Newbie with questions about Respironics BiPAP Auto M

[DRONE]

I'm a newbie to the forum. I searched for a straight answer to this question, spent an hour reading threads, but still not clear, so hopefully one of you can help. I also e-mailed Respironics but who knows when they'll reply?

There's a long back-story here, but let me get to just the basics. I have a 24/7 flow restriction - it's called my nose. If you taped my mouth shut, I could breathe through my nose for a while with great effort but would eventually run out of steam and lose consciousness. However, hook me up to some nasal pillows and push about 10cm of pressure through those puppies and I can breathe just fine through my nose. So, for the past 12 months, I've been using an older bi-level machine set at 10/7 with nasal pillows and I'm sleeping fine. But I have no data to support my subjective feelings. Is my sleep apnea being treated correctly or not?

(Some may ask "Why not go with a full face mask?" Answer - noncompliant patient. I couldn't get used to it.)

So I asked my doctor for a new sleep study to see if the 10/7 is actually optimal. She said I don't need a sleep study -- what I need is an auto-titrating machine. Use it for a month, download the data, and she'll have all the info she needs. "Great" I say.

So I go to the DME and they give me a Respironics BiPAP Auto M with bi-flex. I take it home and turn it on, and it's only pumping out 7cm of IPAP pressure (5cm for EPAP). I can't survive on 7cm while conscious because of my restricted nasal airway. So I take it back to the DME and tell them I need the starting pressures to be a minimum of 10/7. They say OK, but then they say (AND HERE COMES THE PROBLEM) if we set it to 10/7 it will basically become a straight bi-level machine and it will not be able to auto-titrate. It will, however, be able to collect data. They also say, by the way, that they will have to set it at either 9/7 or 10/8, take my pick, because the machine does not allow IPAP and EPAP settings to be more than 2cm apart.

So they want me to try it at 10/8 for a month, then bring in the card so they can read the data. Then if it needs to be adjusted, they'll adjust it and send me back home for another month of data collection. This experiment will continue until everybody is happy.

This just doesn't sound right to me. Seems to me that my doctor wanted me to have a machine that will treat my apnea minimally at my current levels AND will auto-titrate the more stubborn events in the night AND will still collect all the data.

My question, then, is this -- If you set the Respironics BiPAP Auto M at 10/8 start-up pressures, does that automatically disable the auto-titration function as stated by my DME? If my DME is wrong, what set-up instructions do I need to tell them? Secondly, is it true that a fairly sophisticated machine like this one has a built-in 2cm restriction on EPAP/IPAP separation as stated by my DME? If my DME is wrong, what instructions do I need to give them?

Thanks in advance for any help.

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, bipap, newbie, DME, Nasal Pillows, auto, Bi-Level Machine

[Wulfman]

I'm not anything close to being an "expert" on Bi-PAPs (have never used one), but if that's in fact what your DME told you, they're clueless......I know better than THAT.

Den

[Guest]

DRONE--that's not true what they said. It's true about the 2cm diff but you can set ipap at say 11 and epap at 8.

[Wulfman]

DRONE--that's not true what they said. It's true about the 2cm diff but you can set ipap at say 11 and epap at 8.

Are you talking "minimum" or "maximum"?

This is what he said that they said:

"....the machine does not allow IPAP and EPAP settings to be more than 2cm apart. "

If you're talking about "minimum" pressure gap, then I would go along with that......but you can set up a Bi-PAP as a plain, single-pressure CPAP as well as a considerable pressure gap between IPAP and EPAP.


Den

[Catnapper]

Hi Drone

I happen to have the M series bipap auto with biflex. It does indeed collect lots of data besides compliance. It does indeed run in auto mode and can be set for different IPAP and EPAP pressures. The least far apart those pressures can be is 2 cmH2O. They can be as far apart as EPAP 4 and IPAP 20 if you so choose. That is actually the way mine arrived in my hands. I reset it to a more appropriate set of pressures and have adjusted it since both to straight bipap and now back to auto bipap.

If the DME does not know how to do set these pressures, I would not trust them to make judgments about how well my sleep problems are being treated.

You could make these adjustments yourself with the help of folks here who can tell you how to do so using just the display and a couple of arrow buttons. If you were to be lucky enough to acquire the software and reader, you could probably do a better job of determining how well you are doing than that DME.

I am guessing you have the machine for a month of data collection. Why not see if you can make it your own machine somehow? The bipap with biflex makes therapy much more comfortable than any other machine I have tried, and that is 3 previous machines, all from the big R companies. Your experience may be different than mine. I hope you understand that I can't give you advice since I am not a medical professional. I was trying to answer your questions based on my experience.

