Changing BiPAP Settings

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Holden4th
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Changing BiPAP Settings

Post by Holden4th » Wed Oct 06, 2021 3:50 pm

It's been a long time since I posted

After getting a BiLevel machine a few years ago and making adjustments to get optimal settings, I settled into a long period of good nights of sleep. However, over the last year or so, sleep has not been quite as good and is deteriorating. Daytime fatigue has also become prevalent. I've been putting this down to a medical issue (cardiac arrhythmia due to mitral valve prolapse) but an event last night has changed my thinking.

For quite a few months now I've been waking up more than once at night with a feeling of breathlessness. Often, when trying to go back to sleep, I put the nasal mask back on but the feeling of being short of breath remains and I either have to take it back off in a hurry or really focus on my breathing to get it steady and under control.

This occurred again last night and after the third time, on a whim and out of sheer desperation, I went into the settings control of my Resmed Aircurve V10 and made three changes. These were:

IPAP from 20 to 25
EPAP from 9.5 to 12.0
PS from 4 to 5

The effect was instantaneous, I put the mask back on, immediately felt comfortable and was asleep in 5 minutes, I slept through to my alarm.

I suspect that not all three of these changes was necessary and am seeking advice as to which of them to tweak. In hindsight, I can't see the IPAP change having much effect (but you never know) - I'll look at some OSCAR charts tonight. This leaves the question as to whether I only change EPAP, PS or both. Raising EPAP seems counter intuitive but I've also heard that this will increase Tidal Volume and maybe my feeling of being short of breath is a result of my TV being too low - but I don't really know.

Once I get some guidance from here I'll start tweaking. Any other ideas would be much appreciated.

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ChicagoGranny
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Re: Changing BiPAP Settings

Post by ChicagoGranny » Wed Oct 06, 2021 4:35 pm

Holden4th wrote:
Wed Oct 06, 2021 3:50 pm
Once I get some guidance from here I'll start tweaking. Any other ideas would be much appreciated.
Without seeing your data, it would mostly be guessing. You need to post a screenshot of a typical night using the latest settings. Screenshot-posting instructions are here - https://www.cpaptalk.com/viewtopic/t158 ... eview.html

Holden4th
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Location: Gold Coast Australia

Re: Changing BiPAP Settings

Post by Holden4th » Sun Oct 17, 2021 1:04 am

Hello All

I've attached three different nights. The one from August is a good one. In the others you can see the broken nights sleep though it's not the worst. Is there a graph I should have included?

EDIT:
Based on what Pale Rider said in another thread, I've raised the EPAP to 11.0, set the IPAP at 20.0 (could I go max anyway?) and put pressure support at 4.0

Comments please

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Attachments
screenshot- Oct 15.png
screenshot- Oct 15.png (194.5 KiB) Viewed 589 times
screenshot- OCT 11.png
screenshot- OCT 11.png (186.27 KiB) Viewed 589 times
screenshot-Aug 5.png
screenshot-Aug 5.png (185.8 KiB) Viewed 589 times

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Pugsy
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Re: Changing BiPAP Settings

Post by Pugsy » Sun Oct 17, 2021 7:48 am

Any new meds or change in dosage of old meds?

Changing IPAP max isn't a factor (but doesn't hurt to make the change) since you never go anywhere near max anyway.

Now changing PS even just a little can make a difference on how things feel when it comes to breathing those breaths and are those breaths comfortable or not.

My personal opinion... I would be wondering why my breathing needs seemed to have changed and the first thing I would look at would be your recent health issues.
It sure looks like your overall sleep quality is in the toilet but I have my doubts as to it being from OSA issues and a need for tweaking from a therapy point. Now maybe from a comfort point....maybe.

Something is trashing your sleep quality in general. Figuring out what may take some detective work.
I think your original EPAP setting was fine....if it had been me I would play with PS first from a comfort aspect.

