New to BiPAP/Needing some assistance

Hi all,
I was given a BiPAP a few days ago after zero progress was made on a CPAP (actually - CPAP made me feel worse). I've only used the new machine a couple days but so far not much progress, however I don't feel as bad as I did using the CPAP. I've attached some data for review..let me know if there is anything else that might come in handy.

Here are a few observations so far:

-The biggest concern I have is with my inhale/exhale times. The majority of the time it seems I am breathing OUT about twice as long as breathing in. The exact ratio given by the machine is 1:2.2 - this doesn't seem normal to me but I am not sure how to remedy it. I've included an enlarged screenshot on the INSP/EXP graph for reference.

-Pressures were prescribed at 15 IPAP/11 EPAP but I changed to 15/9 the first night and 15/10 the second night.

-My AHI has gone up - 11.34 on the first night and 5.46 the second night. Almost all events were CA, I believe only 1 or 2 were OA.

-Last night when I got up to use the restroom, I felt slightly dizzy - could this have something to do with the INSP/EXP issue?

-The TI Max setting was set to 2.0 and TI Min was 0.3. I changed this to TI 2.5 to see if that would help with the inhaling but I'm not sure it did.

This is about all I can come up with right now. Please let me know if anyone notices anything that may not seem right. Any info or general advice for using BiPAP is greatly appreciated!

Actually your I:E ratios are within a normal range.
https://derangedphysiology.com/main/cic ... -ratio-and

I have a bilevel machine and I just checked and my Expiratory time is a little bit higher than yours on average

Jake B wrote: ↑

Sat Oct 31, 2020 9:19 am

I changed to 15/9 the first night

Jake B wrote: ↑

Sat Oct 31, 2020 9:19 am

My AHI has gone up - 11.34 on the first nigh

This doesn't surprise me. More CAs/Central apneas because of the PS (pressure support which is the difference between inhale and exhale) was at 6. For some people increasing PS causes too much carbon dioxide to be washed out and it's the carbon dioxide levels which actually trigger the brain's signal to the body to "breathe".

The centrals reduced a bit the second night with the reduction in PS to 5.

How about trying the prescribed settings which amount to a PS of 4? Go back to the original default Ti Min and Max settings as well.
There is a reason those are the default settings.

You are changing things all over the place and making multiple changes and that makes for a really hard to evaluate accurately experimentation. You have no idea which change might have caused what result.

Now if you have known pulmonary issues with restrictive lung disease of some sort then some adjustments might be needed but they need to be done in conjunction with a doctor's input. It's not something people should be doing willy nilly. Not only does the body need adequate oxygenation it also needs adequate removal of carbon dioxide. There has to be a balance in the exchange of gases.
You are messing with the balance.

For some people pressure support increase does cause central apneas. Sounds like you might be one of those.
Back off PS to what the prescribed settings were and see how many centrals per hour you have. You might end up needing less PS to keep the centrals away. I have a friend that gets about 15 centrals per hour with PS of 4 and essentially none with PS of 3.

Pugsy wrote: ↑

Sat Oct 31, 2020 9:45 am

Actually your I:E ratios are within a normal range.
https://derangedphysiology.com/main/cic ... -ratio-and

I have a bilevel machine and I just checked and my Expiratory time is a little bit higher than yours on average

Jake B wrote: ↑

Sat Oct 31, 2020 9:19 am

I changed to 15/9 the first night

Jake B wrote: ↑

Sat Oct 31, 2020 9:19 am

My AHI has gone up - 11.34 on the first nigh

This doesn't surprise me. More CAs/Central apneas because of the PS (pressure support which is the difference between inhale and exhale) was at 6. For some people increasing PS causes too much carbon dioxide to be washed out and it's the carbon dioxide levels which actually trigger the brain's signal to the body to "breathe".

The centrals reduced a bit the second night with the reduction in PS to 5.

How about trying the prescribed settings which amount to a PS of 4? Go back to the original default Ti Min and Max settings as well.
There is a reason those are the default settings.

You are changing things all over the place and making multiple changes and that makes for a really hard to evaluate accurately experimentation. You have no idea which change might have caused what result.

