First hour on BiPAP Auto

OK, so I've had this BiPAP Auto machine I've just been itchin to use for 5 days, but it reeks of cigarettes and perfume and ... well, it's a long story.

Anyway, I was sleepy and decided to bite the stench bullet and give it a whirl for a nap.

My CPAP PSG number was 15cm. I had tried 12 to start and felt it was way too high, so I was running at 9, and I had increased to 10 and I've been feeling pretty good. 10 was the number I was at for my sleep study until they had me sleep on my back loaded up with Ambien, and in those conditions they had me up to 15. I rarely sleep on my back in real life so... One other thing, my CPAP is just an old REMstar Plus so no data.

I set the BiPAP Auto to 12/8 with Max Pressure Support of 3 and BiFLEX 3.

Anyway I awoke from my nap and had 1 hour and 13 minutes of data! Woo Hoo! I downloaded the data into EncorePro and after the 30 minutes of ramping, it looks like I had only 1 FL event in about 43 minutes. Not enough data to strike up the band but it only touched 12 once.

I plan on setting the machine to 15/8 and the Max Pressure Support to 5. I'm not sure what to do with BiFlex. I wonder if I should shut it off to try to reduce the variables.

During ramping, I was having all sorts of events. Perhaps I need to shorten the ramp time and/or increase the ramp starting pressure. I think it's at 4 or 5 and with the machine set up the way it was 10/8 with BiFlex didn't feel particularly uncomfortable to get used to. Getting rid of most of the ramping might make all my troubles go away.

However, as I was falling asleep I was having some problems with the therapy. There was so much pressure relief that it was almost uncomfortable and at time I found myself fighting the machine for air. I don't know whether it's the pressure differential I just need to get used to, or if BiFLEX 3 is too much.

When I was taking long, slow, deep breaths the machine went into exhale mode as I was drawing in, and I could feel my heart pounding against the pressure, if that makes any sense. Previously on CPAP I had some centrals my first night that went away in a day or two, so i know what they feel like. These were cases when I was deep breathing and the machine lowered the pressure, perhaps thinking I had a leak? I dunno.

Any similar experiences?
Also, any experienced BiFLEX users have a suggestion on BiFLEX or the other settings?

Thanks!

PS I see the sleep Dr. tomorrow afternoon for the first time since he ordered my titration PSG! LOL We'll see what he suggests, too.

RG will probably disagree with me, but I find myself that I don't like to have a high max ps... I sleep better with it set to about 3. Do you really need to use the ramp? I don't use it at all. Running mine at 16/11.5 with a PS of 3 (I think, it's been a little while since I checked the settings).

I shut off the biflex, ramp and the auto function as well. It's running bipap mode only. I found using the auto bipap mode triggered events with lower pressures before it ramped up the pressure. It was a cycle....

heheh, well, I think "what works" for each person is what they should use...not what anyone (including me!) says "to use." The nice thing about the BiPAP Auto is its versatility. So with some tweaking and the software, many people can get both comfortable and effective treatment.

RonS wrote:any experienced BiFLEX users have a suggestion on BiFLEX or the other settings?

Ron, is the BiPAP Auto you've just gotten an M series machine or is it the older classic non-M?

Got some suggestions you could try, when I know which model you have. A couple of the menu items have different names depending on which machine you have.

It is the BiPAP Auto M Series, sorry. Very interesting little machine.

Last night was a little strange. After 2 1/2 hours I woke up and adjusted the mask and when I rolled over to go back to sleep both sides of my nose were stuffed up almost immediately. Odd. Usually only one side gets blocked, the side on which I'm laying. So I propped my head up on my elbow and my nose cleared immediately. Also odd. So I laid back down on the other side and again both sides clogged. So I decided to try my back. Like I said, I seldom sleep on my back. Strangely, I didn't clog up. I will be talking to the doctor about my nasal issues today!

So the results were very interesting. I set the machine at 15/8 and BiFlex of 1. Much more comfortable, and I may try shutting off the BiFlex all together.

For the first 2 1/2 hours on my side I had 2 Flow limitations, 1 OA, 2 Hypopneas and 1 snore. I guess that would be an AHI of about 1.2 or 2.0 if you count the Flows. Not bad!

Then I rolled over on the back for about 2 hours. I had 10 OAs and 1 snore in about 20 minutes as the machine moved IPAP right up to the max 15 setting (my script number based on titration PSG). As soon as it hit 15 all the OAs stopped, there was 1 more OA and 1 FL and 6 H during those 2 hours. Then I must have turned back on my side. There were no more OAs and there were 6 H and 1 FL over the next 3 hours.

When I wasn't supine (on my back), the EPAP was right on the 8 minimum all night. While supine, the difference between I and E looks like it was 4 most of the time.

Encore is reporting a total AHI of 3.8 (plus FL of 0.5), 90% IPAP of 15 and 90% EPAP of 12.

Not too shabby!

I was totally shocked at one point when I looked at the machine and it said I was at 13 and 10... and it was so easy to breathe!

I'm not sure how to post parts of the report, but if anyone is interested in seeing it, I'll read up and try to figure that out.

The Doctor said:

Looks like you've got the numbers just about right, the IPAP number is exactly like the titration study, so probably keep that at 15, you can play with the EPAP number if you like, feel free to set the spread anywhere up to a maximum 10cm. I wish I had more patients like you, see you in a year. Feel free to call if you have any questions.

