BiPap Pressure Problem - please help

[carissanb]

Hello,

My wife recently got a bipap machine. She failed compliance with her CPAP machine because she could not tolerate a high "EPAP" pressure. She had a setting of 4-8 on cpap. I adjusted the flex to the max of 3 but it was still hard for her to tolerate. Her Dr. has prescribed a bipap machine. Note that my wife does not have an obstructive apena but rather an neurological condition where her brain does not tell her body to breathe. Breathing out even at a low pressure setting of 4 is difficult and suffocating for her.

Her Dr. said that the minimum EPAP pressure setting was 4. He was not aware of a way to lower it below 4. However, before giving up, I though I would seek help in this forum.

We currently have a Phillips Respironics dream station BiPAP machine.

1. Does anyone know if the Min / Max pressure differentials can be set to create a lower EPAP setting than 4?
2. Is there another Make / model of machine that has the ability to be set lower than 4?
3. Does anyone have any other suggestions at all as to what can be done to address my wife's issue.

Her doctor is a really nice guy and he actually taught us how to make adjustments ourselves. However, he does not know the dreamstation that well and didn't know if we could get a lower pressure than 1. Ideally EPAP would be 1-1 and IPAP 8-10.

Any help at all would be MUCH appreciated...we are desperate to get her sleep.

Thanks,

NB

[palerider]

Breathing out even at a low pressure setting of 4 is difficult and suffocating for her.

it's quite common for people to feel suffocated at a pressure of 4, but that's when they're trying to breath in.

[Pugsy]

I think the only machine that offers a setting lower than 4 is the DeVilbiss and it offers a 3...I think.
I don't know about their bilevel machines though...
You might do some research on the DeVilbiss bilevel machines...they used to make one (bilevel)...not sure if they still do...no one I know has one (bilevel)...when it comes to bilevel machines Respironics and ResMed pretty much dominate the market.
I doubt that 3 would be any easier than 4...there's not really that much difference.

Exactly what settings is she trying now with the DreamStation BiPAP?
EPAP
PS (the difference between epap and ipap)
IPAP

Do these settings have minimums and maximums available or are they fixed with no ability to auto adjust?

[carissanb]

Hello Pugsy and thanks for your response. She is currently using the following settings
EPAP 4
IPAP 8
Min pressure support 4
Max pressure support 4

She is using the Auto BiPap mode which ramps up to 8 max IPAP with EPAP generally fixed at 4. I was wondering if adjusting the min or max pressure support would allow for the EPAP to dip lower than 4. Even at 5 her exhaling feels labored. She was not albe to tolerate a cpap machine for this reason because the max flex setting was 3.

Let me know your thoughts.

Thanks,

NB

[Pugsy]

If IPAP max is 8 the machine is working like a fixed bilevel in auto mode.
It's always going to do EPAP at 4 and IPAP at 8 with the PS at 4...unless the Max IPAP is higher than 8.
Since she is using this machine more as a ventilator and not for treating OSA I don't think that having the machine go higher than 8 in auto mode is that critical because it isn't fighting OSA.

We can't go below 4 on the EPAP but you might be able to make it seem easier by increasing the PS.
It's weird sounding but as the difference between EPAP and IPAP (that's what PS is) increases so does the perceived relief when it drops during exhale.

I hesitate to offer specific setting ideas because her situation is unique but you might try increasing PS to 5 or even 6 and just have her try it to see if it is a bit easier for her.
If increasing the PS helps...then run it by her doctor to see if he feels like it is an acceptable setting to try in her situation.

Also...if she is using BiFlex at all...play with the settings in BiFlex and see if one of the settings feels better for her. I found with Flex it wasn't so much about the amount of exhale relief as it was about the timing of the relief. So while the setting of 3 might technically offer the greatest amount of relief the timing might not suit her own particular breathing pattern and she might do better with a different setting.

[Pugsy]

To be clear...we are talking about actual difficulty in exhaling and not feeling like there is not enough air movement????

[ChicagoGranny]

Note that my wife does not have an obstructive apena but rather an neurological condition where her brain does not tell her body to breathe.

So she has Central Sleep Apnea?

Does anyone have any other suggestions at all as to what can be done to address my wife's issue.

The pressures you are mentioning are very low. Unless a person has lung dysfunction, the feeling of not being able to exhale against the pressure is mental, not physical. Even at higher pressures, e.g. 20 cm, the average female can breathe out.

Usually when this problem of exhaling arises, it is because the person is concentrating on the machine pressure and the corresponding breathing effort. We have had people who at first thought it was impossible to breath out against the pressure. Then later, when they were able to relax and fall asleep, the autonomous nervous system took control of breathing, and the body breathed easily and comfortably all night long.

The mind should be distracted when trying to fall asleep. Don't think about CPAP or your own breathing. Think of something pleasant and relaxing.

I used to think of sitting under an umbrella on a quiet beach in a warm breeze. After some experience, I now never notice the pressure, not even when I awaken mornings and lay quietly in the bed for a few minutes.