Now if you have known pulmonary issues with restrictive lung disease of some sort then some adjustments might be needed but they need to be done in conjunction with a doctor's input. It's not something people should be doing willy nilly. Not only does the body need adequate oxygenation it also needs adequate removal of carbon dioxide. There has to be a balance in the exchange of gases.
You are messing with the balance.

For some people pressure support increase does cause central apneas. Sounds like you might be one of those.
Back off PS to what the prescribed settings were and see how many centrals per hour you have. You might end up needing less PS to keep the centrals away. I have a friend that gets about 15 centrals per hour with PS of 4 and essentially none with PS of 3.

Thanks for the reply. So you are saying it is normal to exhale more than I inhale? The original reason I wanted to switch to bipap was because I couldn't breathe out well which I thought could cause CO2 buildup or small arousals while I was struggling to exhale.

I am going to go back to original settings and see what happens... I changed them around to what I thought would be best for me. Luckily I don't feel as terrible as I did using CPAP, but as I mentioned I haven't made too much progress yet.

Jake B wrote: ↑

Sat Oct 31, 2020 11:44 am

So you are saying it is normal to exhale more than I inhale?

I provided one link to document a normal I:E ratio. There are others if you search. Did you read the document?
Unless someone has significant lung disease or issues...yes, expiration takes longer than inspiration for optimal gas exchange.

Jake B wrote: ↑

Sat Oct 31, 2020 11:44 am

The original reason I wanted to switch to bipap was because I couldn't breathe out well which I thought could cause CO2 buildup or small arousals while I was struggling to exhale.

Your first machine was the ResMed AutoSet with EPR set to 3. You had trouble exhaling against your prescribed settings.
The Setting of 3 EPR is pretty much equal to PS of 3 on your new machine and it is the difference between inhale and exhale that makes it easier to exhale. So your doctor increased the difference to 4 cm with the bilevel machine. EPR won't go above 3 cm reduction during exhale.

CO2 build up is actually a needed part of the blood gas balance. It's what triggers the brain to send the breathe signal to the body.
Having trouble exhaling against cpap pressure isn't because of CO2 build up. It's just because for some reason you find it difficult to exhale against your pressure. It happens to some people. When you used PS of 6 your caused too much CO2 to be blown off and your brain didn't know to send the breathe signal to the body and when we don't breathe on our own that's a central apnea. The airway is open but there is no effort to breathe.

Get the I:E ratio stuff out of your head right now. There is actually a normal range for most people. It's not your problem.

Use your machine while awake...watching TV or reading so that your body/brain gets used to the new way of breathing and just breathe normally. If you continue to have a problem exhaling against the pressure then maybe a lower starting minimum EPAP is in order.

Not everyone has a problem with more PS causing centrals but it is unfortunate that you drew the short straw in that regard.
The very thing that makes it easier for you to exhale against the pressure actually causes central apneas for you. A small percentage of bilevel machine users find this happens to them. You may or may not have a higher than you want number of centrals with PS of 4.
Now is it possible that the central apneas are disturbing your sleep? Entirely possible. You end up caught between a rock and a hard place kind of thing. Obstructive apneas causing sleep disruption or the fact that cpap therapy causes centrals which can cause sleep disruption. Just replacing one type of apnea event for another but the results end up being the same.
Now I don't know that is what is going on in your situation but it wouldn't be impossible.

I read your old thread from back in April. You felt worse on cpap than without but we never really were able to isolate the why behind the worse feeling. I don't remember if you mentioned problems exhaling causing problems sleeping or that you even had problems sleeping. You have a doctor trying to help you resolve your issues....listen to him/her. That's the best thing to do to at least start with.
Give the doctor's idea a fair trial. The increase to PS of 4 from essentially PS of 3 is/was the next logical step since you feel you had problems exhaling against the pressure.

Jake B wrote: ↑

Sat Oct 31, 2020 9:19 am

-The biggest concern I have is with my inhale/exhale times.

Which is why I argued *AGAINST* having the IE times shown in anything but expert mode, because people that don't know anything about it think it's some sort of a problem.

It's not.