Hope that helps.

[BelmontAl]

Drone,

I have a very similar machine - a BiPaP Auto with BiFlex (mine is not an "M series").

With this machine in "Auto BiPap" mode, you can separate your IPAP and EPAP by 3 or more if I remember correctly. I too breath better with some pressure, and so set mine to 16 IPAP, 8 EPAP. This means that the machine will limit your IPAP to a maximum of 16 and your EPAP to a minimum of 8. On average, for me the machine auto-titrates and delivers 13 IPAP and 9 EPAP.

This machine (at least in Auto BiPap mode) does not allow IPAP and EPAP to be CLOSER than 2cm apart (not more than).

Thus, if you set your machine like I do at 16 IPAP and 8 EPAP, the minimun IPAP will be 10 (2 more than the EPAP of 8 ).

Another feature of this machine is that it has BiFlex, which provides relief when you start exhaling. With this feature activated, your initial exhale presure starts out at less than what you set your minimum EPAP pressure for (for example (with EPAP set at 8, the INITIAL exhalation pressure will be less than 8; how much less depends on the BiFlex setting you chose).

I'm not a doctor, but it seems to me that you might want to try something like:
"Therapy Mode" setting to AbFLE (for Auto Bi-level with BiFlex)
Min EPAP setting: 8
Max IPAP setting: 16 (or more)
Flex setting: 2
Ramp: off
These setting will result in a minimum IPAP of 10 (which you already suspect you like), will auto-titrate upward from there as required, and will provide you with initial EPAP of around 7 (factoring in the exhalation relief feature).

You should be aware that the available menu settings are dependent on the "Therapy Mode". If your DME does not have the "Therapy Mode" set correctly, some of these settings may not be available on the menu.

A final thought. I commend you for your patience in working with your DME on a monthly basis to adjust your settings - that would drive me crazy. I learned how to set the machine myself (found instructions through this forum) and got a smartcard reader and Encore Pro software so that I could control my own treatment and adjust as I determined appropriate.

Good luck,
Al

[GumbyCT]

The DME is supposed to set it up according to what the doc ordered - hoping that is what is causing the confusion.

Your doc could have ordered an overnite O2 test to see if your therapy is effective. So I doubt the doc would be upset about YOU dialing in your own settings.

I did it - printed out the Encore report and BINGO she wrote a script for what was working for me.

I'm not a doctor, but if it were me - well I did mine like this:

Max IPAP setting: 25 (Max)
Min EPA setting: 8
Max. Press. Sup: 8 (I think this is where the separation is for the press. - so it IS adj.)
Flex setting: 3
Ramp: your choice - I set mine to ON
AutoRamp: 7

the others are your choice.

This should find your 90% settings in a day or two.

Keeping in mind - I am new to bipap - this was my 1st time setting one up. But the bipap sure did me right.

Make sure you write down ALL the setting before you make any changes.
http://www.cpap-supply.com/Articles.asp?ID=130

Be sure to press power on/off to save any changes.

Also search for posts by Rested Gal on how to set these bipaps up. But by all means post back if you still have questions or problems.

Good Luck,
GumbyCT

[dsm]

I'll have a go at this (I have a Bipap Auto Tank model) but because of similar problems that you have - struggle with air through my nose on many nights, I haven't used it much.

But the way they are set up (when in Bipap Auto mode) , the epap gets set then ipap will start at epap + 2 - there is a pressure support value that sets how high the ipap can go above epap (min 2 max 8 ). Ipap will normally only rise when events occur and it can and will rise independently of the epap. The machine tracks epap separately and will raise it if breathing out creates 'events'.

Ipap will always be at least 2 CMS above epap if epap gets raised.

Ipap can go beyond the 2 CMS if Ipap events dictate. The max gap between epap and ipap is hard set to 8 CMS.

The clinic is being honest when they say if you want a greater that 2 CMS ipap epap gap to start, they must switch it to Bipap mode (not Bipap Auto mode). They would like Bipap Auto mode as the Auto data is very helpful to them. I haven't seen them showing any incompetence from what you posted (others may think so but thus far not me).

Most people who have these machines really like them. They are very good for gathering data if you can accept the starting epap/ipap settings in Bipap Auto mode.

Cheers

DSM

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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, auto

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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, auto

[DRONE]

I have a very similar machine - a BiPaP Auto with BiFlex (mine is not an "M series").

