Starting ramp pressure below 4cm (DS760TS)

[mrwatkin]

I have a respironics DS760TS. I have a prescription for 17cm/11cm, but the initial pressure it too much. So, I tired ramping up, but the lowest initial pressure is 4cm (E) and 10cm (I). Is it possible to lower these pressures any further? The machine is in BiPAP mode. I have BiFlex on so when I exhale, I sometimes get relief. Any and all responses are greatly appreciated.

[Pugsy]

No, 4 cm is as low as the machine can go.

When using fixed bipap mode with PS of 6 your IPAP has to be 6 cm greater than EPAP.
Is the IPAP what is uncomfortable or is it the EPAP?
Have you tried the various BiFlex settings to see if one is better than another? Don't assume that a setting of 3 offers the greatest relief. It doesn't necessarily work out that way in terms of how it feels.

Now if you changed to auto bipap mode then you could use a PS range that would allow for IPAP to be closer to EPAP during ramp time.
We could probably come up with a tight EPAP/IPAP range that would mimic fixed bipap mode but allow for lower IPAP if you found that was more comfortable.
You might try 4 EPAP and 7 or 8 IPAP while awake just to see if it is more comfortable for you.

[mrwatkin]

My issue is usually when I'm exhaling. If I have too much pressure pushing back, I can't exhale and I freak out.

[Pugsy]

You just started on this machine didn't you? Like really recent?
EPAP can't go below 4 cm, no way around that.
Play with it during the day while watching TV or reading so that you aren't so overwhelmed by things and stressed out.
It will/should get easier with just a little time and experience.

If for some reason you can't adapt to the 4 cm exhale...then you should be talking to your doctor because most people can manage 4 cm quite easily and you may need further evaluation as to why it is so extremely difficult for you. You don't have any lung issues like COPD or something like that do you?
Bilevel pressures are the easiest to adapt to because of the inhale/exhale rhythm.

[mrwatkin]

I actually managed to get used to it. The issue was I had the biflex at level 3. So when things go really low when I'm exhaling, a burst of air pushes in when inhaling. So, I switch to a biflex level of 2. This made it so that there's no burst, but an ease into higher pressure. That, plus ramping up the pressure over 40 minutes helped me get to sleep. It still takes some getting used to, but I'll be ok. Things take some getting used to because I'm a stomach sleeper (with head turned to the side).

[Pugsy]

I can do BiFlex at 2 or 3 without issues but BiFlex at 1 just feels out of whack with my own breathing rhythm.
CFlex was totally useless for me.
AFlex...I loved it at 2 but hated it at 1 because it was too slow and 3 was making me feel like I was hyperventilating.

All the various Flex exhale relief functions on the Respironics machine work by optimizing the relief during exhale based on your own force of breathing. It's hard to describe how it feels but I found it more of a rhythm thing than an actual perceived reduction.
It isn't explained the best here but it may help you understand it a little.
http://biflex.respironics.com/

Everyone thinks that 3 must offer the greatest relief and technically it does offer the greatest potential reduction but sometimes it isn't so much the amount of reduction as it is when the reduction occurs during the breathing sequence...timing of the reduction in other words.

With time you will get to where you won't even notice the pressure. Now when I start my machine I start out with EPAP at 10 and IPAP at 14 and it feels no different to me now than normal breathing while awake.
Even back before the bilevel machine and I was using the APAP machine it didn't take long to get using to exhaling against 10 cm even without the ramp feature being used.

But I do understand that for newbies this pressure seems like hurricane force winds at the beginning of the night.
Give yourself a month or so and you will be wondering what all the fuss was about.

[mrwatkin]

I can do BiFlex at 2 or 3 without issues but BiFlex at 1 just feels out of whack with my own breathing rhythm.
CFlex was totally useless for me.
AFlex...I loved it at 2 but hated it at 1 because it was too slow and 3 was making me feel like I was hyperventilating.

All the various Flex exhale relief functions on the Respironics machine work by optimizing the relief during exhale based on your own force of breathing. It's hard to describe how it feels but I found it more of a rhythm thing than an actual perceived reduction.
It isn't explained the best here but it may help you understand it a little.
http://biflex.respironics.com/

Everyone thinks that 3 must offer the greatest relief and technically it does offer the greatest potential reduction but sometimes it isn't so much the amount of reduction as it is when the reduction occurs during the breathing sequence...timing of the reduction in other words.

With time you will get to where you won't even notice the pressure. Now when I start my machine I start out with EPAP at 10 and IPAP at 14 and it feels no different to me now than normal breathing while awake.
Even back before the bilevel machine and I was using the APAP machine it didn't take long to get using to exhaling against 10 cm even without the ramp feature being used.

But I do understand that for newbies this pressure seems like hurricane force winds at the beginning of the night.
Give yourself a month or so and you will be wondering what all the fuss was about.

I also figured out that the mask really needs to be on tight as so not to feel like your face is out of the window doing 90 mph.

[chunkyfrog]

I would recommend a mask liner, because the unavoidable leaks are not nearly as noisy--or feel as strong on the face.
You will get used to the pressure if you keep at it.
Many of us have to use our hand in front of the vent so we know the machine is running.
I don't feel like I'm getting enough air until the pressure is at least 7.