Respironics BiPAP Auto/Bi-flex. Need Help

OK. Finally Respironics BiPAP Auto/Bi-flex is in my possession and as I expected I’ve gotten a jet (comparing to biplane - my old machine RemStar Plus).

Two reasons I have made this upgrade.
1. I wanted machine with software capability
2. I wanted better treatment


Hopefully I will get both, but so far I am a little bit disappointed. My Respironics BiPAP Auto/Bi-flex has settings 8/15, biflex=2. My old machine has setting 10 straight. I am relatively OK with old machine, but the new one is making me crazy. First of all I have an impression that my mask is making a push-ups from my face when machine is switching from inhale to exhale. And second thing – machine is pushing me off from my natural rhythm of breath. It is like I am doing 20 inhale/exhale per minute, machine is pushing me to breathe twice as fast. I understand that this could be and will be changed with settings but, at this point would it be a good idea just to bring settings of new machine to 10 striaght (as in old machine) and to monitor my AHI- SHMAHI? And then maybe to proceed from that point. I need some advice if my approach is a good one and if it is, how do I set my new Respironics BiPAP Auto/Bi-flex to 10 straight.
Thanks for any input.

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, bipap, AHI, auto

Sergey
There are several possibilities here ...

For a start, the bilevel machines do seem to pulse on your face when switching from ipap to epap - that can be adjusted by altering risetime (almost all bilevels have a rise time adjustment - IIRC the Bipap Auto has settings from 0-5 - try setting to a higher number).

This pulsing often is worse when you start to go to slepp as most people tend to breathe deeper at first then go into much more shallow breathing as they go into normal sleep

One other issue that can imapct some people is if they have any distinct nasal airflow difficulties either from the way the nose is structured or from things like sinus / hay fever etc:

If you are a restricted nose breather then the Bipap's autotrak may have difficulty tracking your breathing and switch from ipap to epap when you are still taking a long slow breath through your nose. Speaking for myself, I can't get Bipaps to work for me for this very reason. I have used all current model Bipaps except the M series.

Hope this info helps

DSM

Thanks.
It is helpful of course but not very encouraging. You see, my impression was that if I want to I can set bipap to work as straight CPAP. It’s seems not be the case?

[quote="Sergey45"]Thanks.
It is helpful of course but not very encouraging. You see, my impression was that if I want to I can set bipap to work as straight CPAP. It’s seems not be the case?

Holy Cow!
It is like a racket science for me so far. Thanks.
Little by little, hopefully I’ll learn something.

Sergey,

BiLevels are my fav type of machine. Have tried several straight cpaps, several Autos & several Bilevels & keep coming back to BiLevel because of two very valuable (to me) benefits.

1) For me a Bilevel greatly reduces aerophagia (a very valuable aspect)
- aerophagia is the process of ending up with air in the stomach which comes out as a head wind or a tail wind (belch or flatulance ) and can cause stomach aches

2) The breath-out relief is in itself very very helpful - with the ipap epap gap, I don't need ramp time & it feels very normal. Even a gap of 2 (as is the starting gap in the BiPap Auto) is very helpful. Add BiFlex and you get even more assistance.

Good luck

DSM

Sergey, I looked back at one of the topics you started on August 1, when you first got the BiPAP Auto with Bi-flex.

viewtopic.php?p=197061

You mentioned this:

my natural rhythm of breath would be 5 sec inhale- 4 sec exhale; the machine is trying to do it at least two times faster.

If you're taking in a normal amount of air when you inhale, five full seconds of inhaling is an extremely long amount of time. I'd think a person would have to be slowly taking in very little air to extend an inhalation that long.

So, my question is... are you consciously and deliberately trying to make your inhalations last that long, or do you think that's really the normal amount of time you inhale even when you're not concentrating on breathing? Have you timed your inhalations and know for sure that you usually inhale for five seconds every time? Those would be very unusually long, slow inhalations, I'd think. But I'm no doctor or RT, so I dunno.

As far as I know, the maximum amount of time the BiPAP Auto will allow the higher IPAP pressure to be delivered is 3 seconds or perhaps a little more...not more than 4, anyway. It has a built-in maximum time that it will allow the IPAP pressure to last if the person doesn't start to exhale before the time is up. The IPAP pressure will last the maximum built-in time only if you're inhaling smoothly and steadily throughout your entire inhalation. Any hitch or hesitation during breathing in will make the machine think you're starting to exhale and cause it to switch to EPAP...the lower exhale pressure.

As for time spent exhaling, I don't think there's any limit on the amount of time the machine will stay down at the EPAP pressure. As long as you are exhaling, it will not switch to IPAP (inspiratory pressure, or as I think of it..."inhale" pressure.) It will maintain the lower EPAP pressure all the way through the exhalation. Also, if you normally pause at the end of breathing out, or even if you deliberately hold your breath at the end of the exhalation, the machine will still stay at the EPAP pressure. It won't switch to IPAP until it senses you starting to inhale again.

By the way, as far as I can tell, the BiPAP Auto does not have to spend minutes "learning" your breathing pattern, or take time to get "in sync" with you. I've not seen anything in the Provider manual that says anything like that.

Nor do you need to try to learn to breathe "with" the machine. You're the boss. Your breathing is what it goes by. Don't try to take unusually long breaths or try to change your breathing to match what the machine does if something about a breath you take now and then confuses the machine for a moment or two. Just relax and breathe naturally...not deliberately deeply...and the machine will follow your lead.

I know it's hard to not concentrate on your own breathing or listen to the sounds the machine makes, but try not to do that. Just breathe naturally -- and I hope your natural breathing isn't 5 second long inhalations all the time. Because if that's always the normal length of time for you to inhale, then the machine is always going to switch prematurely to the lower EPAP pressure. Any regular bi-level machine would.

If that's the case, then you would be better off setting it with EPAP/IPAP the same, 'cause I don't think inhalations that long are going to work with a bi-level machine that has EPAP and IPAP set differently. Or just use a cpap machine or an autopap machine instead of a bi-level machine.

If you want to use your BiPAP Auto at a single pressure, as if it were a straight CPAP machine just switch it to one of the two modes that starts with a letter B. Either BPAP (bipap with no Bi-flex) or BFLE (bipap with Bi-Flex enabled.)

Bi-Flex will give some drop in pressure at the beginning of each exhale (much like C-Flex does in a straight CPAP.

For example, to use the machine like a straight CPAP at a single pressure of 10 and with some slight pressure relief for exhaling, you'd set the "classic" (non-M series) BiPAP Auto this way:

BFLE mode (bipap mode with bi-flex turned off.)

10.0 Min EPAP

10.0 Max IPAP

3 Flex or 2 or 1 -- whatever Bi-Flex drop feels comfortable. As with C-flex, 3 gives the most drop in pressure at the beginning of each exhale.

0:00 Ramp (unless you want to set a ramp time, in which case it would then ask you to set "Ramp Start" for the pressure you want to start out at, like 6 or 7.)

0 Patient

1 Light

Nights - leave this number as is.

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If you want to use the machine like a straight cpap but with bi-flex turned off, set the operating mode to BPAP and set the EPAP/IPAP pressures the same, like both at 10. The menu will appear as above, but without "Flex" coming up.