Help -- Auto BIPAP Settings

I may have talked myself into a corner. I'm good at that.

I am on Bipap at 15E and 19I. On my last visit to my sleep doc I convinced him I needed to have an auto-BIPAP machine. He agreed and wrote a script for one stating E at 12 to 17 and I at 17 to 22. He actually wrote the numbers backwards on the script -- E at 17/12 and I at 22/17. I thought to myself -- piece of cake, I can set those number. HEH!

Well, I purchased the Philips auto BIPAP (760) and am trying to set it up but don't know how. It has a max I setting and min E setting. No problem -- but how do I set the range he wants or is that possible? The max and min PS settings have me confused. I do have the provider manual but its not much help. I'm quite sure it's something simple and I'm just not seeing it. HELP!

Thanks in advance
Phil

Set your minimum EPAP to whatever you think is needed...maybe the 13 since your previous EPAP was 15. With previous settings of 15 EPAP and 19 IPAP that means you were using PS of 4 cm. PS is just the difference between EPAP and IPAP.
Set your PS to minimum 4 and max of 5....or set minimum to equal maximum at 4 if you wish to use 4 cm PS like you used on the fixed bilevel mode.
Set your Max IPAP to 22 if you wish.

When you start the night the machine will start out with 13 EPAP and 17 IPAP and as the night goes along it can go to 22 IPAP with EPAP being 17 if the machine wants PS of 4 or 5


Then check your reports after a couple of nights to see if maybe more minimum EPAP is needed ...if you see lots of OAs or snores more minimum is needed
and if you are hitting 22 max IPAP often...then open up the IPAP to 25 but to be honest I would probably just set max IPAP to 25 and be done with it. It won't go there unless it thinks it needs to anyway.

Set the min EPAP to 14 and max IPAP to 22 and the machine will take care of the rest.
To provide better flexibility, set the max PS to 8.

These settings a just a little wider than you current ones. Respironics Auto BiPap machines allow the system to adjust IPAP and EPAP pressures independently.

After a couple of days, look at your therapy numbers to see if you need to increase the min EPAP a little to suppress any OSA or Hypopnea events that have crept in. My experience with the 750 predecessor machine was that it was a little slow in responding so that getting the min pressure closer to what is actually needed is better rather than relying on it chasing the events.

Pugsy wrote:Set your minimum EPAP to whatever you think is needed...maybe the 13 since your previous EPAP was 15. With previous settings of 15 EPAP and 19 IPAP that means you were using PS of 4 cm. PS is just the difference between EPAP and IPAP.
Set your PS to minimum 4 and max of 5....or set minimum to equal maximum at 4 if you wish to use 4 cm PS like you used on the fixed bilevel mode.
Set your Max IPAP to 22 if you wish.

When you start the night the machine will start out with 13 EPAP and 17 IPAP and as the night goes along it can go to 22 IPAP with EPAP being 17 if the machine wants PS of 4 or 5


Then check your reports after a couple of nights to see if maybe more minimum EPAP is needed ...if you see lots of OAs or snores more minimum is needed
and if you are hitting 22 max IPAP often...then open up the IPAP to 25 but to be honest I would probably just set max IPAP to 25 and be done with it. It won't go there unless it thinks it needs to anyway.

Wonderful, Pugsy -- thank you *very* much! That's kinda what I was thinking but the manual is not very clear -- or I'm just too stupid to understand.

My reasoning:

After studying my titration (tech simply upped pressure until the events stopped plus switched to bipap at a point) plus studying 6 weeks of Sleepyhead and Encore graphs, I see I now have mostly hyopneas which I take to be my body trying to go into OA. It's my thinking just a touch more pressure might stop them but I don't care to have that much in my face all night. An auto-BIPAP just seemed the answer. Plus, I will have a lot more to talk about when I return to my sleep doc.

Again, thank you!
Phil

JDS74 wrote:Set the min EPAP to 14 and max IPAP to 22 and the machine will take care of the rest.
To provide better flexibility, set the max PS to 8.

These settings a just a little wider than you current ones. Respironics Auto BiPap machines allow the system to adjust IPAP and EPAP pressures independently.

After a couple of days, look at your therapy numbers to see if you need to increase the min EPAP a little to suppress any OSA or Hypopnea events that have crept in. My experience with the 750 predecessor machine was that it was a little slow in responding so that getting the min pressure closer to what is actually needed is better rather than relying on it chasing the events.

