Please HELP

[Komodo]

My normal settings on my Vpap are:
Min EPAP: 10.0 cmH2O
Max IPAP: 18.0 cmH2O
Pressure Support: 4.0 cmH2O
The next day data results for pressure are pretty much like this:
Median: 14.6
95th Percentile: 16.0
Maximum: 17.2

So far, so good, those are the numbers I expect.
HOWEVER.....here's the problem I need help with! Due to the heat wave, I had trouble breathing and changed my settings in the hopes of making it easier to breathe. I changed them to:
Min EPAP 10.0 cmH2O
Max IPAP: 20.0 cmH2O
Pressure Support: 2.0 cmH2O

I felt like I was sucking air through a straw all night long! It was horrible! I knew I was having trouble breathing to start with, but didn't think it was THAT bad.
THEN I CHECKED MY RESULTS THE NEXT DAY!!!!
Pressure;
Median: 12.8
95th Percentile: 13.8
Maximum: 14.8

CAN SOMEONE PLEASE TELL MY WHY MY PRESSURE WENT DOWN WHEN I RAISED THE SETTINGS?

I expected the pressure to go UP by 4cmH2O, not go down! Did I do something wrong, or is there a problem with my Vpap???
PLEASE let me know....................asap!!!!

[ozij]

The pressure support means the difference between IPAP and EPAP. Instead of you usual 4 cm/h20 difference, you dropped it to 2. So whenever the machine thought you needed a EPAP of 10, it gave you IPAP of 12, and so on.

A pressure support of 4 is the recommended minimum pressure support on bi-level therapy. Any one making changes in their own pressure should study the subject carefully before doing so - I'm kind of surprised you decided to ignore this very basic 4 cm difference recommendation.

Ask your doctor - or RT what you should do when you feel you can't breathe -- don't just assume you need a change in pressure.

O.

[Komodo]

The pressure support means the difference between IPAP and EPAP. Instead of you usual 4 cm/h20 difference, you dropped it to 2. So whenever the machine thought you needed a EPAP of 10, it gave you IPAP of 12, and so on.

A pressure support of 4 is the recommended minimum pressure support on bi-level therapy. Any one making changes in their own pressure should study the subject carefully before doing so - I'm kind of surprised you decided to ignore this very basic 4 cm difference recommendation.

Ask your doctor - or RT what you should do when you feel you can't breathe -- don't just assume you need a change in pressure.

O.

Are you sure about that? If you are, it wouldn't be the first (or last) time I was wrong! I was lead to believe that the EPAP had nothing to do with the IPAP, and the Pressure Support would set the minimum pressure for the IPAP. For example, with my standard settings of 18/4, my pressure starts off at 14cm, 4cm less than the max of 18cm. Also, a setting of 5cm, was the MAX for Pressure Support, so dropping down to 2cm shouldn't be a problem.

BTW, my breathing problem wasn't OSA related. It was because of the heat (102 degrees!!!) and I needed a "boost" getting air in my lungs. Upping my pressure to 20cm isn't a problem either as my original prescription was FOR 20cm.

[profoundapena]

Well, my understanding is that you should not be doing your own titration; that's what the sleep lab is for. I was also told that with a difference of more than 4, you would have a hard time breathing. So that may account for the bad sensation you had. I have also noticed (see my post) that the machine heats up the air even more, probably because it is cooling the motor. So I can't go to sleep in a 75 degree room, because it makes the air too hot and heats up the room in a few hours. I crank the AC down to at least 73 and it's better.

So my advice is set your bipap to 20/16, try decreasing the temp of your bedroom, and see how that goes. You should also consult your Dr. The settings on my Auto 25 are not available to me, so I can't change them, and my pressure is 21/17. The technician adjusted some time, like the drop off time, but that was during the inital fitting. In any case, I would leave the adjustments to the pros.

[Muse-Inc]

Komodo, you have my sympathy. I have a similar hard to breathe issue when the temps are really high or I get really over-heated. I've already dropped my humidity to passover and that helps. I sleep as cool as I can. I remember to stay esp well hydrated too. Can't help you with the settings but calling your doc/RT might be in order to talk about what to do. When our temps and humidity are high, I feel like I'm back having my exercise or bronchitis induced asthma...sucks, literally, like I can't get enough air...annoying as hell if not downright scary at times.

[timbalionguy]

Komodo, Here's is what I would try, if you are just looking for a little pressure boost with that machine: Set you minimum EPAP to 12, your maximum IPAP to 20 and leave everything else alone. If fact, you might try just 1 cm boost on your min EPAP, and 2 cm on the Max IPAP to start.

[kteague]

Komodo, since the heat is your issue and it affects you at night, I'm interpreting that to mean you don't have A/C for sleeping. Several years ago I worked in an office without air, and even though I was told they are worthless, I bought a small tabletop air cooler, reputed to drop the temp 10-15 degrees within 3 feet of the unit. It did! It made the heat tolerable and made it easier for me to breathe. Don't know if that would help your situation, just throwing that out there.

[Komodo]

Komodo, Here's is what I would try, if you are just looking for a little pressure boost with that machine: Set you minimum EPAP to 12, your maximum IPAP to 20 and leave everything else alone. If fact, you might try just 1 cm boost on your min EPAP, and 2 cm on the Max IPAP to start.

After reading the reply from ozij, I did exactly what YOU suggested, and got the desired results.

I want to thank ozij for setting me straight on the settings, I had them backwards.

[Komodo]

Komodo, you have my sympathy. I have a similar hard to breathe issue when the temps are really high or I get really over-heated. I've already dropped my humidity to passover and that helps. I sleep as cool as I can. I remember to stay esp well hydrated too. Can't help you with the settings but calling your doc/RT might be in order to talk about what to do. When our temps and humidity are high, I feel like I'm back having my exercise or bronchitis induced asthma...sucks, literally, like I can't get enough air...annoying as hell if not downright scary at times.

That's what happened to me. I had gone to a 4th of July BBQ, it was 102 degrees, and I got heat exhaustion/heat stroke without realizing it at the time. (thought it was an alergic reaction to something I ate) Instead of going to the hospital like I should have!!! I went home and put on my VPAP to force in some much needed air.

[Komodo]

Komodo, since the heat is your issue and it affects you at night, I'm interpreting that to mean you don't have A/C for sleeping. Several years ago I worked in an office without air, and even though I was told they are worthless, I bought a small tabletop air cooler, reputed to drop the temp 10-15 degrees within 3 feet of the unit. It did! It made the heat tolerable and made it easier for me to breathe. Don't know if that would help your situation, just throwing that out there.

Thanks for the hint, but I do have AC, and crank it up high every night. I've got COPD and couldn't live without it in this heat.