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Miss Emerita
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Re: Changing BiPAP Settings

Post by Miss Emerita » Sun Oct 17, 2021 11:41 am

What is happening to cause the breaks in therapy? A need to urinate? Getting up for some other reason? Or??
Oscar software is available at https://www.sleepfiles.com/OSCAR/

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palerider
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Re: Changing BiPAP Settings

Post by palerider » Sun Oct 17, 2021 1:41 pm

Holden4th wrote:
Sun Oct 17, 2021 1:04 am
Hello All

I've attached three different nights. The one from August is a good one. In the others you can see the broken nights sleep though it's not the worst. Is there a graph I should have included?

EDIT:
Based on what Pale Rider said in another thread, I've raised the EPAP to 11.0, set the IPAP at 20.0 (could I go max anyway?) and put pressure support at 4.0

Comments please
I'd bump the EPAP to 12, may need to go to 13.

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Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

Holden4th
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Location: Gold Coast Australia

Re: Changing BiPAP Settings

Post by Holden4th » Sun Oct 17, 2021 4:08 pm

Miss Emerita wrote:
Sun Oct 17, 2021 11:41 am
What is happening to cause the breaks in therapy? A need to urinate? Getting up for some other reason? Or??
Thanks for everyone's input.

Initially, I would wake feeling breathless and I wondered if my mitral valve issue was a possible cause. My cardiologist says no and he's the expert.

I'm going to try PRs suggestion of raising the EPAP to 12 and see what happens. I'm not sure what to do about pressure support which is currently set at 4.0. Should I drop it back to 3, leave it at 4 or raise it further?

I'll do another screen shot after tonight.

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palerider
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Re: Changing BiPAP Settings

Post by palerider » Sun Oct 17, 2021 5:44 pm

Holden4th wrote:
Sun Oct 17, 2021 4:08 pm
Miss Emerita wrote:
Sun Oct 17, 2021 11:41 am
What is happening to cause the breaks in therapy? A need to urinate? Getting up for some other reason? Or??
Thanks for everyone's input.

Initially, I would wake feeling breathless and I wondered if my mitral valve issue was a possible cause. My cardiologist says no and he's the expert.

I'm going to try PRs suggestion of raising the EPAP to 12 and see what happens. I'm not sure what to do about pressure support which is currently set at 4.0. Should I drop it back to 3, leave it at 4 or raise it further?

I'll do another screen shot after tonight.
I'd leave it where it is for a bit, see if the higher EPAP smooths out the pressure trace, and then if so, you can experiment with the PS to see which way works better for you.

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Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR

Accounts to put on the foe list: dataq1, clownbell, gearchange, lynninnj, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

Holden4th
Posts: 569
Joined: Wed Feb 24, 2016 3:15 am
Location: Gold Coast Australia

Re: Changing BiPAP Settings

Post by Holden4th » Tue Oct 19, 2021 2:30 am

palerider wrote:
Sun Oct 17, 2021 5:44 pm
Holden4th wrote:
Sun Oct 17, 2021 4:08 pm
Miss Emerita wrote:
Sun Oct 17, 2021 11:41 am
What is happening to cause the breaks in therapy? A need to urinate? Getting up for some other reason? Or??
Thanks for everyone's input.

Initially, I would wake feeling breathless and I wondered if my mitral valve issue was a possible cause. My cardiologist says no and he's the expert.

I'm going to try PRs suggestion of raising the EPAP to 12 and see what happens. I'm not sure what to do about pressure support which is currently set at 4.0. Should I drop it back to 3, leave it at 4 or raise it further?

I'll do another screen shot after tonight.
I'd leave it where it is for a bit, see if the higher EPAP smooths out the pressure trace, and then if so, you can experiment with the PS to see which way works better for you.
Good advice which I applied last night. I've attached last night's OSCAR data. While I got up twice, 8 hours sleep was good and I felt much better today.
screenshot-Oct 18.png
screenshot-Oct 18.png (180.3 KiB) Viewed 460 times

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