Thanks for the info, JDS74. Yeah, the min and max numbers are pretty much a no-brainer but that PS stuff had my head hurting. Since it's *my* health we're talking about, I want to be certain I get it right.

You can trust I'll be watching my numbers very closely -- already do. I am aware the Philips machine is a little slower to respond to changes and took that into account while making my purchase decision. That's about the only meaningful difference between the two major players and as long as the user is aware of that difference, it shouldn't matter.

Thanks for your help!
Phil

If you want to keep the "feel" like your fixed settings I would use a close minimum and maximum PS setting....like the 4 to 5 or even 4 min and 4 max so it stays the same so it will feel the same. If you go changing how it "feels" it possibly could affect sleep quality in general. The body likes for things to "feel" the same.

I don't advise using 0 minimum and 8 maximum PS. It won't feel anything like what you are used to and your body has been used to 4 cm PS for a long time. A large PS range might be suitable for someone on the ASV types of machines but could be a problem for people who don't already have central issues. It can sometimes cause centrals. A PS range of 3 to 5 is fairly common and likely to be very comfortable and unlikely to trigger centrals except in a very small minority of people.

Pugsy wrote:If you want to keep the "feel" like your fixed settings I would use a close minimum and maximum PS setting....like the 4 to 5 or even 4 min and 4 max so it stays the same so it will feel the same. If you go changing how it "feels" it possibly could affect sleep quality in general. The body likes for things to "feel" the same.

I don't advise using 0 minimum and 8 maximum PS. It won't feel anything like what you are used to and your body has been used to 4 cm PS for a long time. A large PS range might be suitable for someone on the ASV types of machines but could be a problem for people who don't already have central issues. It can sometimes cause centrals. A PS range of 3 to 5 is fairly common and likely to be very comfortable and unlikely to trigger centrals except in a very small minority of people.

Thanks, Pugs -- very good thinking. I certainly don't need my own machine slapping me around at night.

By the way, Pugsly -- the humidifier. I also purchased the newer, heated unit w/heated hose but I am currently NOT using the unit on the BIPAP Pro. Can I simply not hook the heater up on the hose and leave it turned off in the software and have it blow straight through without adding any humidity like I do now? There is plenty humidity where I live so I don't need any help in that area until possibly winter.

Thanks,
Phil

Yes, you can turn off the heated hose and the humidifier and still use either or both if you wish.
Or use a regular hose and turn the heat off. ...with or without water.

The heated hose can be turned off so that the air in the hose isn't warmed.....and the humidifier settings on, off or whatever number are independent of the heated hose.

Not sure if you can heat the air in the hose without humidifier being on though. I haven't tried that but it might work.

I have now actually taken the unit out of the box and have been fooling with the settings. It looks like to reach the prescribed settings of 12E and 17I, I must set the min and max PS to "5". I might be better off to just set the E to 12 and the I to 22 and let the machine do as it pleases, leaving the PS settings alone. What y'all think?

Phil

12/17....that means PS of 5...that's true. Even in auto mode if you do those settings with PS 5/5...that makes the machine work like a fixed bilevel mode.
I thought you were wanting to try Auto mode. If so all you have to do is in auto mode 12 EPAP PS min and max set to 5 and PS will be fixed. If you do a range of PS then PS will also roam. You want at least PS min of 2 though. I don't think you will like if the difference between EPAP and IPAP is less than 2 and you might not like 2.
And then set the max IPAP up wherever. When you start the night the pressure would be 12 EPAP and if you use 5 PS min and max then IPAP will be 17 but could go higher if needed. If needed to go higher then IPAP drags EPAP up with it if you use 5/5 PS

Pugsy wrote:12/17....that means PS of 5...that's true. Even in auto mode if you do those settings with PS 5/5...that makes the machine work like a fixed bilevel mode.
I thought you were wanting to try Auto mode. If so all you have to do is in auto mode 12 EPAP PS min and max set to 5 and PS will be fixed. If you do a range of PS then PS will also roam. You want at least PS min of 2 though. I don't think you will like if the difference between EPAP and IPAP is less than 2 and you might not like 2.
And then set the max IPAP up wherever. When you start the night the pressure would be 12 EPAP and if you use 5 PS min and max then IPAP will be 17 but could go higher if needed. If needed to go higher then IPAP drags EPAP up with it if you use 5/5 PS

OK, Pugsy -- now I'm confused. I read what you wrote above 5 times and I SWEAR you wrote the same thing twice but with different results. If you are trying to confuse me -- it worked.

