respironics m series bipap auto - Help pleeeeeease!

For those experienced in using thte respironics m series bipap auto, I could use some guidance here. I've read what posts I can find on this machine, and am amazed how well everybody else does with it. I just can't get any beneficial therapy.

My 2 nights of sleep studies, with second night spent on titration, resulted in a bipap recommendation for pressures set at 9/5. So far, so good. I get the new respironics m series bipap auto, and turn on the A/HI, mask leak alarm, etc, to see how I'm doing. I have the software and smart card, but the reader order just got processed, so I'm 2-3 weeks away from being able to get nightly data. For now, I have only the 7 day and 30 day capability to view my A/HI data.

Now for the problems. Despite checking my mask very carefully for leaks, using a hose cover to prevent rainout, and all the little tricks I read online, and being 100% compliant, I get absolutely no treatment results from 5 weeks of using this machine. When I realized that I had absolutely no reduction in A/HI on this 9/5 pressure routine, as compared to my first sleep study without xpap, I called the DME. She insisted I had major mask leaks. I really don't think I do. I have worn each of my 3 masks for one week trials, tweaking and have them all working perfectly. (Swift, Comfort Gel, and a Hybrid). I'm religious in my bedtime routine. I waken alot due to joint pain, and any time I awaken, I have no mask leaks. I never take my mask off.

DME states this machine isn't one she has experience with (got it on my own insistence, based on reading on forums, and the fact that we live a sailing/cruising lifestyle, and need to be able to self monitor and keep in touch with pulmy by phone). She says, call respironics, rather than have her try to do it second-hand. I have no problem with this, and call respironics, who advise me my pressure settings may not be letting the machine do the auto-titration, too narrow a range setting between IPAP and EPAP. They obviously don't want to be making medical decisions and refer me to my pulmy for pressure increase adjustments.

I call my pulmy, who doesn't have a clue what this bipap auto can do. He further doesn't even remember I'm on a bipap. Grrrrr. He seems to be a good pulmy, but, this isn't what I want to hear. So I tell him what kind of machine I have, that it is a bipap, per the sleep lab doc's prescription, and that I didn't want to make any adjustments (tho I know how to change the pressures), without medical guidance. My pulmy agrees the pressures are wrong (all that money I have to pay a sleep lab that can't figure out what pressure...or hurried the titration process and didn't get the right pressure). So, my pulmy agrees I can tinker with the pressures in small increments and keep in touch, while I monitor. Remember, all I have to go on is the 7 day rolling average til my card reader comes. Next my pulmy says, just try the machine on a straight CPAP pressure of 7 for both IPAP and EPAP. Well, duh, it's a bilevel machine.

Now, I have my pulmy's blessing to make small adjustments, despite my interstitial lung disease, so I don't think he is horribly worried about the pressures being a bit off during this 'self home titration'.

Now, the issue is that I started out upping my IPAP only, changing it by a .5 setting, and keeping it there for 3-4 days, and watching the 7 day averages. The A/HI seemed to get a tad better at 10, so I upped IPAP pressure to 10 1/2, and AHI got worse. So I stopped upping IPAP, and upped the EPAP pressure to 6. A/HI gets worse again. So next i upped the IPAP to 11, and it gets even worse.

Am I doomed to just keep using a machine that isn't working for my sleep apnea til I get my card reader and can tell what the 'bleep' is going on? Am I able to accomplish anything with this self-titration game of blind man's bluff with only a 7 day rolling average to go on? My pulmy seems good as a pulmy, but I'm wishing I had a sleep doc taking a bit more interest in this pressure problem. I don't feel I should have to sleep with a machine for weeks on end that is not giving me even a 5% improvement. Frankly, I've spent alot of money I don't have on this and I'm getting really frustrated. Is the DME rep and pulmy's lack of knowledge of auto bipaps going to be a bad professional team? Is there a decent beginning setting that will auto titrate and give me the optimal settings? I really thought I had enough of a brain to do this, but, it's not working at all.

I'm so sad. I'm so sick of being sick. Ready to throw this machine overboard! I've been in contact with Rested Gal, but despite all the help, nothing is working for me!

girlsaylor

Some people delete the past nights so they can get one-night results on these machines. The problem with a 7 night average is that it is definitely difficult to see when the change happens. Do you know how to zero out the past days? I have a different machine, so I can't tell you, but I know it has been discussed on the forum.

