AirCurve 10 VAuto Bipap settings help needed

[Angielynn]

Thanks Pugsy! If you turn off the PS, how does it work? Where does it start the IPAP seeing as the machine doesn't allow a starting IPAP, only a max IPAP?

[Pugsy]

If you turn PS off then your IPAP and EPAP are the same...essentially a single pressure like with a cpap or apap machine.

[palerider]

Thanks Pugsy! If you turn off the PS, how does it work? Where does it start the IPAP seeing as the machine doesn't allow a starting IPAP, only a max IPAP?

Your IPAP is just the EPAP + PS, so the IPAP is implicit in the other settings.

[Angielynn]

Thank you for explaining. That gives me something to try and some hope! So what's the point of having a PS? Why not just have minimum and maximum IPAP like the auto-cpap does? Is there a physical benefit to keeping the IPAP a certain number away from the EPAP?

[palerider]

Thank you for explaining. That gives me something to try and some hope! So what's the point of having a PS? Why not just have minimum and maximum IPAP like the auto-cpap does? Is there a physical benefit to keeping the IPAP a certain number away from the EPAP?

Well, that's the entire point of a bilevel machine, being able to support your breathing with pressure support (which is why they call it that.

an auto-cpap with exhalation pressure relief (EPR) is just a limited bilevel, the don't talk about 'ipap' and 'epap' because it's primarily a single pressure machine, though the EPR gives a limited bilevel effect.

true bilevel machines offer much more support for breathing than an auto cpap, it's their entire reason for existing.

For people that need more pressure relief, bilevels are a huge benefit, for people with lung diseases, they're a huge benefit. and on and on.

For you, I have no idea why you have one... incompetence on your doctors part, as far as I can see.

[Angielynn]

Actually no. Even though I am having trouble adjusting to the starting IPAP, the EPAP is really helping me. The EPR just wasn't enough relief. I was grinding my teeth severely even with a TMJ bite guard on with the auto cpap, and with the bipap I no longer am grinding. I needed less pressure on the exhale, so I can completely see why the doctor recommended bipap.

I do understand the concept of the bipap. What I don't understand is why the machine can't manipulate the IPAP and EPAP separately. It seems to me I'd be doing fine with the EPAP staying around 4-5, and the IPAP going to whatever is needed in order to keep me breathing. Why do they have to rise together, with a specific number between them with that PS setting?

[Pugsy]

ResMed bilevel machines have a fixed PS....won't/can't vary.

Now the Respironics bilevel machines in auto mode do have a PS that can vary between the minimum and maximum.
BUT....just because it can vary doesn't mean it will.
We have had this discussion before....just because you might like 2 PS at the beginning of the night doesn't mean that if you have it set with PS range of 2 to 4 that it will ever go to 4...heck it might not ever go over 2.

Your wants and needs are rather unique...what you want doesn't exist.

[palerider]

Actually no. Even though I am having trouble adjusting to the starting IPAP, the EPAP is really helping me. The EPR just wasn't enough relief. I was grinding my teeth severely even with a TMJ bite guard on with the auto cpap, and with the bipap I no longer am grinding. I needed less pressure on the exhale, so I can completely see why the doctor recommended bipap.

I do understand the concept of the bipap. What I don't understand is why the machine can't manipulate the IPAP and EPAP separately. It seems to me I'd be doing fine with the EPAP staying around 4-5, and the IPAP going to whatever is needed in order to keep me breathing. Why do they have to rise together, with a specific number between them with that PS setting?

EPAP is what holds your airway open so that you can breathe, not IPAP. If your EPAP is too low, you get apneas.

IPAP helps to alleviate hypopneas, and flow limitations, for people without lung condition problems.

There's no *reason* for PS to change, since PS is set to give a specific affect.

The only machines that would have a fixed EPAP and wildly varying IPAP would be ventilators, like ASV or iVAPS.

You're complaining about 'hyperventilation', the more PS, the more ventilation. that's the entire point of PS, to ventilate, to blow off CO2.

[palerider]

Your wants and needs are rather unique...what you want doesn't exist.

Well, on an ASV or iVAPS...

[Angielynn]

Pugsy, Yes, I know you're right. It doesn't exist. I just was wondering why they do it the way they do it. Anyway thanks for your help. I'm going to try using it tonight with a PS of 3.

[Pugsy]

Your wants and needs are rather unique...what you want doesn't exist.

Well, on an ASV or iVAPS...

Well yeah but I think I already mentioned those little jewels earlier in the thread. I know I mentioned ASV...but there is still the problem that just because the machine can auto adjust PS doesn't mean it will..
What she wants is just a little PS while awake so she can go to sleep and then have PS of 4 kick in after asleep so she won't grind her teeth and there's no guarantee that even on those high dollar machines that they would do what she wants. They don't care about her teeth.

[palerider]

Your wants and needs are rather unique...what you want doesn't exist.

Well, on an ASV or iVAPS...

Well yeah but I think I already mentioned those little jewels earlier in the thread. I know I mentioned ASV...but there is still the problem that just because the machine can auto adjust PS doesn't mean it will..
What she wants is just a little PS while awake so she can go to sleep and then have PS of 4 kick in after asleep so she won't grind her teeth and there's no guarantee that even on those high dollar machines that they would do what she wants. They don't care about her teeth.

I'm not at all convinced that a PS of 4 will have anything at all to do with grinding teeth.

Bruxism is a known side effect of untreated sleep apnea.... and getting the pressures right may alleviate it.

Have we seen any data yet?

[Angielynn]

Pale Rider, let me make sure I understand correctly. IPAP is what's blowing at you when you inhale. I thought that is what opens your throat - if you're not breathing properly I thought that is what blows it open. I thought EPAP is what blows at you when you're exhaling. Is that correct? Or am I misunderstanding something?

You also said: "You're complaining about 'hyperventilation', the more PS, the more ventilation. that's the entire point of PS, to ventilate, to blow off CO2."

So what would happen if I lower the PS? When the IPAP of 8 is blowing at me when I inhale, that's when I feel like I'm getting too much oxygen. Maybe I'm not using the right word when I say it's "hyperventilation". It's that feeling like I can't get enough air like when you're anxious and you're taking in too much air and the fix is to breath into a bag. When I started the night on a lower setting of 5 on the auto-cpap, I felt fine. So I feel like the level of 8 is just blowing too hard at me. I do better lower.

So I thought if I lower the PS to 3 instead of 4, I would be able to start with a IPAP blowing at me when I inhale at a 7 instead of 8, which I'm hoping will help reduce that feeling. Of course the EPAP would still start at 4.

[Pugsy]

Have we seen any data yet?

I don't remember ever seeing any data at all.

[Angielynn]

Concerning the bruxism, yes. In my sleep study they saw that I was not grinding at the 4/8 level. I was wearing sensors on my jaw joint areas. Plus when I do sleep with those settings, I'm waking without the pain in my teeth. I could not get that relief with the autopap though I tried different settings, and used the EPR.