You said, "Even in auto mode if you do those settings with PS 5/5...that makes the machine work like a fixed bilevel mode."
Then you said, " If needed to go higher then IPAP drags EPAP up with it if you use 5/5 PS"

Yes, I want the machine to work in auto. What I am trying to accomplish is my Doc's recommendation of IPAP 17 to 22 and EPAP of 12 to 17 and let the machine work within those ranges. Is that possible? If so, how? Where did "2" come from?

Sorry for being so dense.

Phil

Phil,
On an Auto BiPap machine, pressure support is the minimum difference in pressure between IPAP and EPAP.
On the 750, my prior machine, there was only one pressure support setting.
Apparently, on the 760 you can set a minimum and maximum for pressure support.

So, starting with an EPAP of 14 cm H2O and a max IPAP of 25,
Then PS 5/5, i.e. PS min = PS max = 5 cm H2O says that EPAP can range from 14 to 20 and IPAP can range from the current EPAP+ 5 to 25. All in auto mode.

JDS74 wrote:Phil,
On an Auto BiPap machine, pressure support is the minimum difference in pressure between IPAP and EPAP.
On the 750, my prior machine, there was only one pressure support setting.
Apparently, on the 760 you can set a minimum and maximum for pressure support.

So, starting with an EPAP of 14 cm H2O and a max IPAP of 25,
Then PS 5/5, i.e. PS min = PS max = 5 cm H2O says that EPAP can range from 14 to 20 and IPAP can range from the current EPAP+ 5 to 25. All in auto mode.

OK, JDS -- you almost have me there. Thanks for that. Now---

In your above scenario, what allows the machine to go 20 EPAP when 20-14=6?

Maybe better yet, in my setup, what will happen?

BIPAP Auto set. IPAP at 22, EPAP at 12 -- min PS set at 5, max PS set at 5. What will happen as pressure requirements change?

Boy, I feel dumb.

Phil

Phil587 wrote:BIPAP Auto set. IPAP at 22, EPAP at 12 -- min PS set at 5, max PS set at 5. What will happen as pressure requirements change?

At the above settings in auto mode when you start out and just turn the machine on you will see
EPAP of 12 and IPAP of 17 because of the PS of 5.....that's what it starts out with and only changes as the machine sees the need to change.
With the PS min and max the same then the difference between EPAP and IPAP will always be 5 cm.
So if the machine wants to go to 13 EPAP then IPAP goes up to 18
if the machine wants to go to 14 EPAP then IPAP goes up to 19
If the machine wants to go to 15 then IPAP goes up to 20
and so on until the max IPAP of 22 is reached (if it is reached or needed) and at that time EPAP will be 17.
The pressure will go up and down through the night but never below the minimum EPAP and never above the max IPAP.

Give me a little bit and I will try to find an old report from my PR S1 760 machine and you can see how it moves around. My settings on the EPAP minimum would be a little different and I used PS of 4 min and 5 max just because I liked that range. It felt good.

Pugsy wrote:

Phil587 wrote:BIPAP Auto set. IPAP at 22, EPAP at 12 -- min PS set at 5, max PS set at 5. What will happen as pressure requirements change?

At the above settings in auto mode when you start out and just turn the machine on you will see
EPAP of 12 and IPAP of 17 because of the PS of 5.....that's what it starts out with and only changes as the machine sees the need to change.
With the PS min and max the same then the difference between EPAP and IPAP will always be 5 cm.
So if the machine wants to go to 13 EPAP then IPAP goes up to 18
if the machine wants to go to 14 EPAP then IPAP goes up to 19
If the machine wants to go to 15 then IPAP goes up to 20
and so on until the max IPAP of 22 is reached (if it is reached or needed) and at that time EPAP will be 17.
The pressure will go up and down through the night but never below the minimum EPAP and never above the max IPAP.

Give me a little bit and I will try to find an old report from my PR S1 760 machine and you can see how it moves around. My settings on the EPAP minimum would be a little different and I used PS of 4 min and 5 max just because I liked that range. It felt good.

Thank you, Pugsy!

So, if I read you correctly this time, my settings as stated with PS min/max set at 5 should give me the results I desire -- a machine that will range from 12 to 17 on EPAP and 17 to 22 on IPAP and never separate by more than 5 CM3 and do that automatically as required. That's what I am after! If I were to change the min PS to zero, my machine might possibly run the same pressure IPAP and EPAP. GAK!

You report would be helpful if you can find it.

Thank you!
Phil