Respironics BiPap Auto SV new user with problems

[alexj]

Hello and thank you in advance for your help and patience with this green-horn. I have searched the posts but did not find this covered. If I am in error, I'm sorry for any aggravation that this may cause -- just kindly redirect me.

I have been on CPAP and BiPap units for years now. I recently went in for a new BiPap titration and was diagnosed with Central Apnea along with the OSA.

Upon getting my new machine, Respironics BiPap Auto SV, the very first night I woke up with the unit seeming to lock up allowing me to breathe in for less than one second and out for less than one second.

So I went to my supplier the very next day and was issued a new unit. Again, having the same problem with this new unit. I switched to a new mask and a higher Ti and the problem was much better.

Now again, the past few nights I am awakened with the same problem of the unit not allowing me to breathe in or out for less than 1 second. I turn the unit off and on, still seemingly locked up.

This problem arises in the middle of the night, not normally when I first lay down.

Two units the same problem.

Here are my settings:

Epap: 10
IPAP min: 16
IPAP max: 26
BPM: 12
Ti: 2.2 (Even at this setting, I usually feel like I could use a little longer breath)

Gender: Male
Age: 52
Ht: 6'4"
Wt: 210lbs

Thanks to any and all that may make some sense out of this.

Warmest regards,

Alex

[Guest]

Rise Time?

Banned

[dsm]

Alex,

Good timing to be asking about the Bipap AutoSV here as we are working through a few cases that fit your use.

My 1st question would be can you ask your doctor why he put you on a fixed RR (Respiratory Rate) vs going for Auto RR (BPM=AUTO setting).
He will usually have a reason for this & his answer will help us. 1st impression is it will be related to the level &
type of Centrals but it helps to have it restated. Also what risetime did you get set for ?.

Another question I am inclined to ask, is what was your AI score in your last sleep study & what pressure was
allocated to you CPAP & also Epap/Ipap.

DSM

PS at this stage your issue appears confined to Ti time but 2.2 should be adequate as you have already said.

[alexj]

Hello dsm,

TY for you help.

I will have to get with my Dr. on this. I have an appt set with the Dr. that reads the sleep lab reports and diagnoses the situation and sets the treatment parameters. I have never seen her. My primary care MD refers me to the sleep lab at the hospital. He follows the recommendation of the doc in charge of all sleep studies.

If you have any further info that I should ask her, I would appreciate it.

Warmest regards,

Alex

[alexj]

Rise time: 6

[Guest]

[quote="alexj
BPM: 12
[/quote]
Also, your BPM of 12 is way too high. It is triggering the EPAP/IPAP switch too fast at Ti 2.2.

You will find relief when you reduce BPM to 10 (BPM: 10).

If the machine is still EPAP/IPAP switching too fast at BPM: 10, you will need to set BPM: 8.

Neither of your BiPAP Auto SV's are/were defective.

Both were set-up improperly.

Banned

[alexj]

Thanks Banned.

I have set the BPM: 10 as you advised.

I will give that a try tonight.

I feel so blessed to have found this great online community.

If there are any other insights available, I thank you all in advance.

Alex

[Guest]

Rise time: 6

Try a shorter RT.
RT: 3.

RT: 6 is a pretty drastic setting, even for someone whose SA is 'restrictive'.
More than likely your SA is 'obstructive' and requires a shorter RT.

Let us know if you find relief at:

BPM: 10
RT: 3

If you still wake up in the middle of the night with a problem, lower your BPM.
BPM: 8.

Been there, done that, bought the T-Shirt.
Banned

[dsm]

I'm inclined to suggest fewer changes in one go & if Alex can engage his doctor before hand it should avoid
creating confusion over why changes are being suggested.

I do go along with trialling 10 BPM but would want to know if the doctor had a medical reason for choosing
RT=6 before suggesting Alex change if, esp if RR is changed at the same time. A night or 2 shouldn't be
an issues esp if we can't see charts showing before & after details.

Cheers

DSM

[Guest]

My 1st question would be can you ask your doctor why he put you on a fixed RR (Respiratory Rate) vs going for Auto RR (BPM=AUTO setting).

Which would take us back to your original question:

Alex, why did the doctor put you on a fixed BPM and not 'Auto'?

Banned

[alexj]

Thanks guys.

I set the BPM to 10 last night and slept without incidence for the whole night! That was a first. The only change I made was the BPM. I definitely felt better rested this morning.

Regarding:
Alex, why did the doctor put you on a fixed BPM and not 'Auto'?

I will ask her that when I see her in a few weeks.

I will keep you informed. I cannot thank you enough for your help.

Warmest regards,

Alex

[dsm]

Alex

We cannot thank you enough for showing such a rapid improvement. It is really good when someone
is able to make a simple & obvious change (thanks to Banned for being so quick on that bit of advice).
We all hate to be 'muddle' headed about such matters

So, the questions then to ask your doc are ...

1) Why the fixed BPM vs AUTO

2) Why the very slow risetime

DSM

[alexj]

OK, thanks.

Where can I find out more about rise time and what it means. Hey, I told ya I was green! LOL!

Thank you,

Alex

[dsm]

OK, thanks.

Where can I find out more about rise time and what it means. Hey, I told ya I was green! LOL!

Thank you,

Alex

Alex,

Here is a complete library of clin manuals to choose from
Pick any one of the Respironics Bipap clinical manuals & look for rise time or pick a Resmed clinical manual & look for the same.

http://www.internetage.ws/cpaphelp/manuals

Here are more ...

http://www.internetage.ws/cpapdata/manuals/

Perhaps try this one & go to page 6-4 & see fig 6-7 (this is from the Bipap AutoSV provider manual)
http://www.internetage.ws/cpaphelp/manu ... Manual.pdf

For further ref try this one too - go to Page 32 fig 9 (a very good explanation with charts) (Fro...
http://www.internetage.ws/cpapdata/manu ... ev%20h.pdf

Hope this helps

DSM

[dsm]

Alex

Just wanted to add that the manuals were both 1st published several years ago & each of them talks of rise time as 'comfort' but in more recent years I believe there is more caution in setting long risetimes esp on machines that have 6-9 levels of risetime. Early bilevels may have had only 3.

E.g. a setting of 6 usually means 600 millisecs (6/10ths of a sec) for pressure to rise from epap (exhale) to ipap (inhale) pressure. That is a long period & the reduced airflow can for some people be like a flow limitation (restricted airflow). Settings of 3 (300 millisecs) are considered the 'norm'.

When the clinicians manual means comfort, they were often meaning comfort for patients with lung disorders as in the early days, they were who got bilevel machines. Fast risetimes could be harmful to them. But as the cost of bilevels has come down, they have become commonplace (preferred by many RTs).

DSM