If you are set to 5 EPAP/9 IPAP, then your exhale will always be from 5 to 7, and your inhale will always be 7-9. The EPAP is a minimum setting, the IPAP is a maximum, and there will always be a minimum of 2 cm pressure difference between the two.

You have a very narrow pressure range, and not particular high pressures, so did the doc want you to have a bipap because of your preexisting lung problem? That makes a difference in tweaking your pressures. If you didn't have the lung problem, I would feel confident telling you that it would be ok to open up the pressures a lot so the machine can titrate for you. However, it looks like you need to be more careful than other people.

Trial and error settings will work, but yes, it will be frustrating. I hope you get your card reader soon, because that should help a lot.

It sounds like you have the mask leaks fixed. Do you have any doubts about potential mouth leaks? That can have the same impact as a mask leak.

Good luck and happy sailing!
Moogy

Girl,

How frustrating!!!

Unfortunately, I don't see a quick fix in your immediate future : (

Moogy's advice seems spot-on.

Having the card reader is huge. You may have to grin and bear it til then.
When you get it, you can analyze the data much better, and make informed adjustments.

Please hang in there, better days are coming!!!

Rick

Girlsaylor, sometimes it's necessary to go backwards for a little while before you can make forward progress. (That's especially true in sailing, by the way.)

girlsaylor wrote:Next my pulmy says, just try the machine on a straight CPAP pressure of 7 for both IPAP and EPAP.

Girlsaylor, your pulmy's right about this. I had to run my BiPAP-auto with IPAP=EPAP (i.e., CPAP) for a while when I first started, too. The pressure of 7 cm serves as a baseline for you (as I presume that was your titration pressure). It should be easy to set your machine to 7 cm for a few nights. I had no problem setting my BiPAP-auto to constant IPAP=EPAP pressures, so I can't imagine the M-series is any different.

Once you have recorded a few nights at 7 cm = IPAP = EPAP, then change up or down by 1 cm every few days and see what impact that makes. Your pulmy will understand how to interpret these results and so will you. After you and your pulmy are both satisfied that you've found your best setting for CPAP (i.e., IPAP=EPAP), then take the plunge to BiPAP mode and see if running the machine in auto mode can lower your AHI or improve your nightly sleep.

By the time you've done all this, you'll be getting confident in operating your machine and interpreting the data. Your results will provide clues about which direction to go in order to fine tune your therapy. Be patient. Be easy on yourself, your machine and your pulmy. Many, maybe even most of us here, have had to work through our own ordeals in order to optimize our therapy. It rarely seems to come quickly or easily.

Regards,
Bill

I don't see how to set it at a straight 7...doesn't seem to allow it...

On my BiPAP-auto, it's as easy as setting IPAP=7 and EPAP=7.

Regards,
Bill

Had to take it off bipap auto and go to straight bipap setting; then it allowed me to set it at 7 for both IPAP and EPAP. Now I can do a few nights per my pulmy's instructions.

Can't figure out how to zero out my past days to get just one night's results rather than the 7 day average...trying to find a relevant post on the M series addressing that. Would be nice if I could do that and not have to wait til the card reader comes.

Anyhow, at least we got the straight 7 figured out so I can take those results to my pulmy and see where to go from here. It's just hard knowing that I've been working this thing for 5 weeks knowing the pressures aren't doing anything for me. Wrong pressure may as well be no treatment at all. Trying to not be too hard on my pulmy. But I sure don't feel I'm getting medical guidance from the medical field on this one. Thankfully there are people here to help! And being ill doesn't allow me the luxury of crawling into bed; too many demands on me. During the week I've been varnishing when not doing routine stuff. Weekends I work along with DH on the mast at the yard. 7 days a week, no matter how rotton I feel. Been wearing a mask while working to try and filter some of the dirt out of the lungs. Seems to help coughing some.

girlsaylor

by default "Reporting" to the LCD is OFF. You have to enable that feature before it will display on the LCD.

Check the box the machine came in, there should be a card that says Homecare Provider Setup or Instructions. It tells you how to access setup and also should display a "tree" of all the parameters on your machine.

Even though yours is a Bi-pap, it should have the following field that needs to be enabled or set to ON: By default it comes set to OFF.

-Show AHI/Leak Feature=ON (On/Off)

I don't have the box the machine came in, Snoredog. But I do know how to get into settings. I already have enabled the show A/HI Leak feature. I get only the rolling 7 day and 30 day averages, nothing for a single night.