Jake B wrote: ↑

Sat Oct 31, 2020 9:19 am

this doesn't seem normal to me

What would 'seem" normal?

Jake B wrote: ↑

Sat Oct 31, 2020 9:19 am

but I am not sure how to remedy it.

There's nothing to remedy.

Jake B wrote: ↑

Sat Oct 31, 2020 9:19 am

-Pressures were prescribed at 15 IPAP/11 EPAP but I changed to 15/9 the first night and 15/10 the second night.

Why?

Jake B wrote: ↑

Sat Oct 31, 2020 9:19 am

-My AHI has gone up - 11.34 on the first night and 5.46 the second night. Almost all events were CA, I believe only 1 or 2 were OA.

I'm not surprised.

Jake B wrote: ↑

Sat Oct 31, 2020 9:19 am

-Last night when I got up to use the restroom, I felt slightly dizzy - could this have something to do with the INSP/EXP issue?

No, it's because you were diddling with settings without knowing what they do, and you hyperventilated yourself.

Jake B wrote: ↑

Sat Oct 31, 2020 9:19 am

-The TI Max setting was set to 2.0 and TI Min was 0.3. I changed this to TI 2.5 to see if that would help with the inhaling but I'm not sure it did.

You really shouldn't be changing settings without knowing what you're doing. that said, increasing TIMax isn't going to hurt anything. (if that's what you changed).

palerider wrote: ↑

Sat Oct 31, 2020 11:30 pm

Jake B wrote: ↑

Sat Oct 31, 2020 9:19 am

-The biggest concern I have is with my inhale/exhale times.

Which is why I argued *AGAINST* having the IE times shown in anything but expert mode, because people that don't know anything about it think it's some sort of a problem.

It's not.

Jake B wrote: ↑

Sat Oct 31, 2020 9:19 am

this doesn't seem normal to me

What would 'seem" normal?

Jake B wrote: ↑

Sat Oct 31, 2020 9:19 am

but I am not sure how to remedy it.

There's nothing to remedy.

Jake B wrote: ↑

Sat Oct 31, 2020 9:19 am

-Pressures were prescribed at 15 IPAP/11 EPAP but I changed to 15/9 the first night and 15/10 the second night.

Why?

Jake B wrote: ↑

Sat Oct 31, 2020 9:19 am

-My AHI has gone up - 11.34 on the first night and 5.46 the second night. Almost all events were CA, I believe only 1 or 2 were OA.

I'm not surprised.

Jake B wrote: ↑

Sat Oct 31, 2020 9:19 am

-Last night when I got up to use the restroom, I felt slightly dizzy - could this have something to do with the INSP/EXP issue?

No, it's because you were diddling with settings without knowing what they do, and you hyperventilated yourself.

Jake B wrote: ↑

Sat Oct 31, 2020 9:19 am

-The TI Max setting was set to 2.0 and TI Min was 0.3. I changed this to TI 2.5 to see if that would help with the inhaling but I'm not sure it did.

You really shouldn't be changing settings without knowing what you're doing. that said, increasing TIMax isn't going to hurt anything. (if that's what you changed).

Wow. Okay then.

I also second Pugsy saying slow down what you are changing.

I also did not do well on a cpap at all.
Like you, a bipap was better but not good yet.

My respiratory was off way more than yours was.
I noticed that my TI Max was at the limit all the time so I upped it and all the other respiratory numbers balanced out instantly.
I don't see your TI Max, but you said upping it didn't help (it would only help if you were sitting at the max for the vast majority of the night).

My respiratory rate hangs around 12-14 most of the time with dips above and below.
My inspiration hangs between 1-2, with a few quick dips outside that.
My expiration hangs around 3-3.3 with some dips above and below that.

Figuring out Ti Max for me dropped me from an AHI of 15 to 8 (rough numbers).
Figuring out a positional issue dropped me down to where now most nights are close to 1 though it is common I will get up into a 2 something.
There are things I could try adjusting, but since things are pretty good I haven't gotten around to it yet.

Everyone is different so you need to find what works for you, but I agree with Pudsy, when you do a change, give it a couple nights before trying something else. It took me a couple weeks to get there, it doesn't happen overnight.