I need help for my mom with bipap

[mechagirl]

hello. Please bare with me as I am not very knowledgable with all the terminology. My mother is 72 and has needed to use a bi-pap machine for about a year but she hasnt been able to tolerate it. Her machine is a Phillips Respironics bipap-pro .Her problem is that the air pressuse is too high & dries out her nose & throat. Also the mask will often leak. It starts out ok when its on "1" but when it rises to a "2" its too strong for her. She no longer wants to wear it.
she took the machine to her doctor once & he supposedly reconfigured it for her but she's still experiencing the same problems. Is the problem the machine? does she need another machine that has a lighter air pressure or is the discomfort normal & she is just not use to it?

btw doctors are very little help, they give as little info as possible so its very hard to understand all this.

thanks...

[JDS74]

Can you post the actual pressures for the machine?
The numbers 1 and 2 don't seem to be related to actual therapy pressures.
The minimum pressure for a Respironics machine is 4 cm H2O.

[kaiasgram]

Welcome. It's great that you're here to help your mom. Are you willing to start posting some of her sleep reports and getting feedback here?

We need the exact make and model of her machine, also her mask. We can show you how to get into the clinical menu of her machine so you can see what the settings are, which will be important information -- her IPAP and EPAP settings, PS min and max, whether she uses the Ramp feature, what her mask leak numbers are, and of course what her AHI (apnea events) numbers are looking like. I'm guessing she was prescribed bipap because she needs a relatively high pressure which may be related to the dryness issues. But it could also be that some tweaks to the humidification settings are in order.

Look for forum member Pugsy -- she has links to instructions on downloading and using software to see what's going on with your mom's therapy. But first if you can get the exact machine info to us, that's the best place to start. We can guide you from there.

[Julie]

It's very possible she's mouth breathing - ok to do it with an FFM - but she may be getting dried out if her mask doesn't seal well. The idea of a FFM is great but it can leak too much if not fitted properly. It's important to try various FF ones and adjust them when lying down, in diff. positions, as your face changes a lot vs standing. We've all gone through a few before finding the right one.

[Bill44133]

Your correct the medical community in general is terrible when it comes to this therapy. They give us these machines and basically
you are on your own to figure things out.

You are in a good place here. Lots of knowledge and helpful people. Good Luck helping your mother.

[mechagirl]

thank you all for the replies.

jds74 the 1 and 2 are the numbers on the dial on the machine.

I will try to fnd all the info you guys want. I need to find her sleep study report.

so far she has been trying to do all this by herself but I dont think she(& I) understand the machine at all. They just tell her how to do the basics.
they should give one a seminar or class to help with this, its so complex!

[BartsBandit]

I use the same machine. A BiPap is good for us elderly folks, because it provides positive air pressure for both inhale and exhale. As we get older, we sometimes forget to breathe and this helps keeping that from happening. I assume you have a humidifier attached to the machine -- the dial where you have 1 or 2 actually goes from0 to 5 and is the amount of heat applying to the humidifier -- higher the number, more heat yielding more moisture. Too much is not good. It will cause a"rain out" in the hose. Make certain your machine is below the sleeping level. I keep my machine set no higher than 2, and usually at 1. That's plenty of moisture.

The settings on your machine tell how much pressure is going in on 1st, the inhalation, and the 2d number is the pressure going in to help exhalation. They are quite often about 4 numbers apart with inhalation being the higher number.

If the mask bothers her because of sleeping with her mouth open, try tyuing a scarve over her head and chin to apply some pressure for not opening her mouth. It also sounds like her mask is not working for her. You might want to try nasal pillows. If all that doesn't work, she is probably going to need a full-face mask. Remember why we use a Cpap, or bipap, the alternate is not breathing at all! It's worth working at.

[mechagirl]

Bartsbandit ,
we never raise the dial above a 2... we had no idea it was connected to heat for the humidifier, it seems to make the air pressure(the air that blows into her nose) stronger as it rises in number.

the mask doesnt bother her much its just that sometimes it will leak air in the middle of the night. The last time she used it, it just wouldnt stop leaking air no matter how we applied it. Its the one with the blue gel cushion.

I will get you guys the info you need soon.
thanks again everyone!

[squid13]

If using the full face mask be sure to wash your face good before you put it on, it gets rid of your skin oils and helps get that better seal. Also you might try a mask liner from padacheek.com.

