Got my Auto Bi-Pap - Need some help with settings?

[brackstone]

I'm very happy I have my own Auto Bi-Pap I don't have to worry about any of the insurance company problems anymore.

However, that being said, I have a bunch of questions.

The first most important question is my pressure is supposed to be 5/10.

However I notice on the display when I breathe out it goes to down 3, which is normal cause my rented machine used to do that. However when I exhale it only goes up to 7.

Now my Biflex is set to 3 so is that why? I'm assuming 10 - 3 = 7 somehow this all corrolates?

Also I'm noticing the Auto indicator is showing on my LED screen where as I don't belive it was on with my old machine.

I checked the settings in Provider Mode and my IPAP was set to 10 and my EPAP was set to 5 so everything should be ok?

I'll ask my other questions later but for now I wanted to get this one out of the way.

Thanks!

[dsm]

Because it is an Auto and when in AUTO mode it can essentially be set to 3 main values (ignoring BiFlex which doesn't relate to cms values - BiFlex provides a momentary dip in pressure on the ipap cycle - perhaps leave it off until you grasp the relevance of the other settings)

1. Min epap

2. Max ipap

3. Max PS (pressure support or max gap between ipap & epap)

You can't set min PS (that defaults to 2 CMS at power on, then varies depending on what ipap & epap do.

In BIPAP mode you can set ipap & epap as you wich.

Good luck

DSM

[brackstone]

Because it is an Auto and when in AUTO mode it can essentially be set to 3 main values (ignoring BiFlex which doesn't relate to cms values - BiFlex provides a momentary dip in pressure on the ipap cycle - perhaps leave it off until you grasp the relevance of the other settings)

1. Min epap

2. Max ipap

3. Max PS (pressure support or max gap between ipap & epap)

You can't set min PS (that defaults to 2 CMS at power on, then varies depending on what ipap & epap do.

In BIPAP mode you can set ipap & epap as you wich.

Good luck

DSM

Hi DSM thanks for yoru reply.

First, does this mean that I'll get the 10 Pressure setting when I need it because the Auto is on?

Also if can you elaborate on the Max PS a bit more? Like if I set max PS to like 5, does that mean my Min EPAP would be 0 and my Max IPAP would be 15 based on if the auto determined if I needed it or not?

[blarg]

First, does this mean that I'll get the 10 Pressure setting when I need it because the Auto is on?

If you set your settings at Min EPAP 5, Max IPAP 10, then here's what will happen. Let's ignore PS for a bit.

Start: Machine starts at 7/5. BiFlex will drop it down below the 5 on exhale, no reason for concern.

Later: If you have events that warrant an IPAP increase, the machine will gradually bump it up, going to the max if needed.
(Edit: Good point DSM! Changed the wording for clarity.)

Here's where PS comes in. Think of it as a leash that holds IPAP and EPAP together. If your max PS is set at 5, what you're saying is, "It's ok if the IPAP increases to 5 points higher than EPAP." So, if max PS was set at 5, operating at 10/5 would be "ok". The machine might still increase EPAP if you get apneas, but 10/5 would be acceptable.

Now let's say you had max PS set on 3. Throughout the night you need IPAP increases. Once it gets up to 8/5, it's still happy because the gap is 3. If you then need a bump up to IPAP of 9, then that PS will drag the EPAP up to 6 with it, to not exceed your max gap between them of 3.

There are two schools of thought here. One is "Why subject myself to higher pressure than necessary on exhale? Let's leave Max PS as high as it will go to not drag EPAP up unnecessarily." The other is, "When there's a gap of more than about 4 or 5, I feel my nares inflating and deflating. It's uncomfortable and probably disturbs my sleep more than a few more points of EPAP would."

So it sounds like you want to set it at Min EPAP 5, Max IPAP 10, Max PS 5 for now. That'll start you out at 7/5 and then throughout the night independantly adjust the pressures based on what it sees. If it thinks you need 10/5, you'll get 10/5.

[dsm]

[quote="blarg"]

<snip>

Later: If you have events that warrant an IPAP increase, the machine will bump it up to 10.

