Advantage of "Auto" Bi-Pap

[mghaner]

After getting the info on how to set my "M" series Auto BiPap I followed the settings used by "Rested Gal" last night. I had a great nights sleep! When I checked the settings (I don't have software yet) it was 18 IPAP and 14 EPAP. According to my sleep study and my Sleep Doc, I am supposed to be at a fixed setting of 20I and 14E but when I was running the unit at those fixed settings I had horrible nights. It seemed like the machine kept waking me up due to the pressure changes even when I ran on ramp setting, it let me go to sleep but then woke me with the changes.

My question is.......What is the advantage to using the auto setting over the fixed setting? Do most of you run on the fixed setting after you find one that seems to work or do you leave the machine on auto. I would think that your needed pressure would change if you were sleeping on your side vs. sleeping on your back. Thoughts? Input? Help? Direction?

[betty303]

For me - after using auto BiPap (generally set in the range of 12 or 13/6) for quite a while and not getting very good results, I switched to set pressure (11/7.5) and I was more comfortable and getting better results with that. Over the months, I have gone back to Auto for a few times, but still like it set with a constant IPAP and EPAP. I continually keep an eye on my stats, and have tweaked it up to 11.5/8 and back to 11/7.5 - not much difference I know, but even that small amount of change has effect on my AI and HI. (BiFlex on 2 most of the time)

I know there are others who have it on Auto all the time. Sometimes I still have to use ramp when I have it set at EPAP of 8, to get to sleep, then it is OK,

I was titrated at 10.

[Catnapper]

I like the auto function better. I have tried with straight bi-pap, but I get better results with the auto, and I need less pressure most of the time. The auto is there if I need a bit more pressure once in a while.

It must be an individual thing, just like all the other parts of this therapy. Unfortunately, that means you have to give it time while you try all the various possibilities. You have the rest of your life to experiment with it, right? Once you find a comfortable range of pressures, you can try different masks, or do that in the reverse order. Such fun! Then you can vary the humidifier, the hose covers, the PAD-A-CHEEKS, and so on. Think of it as a hobby that saves your life.

[dsm]

I used one a few weeks back for a couple of nights & on Auto mode. I did it to compare to my current AutoSV, It was very pleasant to sleep with (I have an older 'tank' model).


I don't like it as much if run on fixed bipap pressures. Seems this varies per person.


DSM

[socknitster]

My auto bipap is set to a tight range around my required pressure so that the changes in pressure zooming up and down do not wake me.

When I was new to bipap, I also found, like you, that if I used the auto mode I "titrated" lower than my prescribed pressure. However that "titration" is where you spend 90% or less of the time--you may spend a few minutes above that level every night.

This can be beneficial for many reasons. For one (and the most important for me) is that you get the benefit of the lower pressure for most of the night and only have the machine take you up to a higher pressure when it needs to to take care of stubborn events. This means Comfort with a capitol C. If you are staying in a fairly tight range, this will not be far away so the machine can respond quickly, but even a few cm of water pressure can make a big difference in comfort as you have clearly discovered.

My original bipap prescription was for 16/12. When I went to auto bipap, the 90% pressure was usually 14/11 in those early days which I found more comfortable since I spent large amounts of the night at a lower pressure.

As I improved the things that contributed to my apnea (treated GERD and huge tonsils removed) I have settled down to a pressure of 10/6 now which is far easier to tolerate and has helped with aerophagia problems too. Not everyone will have the luck to be able to reverse some apnea causal agents like I have, but one should always look for them--especially when the pressure needed is so high.

So, yes, I think your experience is completely normal. Obviously I got similar advice to the advice you are getting about a year ago when I started on bipap and it has proven to be very good advice over the last year for me.

Jen

[socknitster]

I forgot to mention that I still run mine in auto. I figure, if it ain't broke don't fix it. Being pregnant, I figured my pressure needs might go up during pregnancy since pregnancy is well known to induce sleep apnea. But, go figure, my needs have continued to drop during the pregnancy, thanks to that tonsilecomy last summer.

jen

[OldLincoln]

For me the auto advantage is:

a) Comfort: For me higher pressure = less comfort. If I recall correctly, treatment failure on fixed pressure devices is about 50% or so while it's 30% for auto. I was on the edge when I got my Auto. Now, my auto range is 6-12. I spend most of the night between 6 & 7.5, with a couple momentary blips up to 11 or so to clear an event. My last titration would have resulted in setting a CPAP at 12 or BiPap at 12/6.

b) No bloat: My threshold for LES blow-through is between 8 & 9. Anything above 9 and air is pumped directly into my stomach like blowing up a balloon. Not only is that painful and embarrassing at times, but is quite dangerous to your colon. I now spend only a very few minutes above that nightly, whereas CPAP would be 100% of the time and BiPAP 50%.

c) Pressure tweaking: With tracking software and a range to mess with, you can dial in your setting and improve your results which is what it's all about. You read about tighter ranges improving scores because the auto doesn't have as far to go to clear an event.

My unit is still new enough that I'm just collecting data, but I believe I'll raise my 6 to a 7 to see what it impacts. One thing I've seen is that when I jerk the mask off to sneeze it really skews the numbers. I will be looking to remove anomalies when I get into analysis further.

I am now an advocate for autos being prescribed as the initial machine for new patients whenever possible. I and many others went through bad times when it was not necessary.