[robysue]

Her problem is that the air pressuse is too high & dries out her nose & throat.

Since you've only used the humidity setting at 1 and 2, it could very well be that your mom needs MORE humidity rather than less. Particularly if her throat is dry.

If your mom is using a Philips Resprionics System One BiPAP Pro, then the default setting on the humidifier is for "Smart" humidification. In Smart humidification, the humidifier adjusts to take into account the room temperature and the room's relative humidity. I keep my bedroom very cold (as in 60-62 degrees at night) and I use my PR System One humidifier set at 5 all the time and I have no problems with "rainout"---i.e. water collecting in the hose. If I tried to use my machine with the humidifier at 1 or 2, my nasal membranes would be bone dry and SORE each morning.

Another thing that helps prevent rainout is to run the hose under the covers and next to your body. Your mom can try that with the higher humidity setting. A hose cozy will also help with potential rainout problems AND a hose cozy makes the hose not feel "plasticky" or "medicinal" when it touches you.

The pressure settings are NOT readily available from the patient's set up menu. To find out what pressure settings your mom is using will require you to go into the clinical menu. It would be useful if we knew what her settings were. It would also be useful if you could confirm whether your mom is using a System One BiPAP or one of the older Resprionics BiPAPs.

One thing that you could do without going into the clinical menu is look at what the LCD says when your mom first turns the machine on. I'm wondering if she is using the ramp and fitting the mask at very low pressures. And then as the ramp starts to increase the pressure, she notices the pressure more, gets more uncomfortable, and also starts to have leaks because the mask was fitted at a very low starting pressure.

[Pugsy]

Look on the bottom of the blower unit for a 3 digit model number...probably preceded by DS or REF.
Let's figure out exactly what machine she is using.
Be sure to remove the water tank if there is any water in it.
Tell us that model number and then we can know exactly which model it is. The names on the top of the machines are sometimes not all that helpful but model numbers are much easier.

[mechagirl]

ok the model number under the humidifier tank portion of the machine is REF1056215
for the other section its REF 650P

the machine hasnt been turned on for about a week(I threw out the water & cleaned it.) is it ok to turn it on without filling the water tank?

[Bill44133]

When you fill the tank again, make sure it is distilled water only. If you turn it on without water in the tank you wont get any humididty

[Pugsy]

Yes, you can turn the machine on without filling the water tank.
Just don't run it very long without turning the humidifier setting to 0 as the heater plate will heat up. That would be the knob on top of the blower unit next to LCD screen.

The model 650 would be the PR System One BiPap Pro.
This machine.
https://www.cpap.com/productpage/respir ... iflex.html

That's a nice machine. Software is easily available (free) that you can use with that machine's SD card to evaluate therapy results. Check out the links in my signature line for more information on software. Sleepyhead works great with that model machine.

A setting of 1 or 2 for humidification on that model machine and its default mode...isn't going to add much moisture to the air.
Robysue already explained that function.
I have to use a setting of 5 to keep my nose happy and then it really would like more.

Do you have a copy of the provider/clinical manual for that model machine? If not you can request it here
and this is the model term you need to specify
Respironics PR System One BiPAP Pro with Bi-Flex
instructions down near the bottom of this page
http://www.apneaboard.com/adjust-cpap-p ... tup-manual

That setting of 1 or 2 up to 5 available by turning the knob on top of the blower unit...that's only for humidity selection. Has nothing to do with pressure at all.
You can see the pressure numbers when the machine is turned on and hooked up to a breathing live person though.
Otherwise you have to go into the clinical setup menu (explained in that provider manual) to see what the settings are and in there is the only way to alter the pressure.
So you might go in to the setup menu and confirm exactly what the pressure settings are.

[mechagirl]

thanks Pugsy, so it should be higher than a 2 so she can feel more comfortable?
yes the machine came with a manual.
so does that mean it is ok for one to change the pressure setting themselves? I figured that could be dangerous or not allow the therapy to function properly.

One thing that you could do without going into the clinical menu is look at what the LCD says when your mom first turns the machine on. I'm wondering if she is using the ramp and fitting the mask at very low pressures. And then as the ramp starts to increase the pressure, she notices the pressure more, gets more uncomfortable, and also starts to have leaks because the mask was fitted at a very low starting pressure.

oh ok now I get what you mean. I think thats possible as well.