>>>### Just to clarify Blarg's point, the IPAP increase will happen in increments in response to apnea events & some flow limitations. Just wanted to make sure you didn't think it would bump pressure straight up to 10 from 7 as soon as an apnea occured
<<<### DSM

<snip>

Now let's say you had max PS set on 3. Throughout the night you need IPAP increases. Once it gets up to 8/5, it's still happy because the gap is 3. If you then need a bump up to IPAP of 9, then that PS will drag the EPAP up to 6 with it, to not exceed your max gap between them of 3.

>>>###
As Blarg says, max PS (Pressure Support) will hold the gap to no more than the max PS setting (the minimum is always 2 CMS & preset. If your breathing was such that the machine starts lowering Ipap back towards 7, then epap would always be at least 2 cms below ipap allowing that it too allows the machine to lower its setting
<<<### DSM

There are two schools of thought here. One is "Why subject myself to higher pressure than necessary on exhale? Let's leave Max PS as high as it will go to not drag EPAP up unnecessarily." The other is, "When there's a gap of more than about 4 or 5, I feel my nares inflating and deflating. It's uncomfortable and probably disturbs my sleep more than a few more points of EPAP would."

###>>> My advice to anyone is to be wary of gaps over 4 CMS - check out the AHI score during any such periods.
<<<### DSM

So it sounds like you want to set it at Min EPAP 5, Max IPAP 10, Max PS 5 for now. That'll start you out at 7/5 and then throughout the night independantly adjust the pressures based on what it sees. If it thinks you need 10/5, you'll get 10/5.

###>>> Yup
<<<### DSM

[brackstone]

Very interesting pieces of information, thank you both.

A followup question though.

Right now I'm averaging about 2 AHI(?) an hour. Would setting up my Auto system help me fight that off? If so how would I want to configure it?

I'm assuming the 2 AHI I have every hour is just because I have an Apnea that's much worse than usual? And if I had the auto setting on it would probably help eliminate those?

I hope this makes sense!

[brackstone]

Shameless bump!

[rested gal]

brackstone, I'm not a doctor and this is just my opinion...

If it were me, I'd set the machine this way -- assuming it's the classic BiPAP Auto, not the M series, as the menu items are a bit different on the M:

AbFLE mode (auto-titrating bipap mode with bi-flex enabled)

5.0 Min EPAP (or 6)

15.0 Max IPAP (it won't go there unless needed -- the machine will start out using 5 EPAP and 7 IPAP.)

8.0 Max PS (to let IPAP and EPAP work as independently of each other as possible)

3 Flex (the most bi-flex relief you can get...softening the beginning of the already lower EPAP pressure.)

0:00 Ramp

0:00 Start (this needs to always be 0:00 or the machine will use "split night therapy"...you don't want that.)

0 Patient

1 Lights

___ Nights (leave as is)

[Guest]

Just wanted to endorse RG's recomm settings but with one qualification.

Re setting max PS to 8. Personally I would never set it higher than 4.

I did some tests with a BiLevel where I varied the gap between ipap & epap over several nights & discovered that (for me) when I set the gap higher than 4 cms (in straight bipap mode), my AHI score started to climb alarmingly. If I set the gap at 7, I was scoring AHIs in the 40-50 range (ipap = 15 epap=8).

The best estimate I could come up with was that at a gap of 4, all was ok.

Also you mention AHI of 2.0 but haven't clarified if it was mostly HI or AI (there is a big difference). AI are blocks HI are hypopneas. Both can lead to a lowering of blood oxygen saturation & it is that plus preventing disrupted sleep that is the goal of cpap therapy.

But as with all forms of therapy, the best lessons are the ones we learn oursleves

Good luck

DSM

[dsm]

(guested again)

The settings I started with should have shown as ipap=15 & epap=8 not epap=8)

Again goodluck

DSM

[blarg]

And personally I find that if my max is set at 25 on my BiPAP Auto, then I'll hit 25. So, if you find yourself slamming against the max when it's quite high then obviously, that's when you start worrying about reining it in.

Worry about that bottom number first though.