How to Run a PR auto-BiPAP like an APAP?

Hello,

First let me introduce myself by saying thank you for all the work you put into this board. I have been having an incredibly difficult time with my doctors and my insurance and this community has offered some relief.

I was recently prescribed for an APAP by my pulmonologist, and ran into a wall when working with his preferred DME after finding out my employer's provider offers no DME coverage.

After several months of frustration at being stymied on other therapies related to my underlying issue (a horrendous, unprecedented asthma flare) I decided to take things into my own hands. I was able to pick up a PR Dreamstation Auto BiPAP with zero blower hours, for less than the DME wanted for an APAP, and dove right in after researching and discovering that it could run in CPAP mode by accessing the Therapy menu.

Now the machine is here and I realize that CPAP mode does not equal APAP mode! In order to meet my original goal I will need to tweak with the pressure settings in auto-BiPAP mode.

I have searched a lot of posts but none answer my question for this particular machine directly. For other machines there have been two conflicting suggestions:

-set ePAP and iPAP to 20 and PS min and PS max to 0. For the machine being discussed, someone said there was an arbitrary PS min of 2 but on my Dreamststion the 20/20/0/0 setting is at least possible on the menu... From what I understand, however, this is the same as a straight CPAP set to 20 since the PS numbers are flat.

-set ePAP and iPAP closely (e.g. 12/15) and set PS min to 2-3 and PS max to 5-8 in order to give the auto-BiPAP function plenty of room to titrate itself....This makes sense from what I understand about how PS gives auto "leeway" but begins to take me off the path to a strict APAP emulation.

As an EMT I am both confident I can work this out !acceptably! with some help and education, yet humble enough to know I need to do more research before proceeding. I am beginning to reach the concepts of BiPAP basics here but the Auto function complication is still exceeding my grasp. I wish I had the time, money and health to play this by the doctors but I crossed that Rubicon quite some time ago and am willing to accept the risks.

I can always sell the machine for a nice profit but have seen lots of folks wish someone told them to start with an Auto-BiPAP from the get-go. That makes me think it could be best to start out as close to APAP with what I got, and keep the trump card of extra capabilities should it be beneficial as things progress.

That's it for now. Thanks for reading and all input is appreciated even if you just want to remind me how fallible, gullible, dingy and dull I am. If you have actual settings advice that is just icing on the cake.

Welcome to the forum.

If you want to set the auto bipap in auto mode to mimic apap in auto adjusting mode all you have to do is use PS minimum of 0 and maximum of 0.
It's the addition of PS that gives you a true bilevel situation with 2 distinct pressures being used...1 for inhale(ipap) and 1 for exhale (epap).

Minimum EPAP would then be like the minimum pressure setting on the apap....and maximum ipap would then be like the maximum on the apap........this is when PS is set to 0 for both minimum and max.
A good starting point would be minimum EPAP of 6 and max of 20 with PS set to 0 for both...then it would work like an apap.

Should you decide that you want to try to add PS and have the PS have a range....I don't recommend the max PS being more than 5 unless closely monitored. Sometimes higher PS can trigger centrals in some people....so be cautious if you want to have a range of PS at least until you get comfortable playing with the various settings. Usually I suggest a modest PS range of 3 min and 5 max if someone wants a range or start off with fixed PS of 4 is a good starting point.
PS is mainly a comfort feature because it's the difference between inhale and exhale that offers the comfort. It can help especially when someone has difficulties exhaling against higher pressures or the pressures cause some unwanted symptoms like aerophagia or simply because someone just likes how it feels.

If you don't already have the clinical/provider manual for your machine go here and get it.
There's a lot of useful explanations in it that aren't in the regular user manual.
https://www.apneaboard.com/adjust-cpap- ... tup-manual

That arbitrary PS minimum of 2 by default that you read about only pertains to the PR System One 50 Series and older bipaps.
Doesn't apply to the 60 Series or the DreamStation models.

Brilliant!

Many thanks; that is just what I needed to get started.