Back to bipap

So I finally got my Dr to raise the pressure on my bipap to 15-25. On CpAP I was set at 19 and getting AHI of 6-8. My first 2 nights of bipap have been AHIs of 11 and 10. Central-35, obstructive- 25, hypopneas 20. For some reason my 90% pressure is only going up to 19. My question is why isn’t it going higher in order to lower my AHI?

Need to see the detailed report please.

90% numbers just mean you were at or below that number for 90% of the night.

Which brand machine? What are your exact settings...all of them?

I have a dream machine bipap. IPAP max is 25. Epap is 15. PS is 2-6. I don’t have a computer so no further data available. About a month ago, you had suggested I would need a higher pressure range as it was precise set at 8-18 and I was getting AHIs of around 17. My Dr. Thought the Sam so re raised the range. So I am just confused as to why it isn’t going up higher now that it is able.

With EPAP at 15 and PS ranging from 2 to 6....you start the night at 15 EPAP and 17 IPAP...and it apparently isn't going very high if the 90% pressure is 19....is that EPAP or IPAP that is 90%?

Your AHI is weighted heavily towards centrals...clear airway apnea events. The machine won't respond to those at all...it can't fix centrals. It can only fix obstructive in nature events.

35 centrals over an unknown sleeping session time frame (it would help a lot if I knew just how long you slept)
and 45 obstructive in nature (the 25 OAs and 20 hyponeas) over an unknown sleeping session time frame
giving and AHI of 10...if I do the math right means roughly 55% of your AHI is central and 45% is obstructive.

So the AHI of 10...means the OA and Hyponea index was around 4.5 and the central index was around 5.5.

Ignore the central index for the time being...just look at the obstructive in nature stuff (those OAs and hyponeas)...4.5 per hour isn't horrible but it isn't great either....and we don't know the answer to one very important question...were you actually asleep when those were flagged???? The machine doesn't know if you are asleep or not so it can and will flag awake breathing irregularities by mistake.
I don't know when these events got flagged....did the bulk of them get flagged early in the night while you were awake and thus they aren't real and can't be considered worthy of worrying about. Or were they spread out all over the night and you were asleep????

We really, really, really need the detailed data to know if what you are seeing is worthy of worrying about or not.

Tell me....did you spend much time awake with mask on and machine on? Did you wake up often during the night?
The fact that the machine didn't go very high...could simply be that it didn't need to if the bulk of the flagging happened while awake and the parts of the night where you were asleep not much happened and it didn't need to do much.
Awake flagged events have to be removed from the evaluation process...they simply don't count.

I slept about 8.5 hours and I feel like I slept most of the night. I did wake up a couple of times but I don’t think for long. I think the IPAP was 90%. Unfortunately I have no way of knowing when the events are happening as you said. For some reason, I seem to do better on Cpap steady pressure of 19. Then I was getting usually 6-8. One night I had 1.4 which shocked me. I’m not sure what my Dr will advise when I see him in May.

And I feel tired. Less rested than I do with lower AHI.

You may simply need a higher EPAP to start with since the machine doesn't seem to want to go much higher.
And it's very possible that the OAs are real and maybe the clear airway events are more related to arousals from the OAs.
So much we don't know but if you did better at cpap using 19...then I think a better EPAP for you would be 18 or 19...
Worth trying.

I am not familiar with the history, but have there been trials of using a cervical collar, or positional therapy (AKA steps to not sleep on back), to see if that makes a difference in the AHI?

If your device decides it needs a PS of 6 at any given moment, that would limit your max EPAP in that instance to 19, since PS is just the difference between IPAP and EPAP, and it can only adjust within the constraints of the settings.

I would say your baseline EPAP of 15 is inadequate. I'd raise the EPAP min and IPAP min by 1 at the same time, until you're able to more or less prevent those obstructive apnea and hypopnea from occurring. Then you get to see what's left over.

If you set the PS range a bit more conservatively, that would allow the EPAP to go a bit higher if need be, but since the PR machines are slow to react, focusing on the min pressures required will be a major key.

raisedfist wrote: ↑

Fri Mar 22, 2019 1:17 pm

I'd raise the EPAP min and IPAP min by 1 at the same time,

There is no IPAP minimum setting on this machine unless she has one that is different than I suspect she has.
IPAP minimum would go up simply with EPAP minimum increase assuming no change in minimum PS.
I also doubt seriously if it ever comes near to using the max PS of 6....they just don't normally work their way that high. I am betting if we could see a report the PS averages between 2 and 4.

She could maybe help reduce the hyponeas by setting PS min to 4 instead of the 2...so that would force IPAP up without changing EPAP and it might help some but I also feel that more EPAP is likely needed. She's not into changing stuff herself though. I remember that from her other thread. I don't know if those feelings have changed or not.

With no computer available....have never even seen what she had as results on the apap...and now the bipap.
Kinda flying blind here.

Thanks for the input. I have been adjusting my machine on my own abit. I think I will try raising the epap as suggested. Can’t hurt to try.

Assuming those OAs and hyponeas are real and what you were getting with the apap at 19....I am thinking 18 or 19 for minimum EPAP and don't change anything else.
One change at a time so you can best evaluate the results...

Maybe work up slowly... up 1 cm every 3 or 4 days and watch the data every day.

SherriT wrote: ↑

Fri Mar 22, 2019 3:21 pm

Thanks for the input. I have been adjusting my machine on my own abit. I think I will try raising the epap as suggested. Can’t hurt to try.

will the sleepyhead software work with your machine?

and what IS your machine?

zonker wrote: ↑

Fri Mar 22, 2019 3:35 pm

will the sleepyhead software work with your machine?

and what IS your machine?

She has a Respironics DreamStation Auto BiPap....but she doesn't have a computer....so while SleepyHead will work just fine with her machine she doesn't have a computer to put SleepyHead on or know anyone whose computer she can use.
We went all through this back when she had the DreamStation APAP...
It sucks but all we have is DreamMapper and the limited data on the LCD screen.

If at some point you want to get another SD card....and snail mail this current SD card to me...I can plug it into to my software and get an idea what's going on.
I would of course mail it right back to you.

I would want at least 2 weeks worth of data though....and preferably some with EPAP at a higher setting also.

Pugsy wrote: ↑

Fri Mar 22, 2019 3:50 pm

zonker wrote: ↑

Fri Mar 22, 2019 3:35 pm

will the sleepyhead software work with your machine?

and what IS your machine?

She has a Respironics DreamStation Auto BiPap....but she doesn't have a computer....so while SleepyHead will work just fine with her machine she doesn't have a computer to put SleepyHead on or know anyone whose computer she can use.
We went all through this back when she had the DreamStation APAP...
It sucks but all we have is DreamMapper and the limited data on the LCD screen.

you're memory is MUCH better than mine!

prehaps the op would be so kind as to put said info in her sig?