Hi,could someone explain the use of pressure support(PS) to me

[Black Sheep]

Howdy, till 6 years ago I was one of my late mum's caretakers. Now for about a month and a half I'm a user myself. I had a sleep lab polysomnography with these results AHI of 97.8 and lowest oxygen desaturation of 52%. My sleep doctor which is an ENT specialist with sleep study training diagnosed me with the following: Severe OSA + PLMD & hypoventilation related to obesity hypoventilation syndrome. His recommendations are: non-supine sleeping position, Bipap Pi 17 Pe 8 plus humidifier, Oronasal mask, Ramp 15 minutes + O2 2 L/min.
I started with 30 days of spontaneous bipap max Pi 17 and min Pe 8 (AHI median of 4.1)and after a month I myself changed it to auto-bipap(AHI median 2.58). Not knowing better, I set pressure support at 9 cmH2O.
Could someone please explain pressure support and its applied usage to me? My best regards to all of you.

[chunkyfrog]

Can it wait until morning?
Some of our wisest people have to sleep sometime.
I'm about to turn in myself.

[Dog Slobber]

One of the most difficult adjustments for new CPAP users, especially those compromised breathing (COPD) is to exhale against the pressure.

BiPAP, actually BiLevel is the proper name, is capable of delivering two distinct pressures. One for Inhalation, one for Expiration the difference between the two pressures is Pressure Support.

My BiLevel is set to:

• Min EPAP 8 CM
• PS 4

This means, the pressure while I exhale is 8, and when inhaling it's 12 (8+4)

[Black Sheep]

One of the most difficult adjustments for new CPAP users, especially those compromised breathing (COPD) is to exhale against the pressure.

BiPAP, actually BiLevel is the proper name, is capable of delivering two distinct pressures. One for Inhalation, one for Expiration the difference between the two pressures is Pressure Support.

My BiLevel is set to:

• Min EPAP 8 CM
• PS 4

This means, the pressure while I exhale is 8, and when inhaling it's 12 (8+4)

Thank you for your reply. Your EPAP is set at 8 and you have 4 cmH2O pressure support, so why you have an IPAP setting of 25? Why your IPAP is not set at 12? What's it's use?
That's what is confusing me?

[Black Sheep]

Can it wait until morning?
Some of our wisest people have to sleep sometime.
I'm about to turn in myself.

Sorry, my bad. Will do better next time.

[Dog Slobber]

Because the machine is also set to auto adjust, move the pressures up and down as my needs change. The maximum IPAP it can achieve is 25. (The machine max)

When I first turn the machine on, my pressures are, EPAP 8, IPAP 12.

Let's say I roll on my back and the machine detects I need a CM more pressure. My EPAP will be 9 and my IPAP 13.

Here's my pressure trace from last night:

Notice how the pressure moves up and down as my needs change, but the difference between inhale and exhale is always 4.

PS_4.png

[Black Sheep]

Because the machine is also set to auto adjust, move the pressures up and down as my needs change. The maximum IPAP it can achieve is 25. (The machine max)

When I first turn the machine on, my pressures are, EPAP 8, IPAP 12.

Let's say I roll on my back and the machine detects I need a CM more pressure. My EPAP will be 9 and my IPAP 13.

Here's my pressure trace from last night:

Notice how the pressure moves up and down as my needs change, but the difference between inhale and exhale is always 4.


PS_4.png

Many many thanks for your patience with me. Please bear with me, if you were in my place and your Doctor would prescribe EPAP:8, IPAP:17 mode:manual bipap(S mode) and you had to set the parameters yourself, what would you set your equipment to? I fully well know that I do this at my own risk and I take full responsibility for my actions( full disclaimer ).

[palerider]

Thank you for your reply. Your EPAP is set at 8 and you have 4 cmH2O pressure support, so why you have an IPAP setting of 25? Why your IPAP is not set at 12? What's it's use?
That's what is confusing me?

His sig should say MaxIPAP 25, which signifies arrange limit,, not a setting.

PS, Pressure Support, supports inhalation, and indeed the whole respiratory cycle, thus the name.

Not knowing better, I set pressure support at 9 cmH2O.

A PS of 9 is very high for someone of average physiology, usually only appropriate for someone with central apnea, {but that requires a different kind of machine, or someone with obesity hypoventilation syndrome who needs the pressure to counteract the weight pressing on their chest and abdomen.