From my earlier searches, I believe both machines are mechanically identical. Just the size and shape of the cases are a bit different.

With this machine in "Auto BiPap" mode, you can separate your IPAP and EPAP by 3 or more if I remember correctly. I too breath better with some pressure, and so set mine to 16 IPAP, 8 EPAP. This means that the machine will limit your IPAP to a maximum of 16 and your EPAP to a minimum of 8. On average, for me the machine auto-titrates and delivers 13 IPAP and 9 EPAP.

Now you're talking! That's what I thought! The DME obviously does not understand how the machine works. Which, for me anyway, is par for the course for almost all the respiratory therapists I've dealt with.

This machine (at least in Auto BiPap mode) does not allow IPAP and EPAP to be CLOSER than 2cm apart (not more than). Thus, if you set your machine like I do at 16 IPAP and 8 EPAP, the minimum IPAP will be 10 (2 more than the EPAP of 8 ).

What you're saying makes perfect sense the way you describe it. The respiratory therapist at my DME obviously doesn't understand how the 2cm spread works. He thinks thinks that the initial settings must be 2 cm apart. This is going to be interesting when I sit down with him to teach him how to set up the machine. I promise - I'll try to be kind.

Another feature of this machine is that it has BiFlex, which provides relief when you start exhaling. With this feature activated, your initial exhale pressure starts out at less than what you set your minimum EPAP pressure for (for example (with EPAP set at 8, the INITIAL exhalation pressure will be less than 8; how much less depends on the BiFlex setting you chose).

With my old machine I had no flex at all. It's just bang, bang, bang, in-out, in-out. And that's not been a problem for me. But if the BiFlex provides some relief, even if I don't need it, well that's OK.

I'm not a doctor, but it seems to me that you might want to try something like:
"Therapy Mode" setting to AbFLE (for Auto Bi-level with BiFlex)
Min EPAP setting: 8
Max IPAP setting: 16 (or more)
Flex setting: 2
Ramp: off
These settings will result in a minimum IPAP of 10 (which you already suspect you like), will auto-titrate upward from there as required, and will provide you with initial EPAP of around 7 (factoring in the exhalation relief feature).

Now here you lost me a bit. The minimum IPAP will be 10 because that's 2cm greater than the minimum EPAP setting of 8, right? So far so good. And I hate "Ramp", so I agree we should leave that off. But what's the Flex setting? By setting that at 2, is that 2cm of pressure, and does that mean that EPAP will momentarily be at 6cm when I begin to exhale, then quickly build to 8cm (or a higher level if the auto-titrate feature dictates) in order to keep my airway open during the exhale part of the breath? As I write this, I realize I've answered my own question, haven't I? OK, so that's what I needed to know!

You should be aware that the available menu settings are dependent on the "Therapy Mode". If your DME does not have the "Therapy Mode" set correctly, some of these settings may not be available on the menu.

Well, I'll just tell him to change it to AbFLE. Done.

A final thought. I commend you for your patience in working with your DME on a monthly basis to adjust your settings - that would drive me crazy. I learned how to set the machine myself (found instructions through this forum) and got a smartcard reader and Encore Pro software so that I could control my own treatment and adjust as I determined appropriate.

Al, don't be commending me on my patience. My patience? I have no patience! I don't need no stinkin' patience! (apologies to John Huston) When the DME suggested this ridiculous plan, I argued and argued with him. Finally, I left the machine on his desk and I walked out (stormed out) of his office. I shouted back over my shoulder, "I'll be in touch!" That was like 4 days ago. I've been using my old machine since then. So, no, I did not buy into his plan to use my fancy-dancy auto-titrating machine like it was an old-fashioned bi-level machine.

About finding the instructions through the forum - I searched for those and could not find them. Do you have a link anywhere? Also, where'd you get the Encore Pro? I've only been able to find Encore Viewer. I've also found the Smartcards, and the card reader/writer. But not the actual Encore Pro software.

Good luck, Al

Al, you're a lifesaver, man. Don't you just love forums? Reach out and touch lives someplace out there on the globe. The internet is cool. --Drone

[dsm]

I have a very similar machine - a BiPaP Auto with BiFlex (mine is not an "M series").

From my earlier searches, I believe both machines are mechanically identical. Just the size and shape of the cases are a bit different.

With this machine in "Auto BiPap" mode, you can separate your IPAP and EPAP by 3 or more if I remember correctly. I too breath better with some pressure, and so set mine to 16 IPAP, 8 EPAP. This means that the machine will limit your IPAP to a maximum of 16 and your EPAP to a minimum of 8. On average, for me the machine auto-titrates and delivers 13 IPAP and 9 EPAP.

