What is mean- support pressure on auto BIPAP

[adin67]

Hello, I'm back with another question.
From yesterday I switched on an rented auto bipap from an auto cpap(also rented) because I had problems with my ears(barotrauma) due to expiratory pressure.
And now, I am trying to understand the role of Min.and Max.pressure support on my auto PRS One Bipap -Bi flex. I have done some reading, but still don't understand how pressure support works.
My DME set the I/E pressure on my rented machine thus; Ip=12, Ep=4, bi-flex=2 and Min & Max SupPress=0, but i guess something is goes wrong, as though something would explode in my nostrils when inspire.
On the autoCpap the pressure was set to 8-12.
Thank you.

[sawinglogz]

I'm not sure how your DME would set IPAP=12 without specifying a nonzero PS. On the Respironics devices you set EPAP (and possibly EPAP range), Pressure Support (min/max when the machine is auto), and max pressure overall (at least on ASV).

In other words, IPAP = EPAP + PS

So, based on your description, I would suspect your settings are EPAP=4 (fixed), PS=8 (fixed). That produces an IPAP of 12.

I'm guessing your EPAP went down due to your ear problems. It's possible that the "exploding" feeling might be due to the dramatic change between 4 and 12 cmH2O. On CPAP you probably had only a 2cm dip upon exhale (if you had C-flex set to 2).

What's surprising to me is that they didn't preserve the range you used for CPAP. Apparently you were OK with a minimum pressure of 8. So I'd have expected a setting of EPAP=4, PS=(4 to . That would produce an IPAP range of 8-12 but keep EPAP down at 4.

My understanding is that usually IPAP range is used for hypopneas rather than apneas, so most often you'll see an EPAP range (4 to with a fixed PS (4). But since you were having ear problems with EPAP=8, you probably don't want EPAP to range that high, and instead use PS/IPAP to reach your prescribed range.

[Pugsy]

Did they give you a model 760 machine? The model number is on the bottom of the blower unit.

Can you go into the clinical setup menu and tell us exactly what you see the settings are?

Mode...choices are CPAP, bilevel, auto..so which mode

and then the subsequent settings below whichever mode. I also don't think that PS setting would equal 0.
I have a 760 machine and it sounds like they pretty much set it up to mimic APAP settings and that isn't going to help your ear issues because of the 12 IPAP

[adin67]

Thanks for the quick response, my auto bipap it's an BiPAP Auto with Bi-Flex (761P) and i don't know how can i set those pressures for to feel comfortable when i sleep. I think my DME did not set well the device.
I put a picture of the BIPAP(it is set to autoBIPAP mode).

[djhall]

I would expect that to have the effect of imitating an auto CPAP with a range of 4 - 12, but what you describe sound like you are getting an increased pressure on inhale.

When that machine is running I think it displays the inhale and exhale pressures on the screen as you breathe. Can you put it on for few seconds and watch the display while you breathe a few times? That should tell us exactly what the machine is delivering for inhale and exhale pressures.

[Pugsy]

Idiots...they set the machine to actually be functioning at settings pretty much guaranteed to make your symptoms worse and not treat your OSA to boot. Idiots....

Can you get me a screen shot of the daily detailed report showing the pressure graph? SleepyHead or Encore...I don't care which.
Don't know how? Explained in this thread with picture examples.
Screen shot thread viewtopic.php?f=1&t=81072&p=737779#p737779
I want to see what the pressure line looks like and the events graph to see if much was happening.

If APAP was set with 8 cm minimum and max of 12...and it was a doing a good job preventing the OSA airway collapse..
but causing the ear problems likely when it was reaching 12...if it was reaching 12...we need to lower pressures but not to 4 and certainly not give you IPAP of 12.

I am thinking more along the lines of EPAP of 6....PS minimum of 3...PS maximum of 4 and max IPAP of say 12 and it won't reach 12 unless it has a good reason to go there. Instead you would be starting out with IPAP or 9 or 10 (depending on if you used 3 or 4 PS) and should be more comfortable in terms of breathing in general.....then we look at the detailed reports to see if further adjustments are needed and also evaluate the ear problem.

[adin67]

Idiots...they set the machine to actually be functioning at settings pretty much guaranteed to make your symptoms worse and not treat your OSA to boot. Idiots....

I like this. I dont have any raport with this unit because I received the unit yesterday and last night i used 10 min and i take off the mask(I found it impossible to breathe). But firstly i will set the machine as said Pugsy, IPAP=10(or 9) and EPAP=6 (but I don't know how I set the other two pressure suport, what values ​​to put in this case). Like this seems to be more reasonable.

-For djhall, yes I'm "getting an increased pressure on inhale."
"That should tell us exactly what the machine is delivering for inhale and exhale pressures."
-as is now set the unit (Ip-10 and Ep-4) the machine is delivering for inhale 4 and 4 for exhale press.(when i put the mask and starts)

[Pugsy]

the machine is delivering for inhale 4 and 4 for exhale press.(when i put the mask and starts)

Idiots... I tell you...they have limited the machine to essentially function like an APAP machine with minimum of 4 and max of 12 so all you see and get is 4 inhale and 4 exhale until events drive the pressure up.
With PS to 0...you don't get separate pressures for inhale and exhale...you just get the single pressure which is just like an APAP machine offers.
This is scary what they did.. clueless idiots.

but I don't know how I set the other two pressure suport

PS is set to 0 right now both minimum and maximum..you will need to change maximum first because it doesn't allow a minimum to be greater than the maximum.
So change max PS to 4 and then go back and change minimum PS to 3 and it should work just fine.

