Confused about Bi-Pap Auto pressure levels

BrianT · Post by **BrianT** » Mon Nov 26, 2007 6:32 pm

Hello,
I am trying to figure out what levels to set on a Respironics Bi-Pap Auto M series. My prescribed levels from the sleep center are 13/9. It seems to me that the sleep study was conducted under less than comfortable conditions with some level of anxiety thrown in for good measure,and as a resulting titration might not be all that accurate.
If I already have an Auto Machine and I already know how to change to auto mode, wouldn't i be able to find the best pressures by monitoring the AHI numbers myself over time? It concerns me that maybe I don't know much about this and I just don't want to do anything stupid like setting the limits too high or low. Can messing around with this be dangerous? If my numbers were prescribed at 13/9 what would be considered safe upper and lower settings.

Any clarification on this subject would be greatly appreciated!
Brian

AdmiralCougar · Post by **AdmiralCougar** » Mon Nov 26, 2007 7:10 pm

If I were you and felt I wasn't being suffocated at a pressure of 7 or 8 I would set my min to 7 or 8 and upper limit to 14 or 15 just a couple above and below your titrated numbers, and see how that goes for a while. Though truthfully I'd see how your numbers did at the prescribed pressures for a couple of weeks before you changed anything. Especially since the pressure changing of auto can bothersome to some people, and keep them up. Also if you have a doctor that you can talk to and trust you might broach the subject of changing it to auto with them before you just do it.

Good luck on finding what is right for you.

GumbyCT · Post by **GumbyCT** » Mon Nov 26, 2007 9:28 pm

Brian,
w/o any background at all - my question is -
Why do you feel you have to change from the prescription?

BrianT · Post by **BrianT** » Mon Nov 26, 2007 10:31 pm

GumbyCT,
Sorry ,
I left out what's going on with my progress.
I have been using the Bi-Pap for a little over 6 weeks and my average AHI numbers are still over 5.6.
After seeing first hand how hard it is to find a mask that works, it just seems to me that the Titration process can't be that accurate given all of the variables. From what I've been reading, the goal is to get and keep the AHI numbers as low as possible. I started with an AHI of over 60 so progress has definitely being made. I feel better and want to continue to improve things. I don't know for sure if playing with the Auto titration will help in that effort.
Thanks for taking the time to respond.
Brian

rested gal · Post by **rested gal** » Tue Nov 27, 2007 2:53 am

I think AdmiralCougar's suggestion of EPAP set at 9, IPAP set at 15 would be a pretty good range to try at first for your BiPAP Auto with autotitrating turned on. The machine will start out the night using 2 cm's above the EPAP pressure, so you'll be starting out breathing in at a pressure of 11, breathing out against a pressure of 9.

If you have the software (Encore Pro or EncoreViewer...either one displays the full info the same way) so that you could see the detailed data results, I'd probably just go on and set it EPAP 9, IPAP 20. You'd still start out the night using EPAP 9, IPAP 11.

I'd also turn on Bi-Flex (at 3, or whatever feels comfortable to you) and I'd set the Max Press Sup to as much as it will let you. With a range of EPAP 9, IPAP 15, the most the Max Press Sup would allow is to set it at is "6." If you set EPAP at 9, IPAP at 20, you can set the Max Press Sup at 8. That's the most it will allow... 8.

Here are a couple of links to discussions about what the Maximum Pressure Support does. That particular setting was called just "PS" on the older pre-M Bipap Auto machines:

Dec 08, 2006 subject: Question for BiPap users - UPDATED 12/14/2006
viewtopic.php?t=15666

Mar 04, 2007 subject: Need a little help to set my Respironics BiPap on auto !
viewtopic.php?t=17887

BrianT · Post by **BrianT** » Tue Nov 27, 2007 7:29 am

AdmiralCougar,
Thanks for your advice and suggestions. I have had the Bi-Pap Auto (set by the DME) at the prescribed 13/9 for a little over 6 weeks and the resulting AHI averages about 5.6, which is much better than the sleep study AHI of 60. I just want to see if the numbers can improve further.
Thanks again for your help.
Brian

BrianT · Post by **BrianT** » Tue Nov 27, 2007 7:43 am

Rested Gal,
Thank you, I will try AdmiralCougars 15/9 suggestion and see what happens. I do have Encore Viewer and have been watching the AHI numbers daily. I currently am using the Bi-Pap set at the 13/9 as prescribed and am getting an AHI of 5.6. Thanks to information from this forum and the people on it, i now know how to unlock the Respironics Auto Bi-Pap M.
I had no idea what the Max Press Sup was, your links to the explaination were very helpful.
Brian

AdmiralCougar · Post by **AdmiralCougar** » Tue Nov 27, 2007 12:08 pm

It was my pleasure I hope you find what will work for you. I started out as 20/16 with my BiPAP and moved to Auto too since my AHI were still 30+ (My Sleep Study was AHI=150) Which was an improvement but still way to high. So with the suggestion of my RRT and "blessing" of my Pulmonologist, we set it to auto and it has helped a lot. I hope it does the same for you, whether you end up staying auto or you find the right pressure combos for you. I'm sure glad you've kept up with it and continue to try and improve things. .

Patrick A · Post by **Patrick A** » Tue Nov 27, 2007 12:20 pm

I agree with Rested Gal & Admiral Cougar. I have been using a M-Series Bipap Auto since June, with RG's Advice...I took my sleep study to my Doctor. And with what RG suggested he wrote my new Scrip. for my new machine.
Since I have been using this new Bipap I no longer wake up with a head ache, or feeling like I have morning sickness
Good Luck.

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