Now you're talking! That's what I thought! The DME obviously does not understand how the machine works. Which, for me anyway, is par for the course for almost all the respiratory therapists I've dealt with.

This machine (at least in Auto BiPap mode) does not allow IPAP and EPAP to be CLOSER than 2cm apart (not more than). Thus, if you set your machine like I do at 16 IPAP and 8 EPAP, the minimum IPAP will be 10 (2 more than the EPAP of 8 ).

What you're saying makes perfect sense the way you describe it. The respiratory therapist at my DME obviously doesn't understand how the 2cm spread works. He thinks thinks that the initial settings must be 2 cm apart. This is going to be interesting when I sit down with him to teach him how to set up the machine. I promise - I'll try to be kind.

Another feature of this machine is that it has BiFlex, which provides relief when you start exhaling. With this feature activated, your initial exhale pressure starts out at less than what you set your minimum EPAP pressure for (for example (with EPAP set at 8, the INITIAL exhalation pressure will be less than 8; how much less depends on the BiFlex setting you chose).

With my old machine I had no flex at all. It's just bang, bang, bang, in-out, in-out. And that's not been a problem for me. But if the BiFlex provides some relief, even if I don't need it, well that's OK.

I'm not a doctor, but it seems to me that you might want to try something like:
"Therapy Mode" setting to AbFLE (for Auto Bi-level with BiFlex)
Min EPAP setting: 8
Max IPAP setting: 16 (or more)
Flex setting: 2
Ramp: off
These settings will result in a minimum IPAP of 10 (which you already suspect you like), will auto-titrate upward from there as required, and will provide you with initial EPAP of around 7 (factoring in the exhalation relief feature).

Now here you lost me a bit. The minimum IPAP will be 10 because that's 2cm greater than the minimum EPAP setting of 8, right? So far so good. And I hate "Ramp", so I agree we should leave that off. But what's the Flex setting? By setting that at 2, is that 2cm of pressure, and does that mean that EPAP will momentarily be at 6cm when I begin to exhale, then quickly build to 8cm (or a higher level if the auto-titrate feature dictates) in order to keep my airway open during the exhale part of the breath? As I write this, I realize I've answered my own question, haven't I? OK, so that's what I needed to know!

You should be aware that the available menu settings are dependent on the "Therapy Mode". If your DME does not have the "Therapy Mode" set correctly, some of these settings may not be available on the menu.

Well, I'll just tell him to change it to AbFLE. Done.

A final thought. I commend you for your patience in working with your DME on a monthly basis to adjust your settings - that would drive me crazy. I learned how to set the machine myself (found instructions through this forum) and got a smartcard reader and Encore Pro software so that I could control my own treatment and adjust as I determined appropriate.

Al, don't be commending me on my patience. My patience? I have no patience! I don't need no stinkin' patience! (apologies to John Huston) When the DME suggested this ridiculous plan, I argued and argued with him. Finally, I left the machine on his desk and I walked out (stormed out) of his office. I shouted back over my shoulder, "I'll be in touch!" That was like 4 days ago. I've been using my old machine since then. So, no, I did not buy into his plan to use my fancy-dancy auto-titrating machine like it was an old-fashioned bi-level machine.

About finding the instructions through the forum - I searched for those and could not find them. Do you have a link anywhere? Also, where'd you get the Encore Pro? I've only been able to find Encore Viewer. I've also found the Smartcards, and the card reader/writer. But not the actual Encore Pro software.

Good luck, Al

Al, you're a lifesaver, man. Don't you just love forums? Reach out and touch lives someplace out there on the globe. The internet is cool. --Drone

[DRONE]

the way they are set up (when in Bipap Auto mode) , the epap gets set then ipap will start at epap + 2 - there is a pressure support value that sets how high the ipap can go above epap (min 2 max . Ipap will normally only rise when events occur and it can and will rise independently of the epap. The machine tracks epap separately and will raise it if breathing out creates 'events'. Ipap will always be at least 2 CMS above epap if epap gets raised. Ipap can go beyond the 2 CMS if Ipap events dictate. The max gap between epap and ipap is hard set to 8 CMS. The clinic is being honest when they say if you want a greater that 2 CMS ipap epap gap to start, they must switch it to Bipap mode (not Bipap Auto mode).