[robysue]

With these settings on the System One BiPAP Auto running in BiPAP Auto mode:

your System One BiPAP should be acting exactly like a System One APAP running in a 4-12 range because:

min EPAP = 4
min IPAP = min EPAP + min PS = 4 + 0

max EPAP = max IPAP - min PS = 12 - 0 = 12
max IPAP = 12

And since min PS <= IPAP - EPAP <= max PS, we have 0 <= IPAP - EPAP <= 0, which forces IPAP = EPAP all night long. So IPAP and EPAP will both be increased by exactly the same amount any time either one of them needs to be increased.

If that's NOT how the machine is behaving, then there's something not quite kosher going on. And a trip to the DME is unfortunately in order.

But an equally important question is this: Why switch you to a BiPAP set to run in a way that simulates the way an APAP runs???

[adin67]

Thank you Pugsy,
So, I set like this; Ip=10, Ep=6, MaxPress=4, MinPress=3 and Bi-Flex=2. I hope I understood well, if everything goes right during the next night, tomorrow I'll back with a review and raport(jpg).
Thanks again.

[robysue]

Thank you Pugsy,
So, I set like this; Ip=10, Ep=6, MaxPress=4, MinPress=3 and Bi-Flex=2.

These settings will cause the machine do do the following:

Min EPAP = 6
max EPAP = Max IPAP - Min PS = 10 - 3 = 7

min IPAP = Min EPAP + Min PS = 6 + 3 = 9
Max IPAP = 10

So 6 <= EPAP <= 7 all night long and 9 <= IPAP <= 10 all night long.

And EPAP and IPAP might vary just a bit independent of each other because Min PS <= IPAP - EPAP <= Max PS allows IPAP - EPAP to range between 3 and 4 inclusive.

So when:
EPAP = 6, IPAP satisfies 9 <= IPAP <= 10
EPAP = 6.5, IPAP satisfies 9.5 <= IPAP <= 10
EPAP = 7, IPAP = 10

The Bi-Flex = 2 means that you'll get a bit of additional exhale relief beyond just the drop from IPAP to EPAP at the beginning of the exhalation.

[adin67]

[/quote]

The Bi-Flex = 2 means that you'll get a bit of additional exhale relief beyond just the drop from IPAP to EPAP at the beginning of the exhalation.[/quote]
Ok , i understand but then how to make to get a better exhale relief. What is wrong with what Pugsy said.

[Pugsy]

I don't think Robysue meant that there was anything wrong with what I said...she was just explaining in further detail what you can expect in terms of variables with your current settings.
With the PS of 4 max and 3 minimum...and the EPAP at 6 min and IPAP max at 10...it isn't going to have much room for pressure variations beyond inhale and exhale..but that's not necessarily a bad thing. We don't want it to go higher if higher means more ear issues.
If you had set max IPAP to 11...it would have a little more room to roam but you may not need it.

What we want to do is find something that will prevent the airway from collapsing and not hurt the ears...so a tight range is probably preferable.
I never saw your APAP reports so I don't know how high it ever went to or how well controlled your OSA was...
but we have to start somewhere and what you have selected is as good as anything to start with.

It's a good starting point..let's see what the report after tonight might show us and then evaluate your needs.
And also let's see if the ears are a problem with these settings...if they are still problematic and the report looks real good there may be some room to reduce the pressures a bit more.

Without seeing your prior reports it's hard to know just where to start..so I suggested on the conservative side of things just to start with.

[robysue]

I don't think Robysue meant that there was anything wrong with what I said...she was just explaining in further detail what you can expect in terms of variables with your current settings.

Exactly. But you seemed to be asking about how these settings would work. That's all my response was intended to answer.

These settings are clearly worth try.

With the PS of 4 max and 3 minimum...and the EPAP at 6 min and IPAP max at 10...it isn't going to have much room for pressure variations beyond inhale and exhale..but that's not necessarily a bad thing. We don't want it to go higher if higher means more ear issues.

Exactly. A wider range is NOT always better. My own Auto BiPAP range is almost as tight as this one. It works for me. I've been told it's a crazy range and that there's no real need for BiPAP. But try telling that to my stomach.

So if this range works for your ears and keeps the AHI nice and low, the Yipee!!! Pugsy's helped another person through a serious problem!

If not, then rest assured pugsy (and I and others) will continue to work with you to try to fix the problem.

What we want to do is find something that will prevent the airway from collapsing and not hurt the ears...so a tight range is probably preferable.

Agreed.

And I'll throw this in as well: It could be the ear problem is being triggered by the EPAP pressure. Hence keeping the EPAP several cm below the IPAP may be a critical part of the puzzle. And Pugsy's suggested settings about the min PS and max PS do that.

It's a good starting point..let's see what the report after tonight might show us and then evaluate your needs.
And also let's see if the ears are a problem with these settings...if they are still problematic and the report looks real good there may be some room to reduce the pressures a bit more.

Again, I'm in total agreement with pugsy. Except I'd say keep these settings for several days if the ear are not a problem at these settings.

[adin67]

It's a good starting point..let's see what the report after tonight might show us and then evaluate your needs.
And also let's see if the ears are a problem with these settings...if they are still problematic and the report looks real good there may be some room to reduce the pressures a bit more.

Without seeing your prior reports it's hard to know just where to start..so I suggested on the conservative side of things just to start with.

I'm back with new data. So, with these settings ;


report looks like this;

Maybe I should do small adjustments, what do you think