[Dog Slobber]

His sig should say MaxIPAP 25, which signifies arrange limit,, not a setting.

Darn.

Fixing now.

[palerider]

Because the machine is also set to auto adjust, move the pressures up and down as my needs change. The maximum IPAP it can achieve is 25. (The machine max)

When I first turn the machine on, my pressures are, EPAP 8, IPAP 12.

Let's say I roll on my back and the machine detects I need a CM more pressure. My EPAP will be 9 and my IPAP 13.

Here's my pressure trace from last night:

Notice how the pressure moves up and down as my needs change, but the difference between inhale and exhale is always 4.


PS_4.png

Many many thanks for your patience with me. Please bear with me, if you were in my place and your Doctor would prescribe EPAP:8, IPAP:17 mode:manual bipap(S mode) and you had to set the parameters yourself, what would you set your equipment to? I fully well know that I do this at my own risk and I take full responsibility for my actions( full disclaimer ).

I would strenuously question why the doctor prescribed such seemingly absurd settings, was there a legitimate reason, and if so, what, or was it done out of ignorance? I see you mentioned OHV, but that's still a lot of PS.

A comparable auto setting would be MinEPAP 8, MaxIPAP 25, PS 9, But, that ps is highly unusual.

What kind of a machine do you have? Fill out your equipment profile.

[Black Sheep]

My dear pals, I live in a place where having a fully equipped and clean sleep lab, a self-taught misley old E.N.T. doctor and a similar sleep-tech, paying their fee and also being able to buy a machine with a bank loan is a great blessing. No medicare and/or medicaid, everything comes out of my pocket and mine only and I have no DME. My doctor wanted me to buy a simple bipap but I bought a resmed VAUTO bipap based on my findings. I chose the mask and it's size myself( There were no floor units to try and then buy a new one for yourself) you bought it and you get it, good or bad.
I told you all of this, to say i recieved my machine unadjusted and based on doctor's recommendations I adjusted min. EPAP from Pe and max. IPAP from Pi on my sleep report. I had no prior knowledge of pressure support or how to adjust it, so I did it based on searching the net. I'm a man of 57 years and weigh 278 lbs most of it around my belly and chest. Most of my nightly events this past month and a half are OAs.
Based on what I heard from you, I would at first raise max IPAP from 17 to 25 (not changing my PS of 9)and see how do I react to it. Then I would lower PS 1cmH2O once a week from 9 to 4 if all goes well. Wish me luck and a ridiculously low AHI.

[Miss Emerita]

Black Sheep, I think there are people here who could give you some good advice, if you are able to post a daily chart from the Oscar software, see

https://www.sleepfiles.com/OSCAR/

You would need a laptop or desktop computer, an SD card in your machine, and an SD card reader, either built into your computer or purchased as a USB plug-in.

The reason for going to all this trouble is that you get incredible amounts of information displayed helpfully, with graphs that track what was going on second by second all night.

Just to be sure we have the full picture: are you in fact using an O2 bleed to get supplementary oxygen? Are you using an oximeter to see how your O2 levels are doing? And are you being treated for the PLMD?

[raisedfist]

If you have nocturnal hypoventilation due to OHS, it's because OHS negatively effects the chest wall and the mechanics of respiration. A higher than normal PS can be required to overcome this, and provide adequate ventilation while one sleeps. PS helps with the work of breathing and in augmenting (inadequate) spontaneous breathing to normalize ventilation.

[Black Sheep]

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Hi, for those interested these are my last night graphs. Hope you forgive my inexperience if you see any flaws.

[Black Sheep]

Black Sheep, Just to be sure we have the full picture: are you in fact using an O2 bleed to get supplementary oxygen? Are you using an oximeter to see how your O2 levels are doing? And are you being treated for the PLMD?

To answer your question, yes I used a climateline oxy tube to be able to use supplementary oxygen on my doctor's order but after a month he told me from now on I could do without O2. I have a portable oximeter and while using BIPAP my O2 is 93-97 and all other times at 87-92, Resmed oximetry kit costs a fotune but if I can get my hands on a reasonable secondhand I would not hesitate. For PLMD actually no meds, only BIPAP. Other meds I use are: Entric coated aspirin 81mg, Tenormin 100mg for tachycardia, Lipitor 20mg for high cholestrol, Glucophage 2000mg for type-2 diabetes and also Jardiance 10mg for diabetes, that's all.