This is different than what BelmontAl and Gumby from CT are saying. But even so, you're saying that I COULD start with 10cm IPAP and 8cm EPAP, right? So at least I could breathe and fall asleep without suffocating. Or 11/9 or 12/10. And if I started out with these settings, then I can keep the machine in Auto mode, right? So that when I'm asleep, it will then auto-titrate both the EPAP and the IPAP to handle whatever events might occur. And when you say Auto mode, that's the same as when BelmontAl says Therapy Mode of AbFLE?

One thing I don't understand is about the max gap of 8cm. Are you saying that if I start out in Auto mode, with initial settings of say 10/8, the machine will be capable of going only as high as 18/16 and no higher? Frankly, I can't imagine I'll need that much pressure to handle my events, but is that what you're saying?

I guess I'll find out what settings I really need when I start getting the data back. But for now, I just need to get the machine set up right so I can use it.

[dsm]

Hold on & I'll give you a detailed reply within 15 mins

Cheers DSM

[dsm]

the way they are set up (when in Bipap Auto mode) , the epap gets set then ipap will start at epap + 2 - there is a pressure support value that sets how high the ipap can go above epap (min 2 max . Ipap will normally only rise when events occur and it can and will rise independently of the epap. The machine tracks epap separately and will raise it if breathing out creates 'events'. Ipap will always be at least 2 CMS above epap if epap gets raised. Ipap can go beyond the 2 CMS if Ipap events dictate. The max gap between epap and ipap is hard set to 8 CMS. The clinic is being honest when they say if you want a greater that 2 CMS ipap epap gap to start, they must switch it to Bipap mode (not Bipap Auto mode).

This is different than what BelmontAl and Gumby from CT are saying. But even so, you're saying that I COULD start with 10cm IPAP and 8cm EPAP, right? So at least I could breathe and fall asleep without suffocating. Or 11/9 or 12/10. And if I started out with these settings, then I can keep the machine in Auto mode, right? So that when I'm asleep, it will then auto-titrate both the EPAP and the IPAP to handle whatever events might occur. And when you say Auto mode, that's the same as when BelmontAl says Therapy Mode of AbFLE?

One thing I don't understand is about the max gap of 8cm. Are you saying that if I start out in Auto mode, with initial settings of say 10/8, the machine will be capable of going only as high as 18/16 and no higher? Frankly, I can't imagine I'll need that much pressure to handle my events, but is that what you're saying?

I guess I'll find out what settings I really need when I start getting the data back. But for now, I just need to get the machine set up right so I can use it.

[DRONE]

Drone,

Whoa - be careful, some of the advice posted is partially correct but enough to get you embarrassed if you try to debate with the DME. I have the provider manual & can give accurate detail of the settings - so don't be afraid to ask before a sit down with the DME. We here at cpaptalk do our best to advise but repeatedly we can get details wrong & confused. We always mean well but we aren't RTs. Make sure you have a lot of input before assuming any one of us is the authority. You will get enough good input quickly to be confident.

Rested Gal uses a Bipap Auto & she will be very helpful in explaining the way it works. She has used hers a lot more than I used mine.

Good luck DSM

Don't worry, DSM. I'm a smart guy. Many gray cells still functioning despite the apnea. And I know this is just a forum. If I had the provider manual, I could read it and answer most of these questions myself. Where can I get one?

Regarding RT's, to tell you the truth, I really don't have a high opinion of the RT's I've met. How can I say this in a charitable way? Let's see -- how about this -- The RT's I've met seem to be under-trained. How's that? Not too harsh? Maybe in your area they are experienced and well-trained, but I haven't met any around here. I've been dealing with my sleep apnea for 5 years (I told you there was a long back-story) and I just can't leave these decisions to other people anymore. They've been mis-handling my therapy for five years now. I've decided that I have to take control if I want to live to see 60. I was pre-Med at Yale until I flunked Calculus, so I figure I have enough smarts to get on top of this situation and make certain I get the therapy I need.

I am hoping that Rested Gal will chime in here, but I only started this thread this afternoon. Hopefully she'll see it sometime in the next few days and give us her thoughts.

It's after midnight here, so I'm going to log off for now. Thanks so much for caring. Really. I'm not saying that to be cute. It's great that you take the time and interest to get involved in these discussions. Thanks. But I'm done for tonight!

[dsm]

Some notes

BFLE = Bipap mode with BiFlex (not auto)

AFLE = Auto with BiFlex

AUTO = Auto without BiFlex

FLEX = 1 2 or 3 for BiFlex (an added breathing relief feature) 1 = lowest 3 = highest.

DSM