyHead 1.0 (don't remember if you ever got that version or not) and of course OSCAR which is based on SleepyHead 1.1.
You can easily see how fixed bilevel happens to work or not. Worth trying IMHO.