Oh, and here's a coupon for a freebie month of Veramyst for you to try.



Well, OK.. it took longer than that, he answered a ton of questions I had. But that's the gist of it.

THANKS EVERYBODY -- you all taught me so much so quickly. I'll hang around and stick my nose into other people's threads and I'm sure I'll have more questions, but you all have made this transition into PAP therapy so much easier.

I'd love to kiss you with all the lips on my face.

If you want to try some different settings with the M BiPAP Auto, I'd give this a try:

auto bilevel (Auto-titrating bipap mode)
Max IPAP 20.0
Min EPAP 12.0
Max Press Sup 8.0
Bi-Flex Setting 3
Autoramp time 0:00
Mask Alert Feature OFF
Auto Off Feature OFF
Split Night Time - Off
Show AHI/Leak Feature ON
Patient Reminder OFF

Nice doctor's visit you had. That's great that he likes it that you are tweaking your treatment.

I think that where a person sets "EPAP" is a little more important than the doctor seems to think, since he is kinda' dismissing EPAP with "you can play with the EPAP number if you like." EPAP ideally should be set up high enough to prevent all obstructive apneas (just the full obstructive apneas) right from the get-go, imho.

Any playing around with EPAP I'd do, would be to see where it prevents full obstructive apneas. That might be EPAP 9, or 10, or 11, or 12, or even less than 9. You have the software to see where EPAP actually does prevent all or most OA's for you.

That setting for EPAP will not usually be anywhere near as high, of course, as the single pressure found in a sleep study which was needed to take care of "everything.

But the lower EPAP is not just for "comfort"...it really does have a purpose, as I understand it. EPAP is to prevent full apneas so that the throat is open "enough" at the end of exhaling, so that the person is able to START to breathe in again. That's important, imho, because regular bilevel machines (and the bipap auto) will continue to blow only the lower EPAP pressure UNTIL a person STARTS to inhale again.

If a full apnea has your throat slammed shut, you can't even begin to inhale again...thus could not get the higher IPAP pressure going at all. At least not until your brain arouses you enough during the full obstructive apnea to get the throat open enough to start to inhale at least a thread of air.

But, I'm not a doctor.

I'm a dog person.

rested gal wrote:If you want to try some different settings with the M BiPAP Auto, I'd give this a try:

auto bilevel (Auto-titrating bipap mode)
Max IPAP 20.0
Min EPAP 12.0
Max Press Sup 8.0
Bi-Flex Setting 3
Autoramp time 0:00
Mask Alert Feature OFF
Auto Off Feature OFF
Split Night Time - Off
Show AHI/Leak Feature ON
Patient Reminder OFF

Nice doctor's visit you had. That's great that he likes it that you are tweaking your treatment.

I think that where a person sets "EPAP" is a little more important than the doctor seems to think, since he is kinda' dismissing EPAP with "you can play with the EPAP number if you like." EPAP ideally should be set up high enough to prevent all obstructive apneas (just the full obstructive apneas) right from the get-go, imho.

Any playing around with EPAP I'd do, would be to see where it prevents full obstructive apneas. That might be EPAP 9, or 10, or 11, or 12, or even less than 9. You have the software to see where EPAP actually does prevent all or most OA's for you.

That setting for EPAP will not usually be anywhere near as high, of course, as the single pressure found in a sleep study which was needed to take care of "everything.

But the lower EPAP is not just for "comfort"...it really does have a purpose, as I understand it. EPAP is to prevent full apneas so that the throat is open "enough" at the end of exhaling, so that the person is able to START to breathe in again. That's important, imho, because regular bilevel machines (and the bipap auto) will continue to blow only the lower EPAP pressure UNTIL a person STARTS to inhale again.

If a full apnea has your throat slammed shut, you can't even begin to inhale again...thus could not get the higher IPAP pressure going at all. At least not until your brain arouses you enough during the full obstructive apnea to get the throat open enough to start to inhale at least a thread of air.

But, I'm not a doctor.

I'm a dog person.

I agree, I'd be more worried more than Peggy if I had his doctor, obviously his doctor doesn't have a clue as to how these machines function to suggest he play around and set EPAP anywhere he desires.

As you well know EPAP addresses specific events, if he doesn't know that he should get out of medicine and buy into Burger King or something.

Don't worry, all the dogs love ya

Snoredog, between your post telling me that if I wasn't on a machine that I'd be in full fight-or-flight panic mode, this post and your dismissal of another doctor's advice on steroids it is truly amazing that there seems to be no subject on which you are not the preeminent expert in the world even without the facts in front of you.

Perhaps you should know that I chose this doctor after due diligence and recommendation from several sources. He started his career in pulmonology and decided to specialize in sleep disorders. Perhaps you should know that he is quite young, dynamic and interested in the field. Perhaps you should also know that if you've ever eaten a hamburger at a Burger King, you partially bought my house for me. Thank you.

Rested Gal, my post was a quick synopsis of our hour long discussion, not a 2 minute conversation! He really wasn't that dismissive, it's my error that it came across that way. We had lengthy discussion on the theory behind IPAP and EPAP and OAs and tidal volumes and carbon dioxide and centrals and stretch receptors.

His recommendations for pressure was 15 IPAP and 8 EPAP, exactly where I had set them, and he said I could experiment with the EPAP with a floor of 8, but he'd leave the IPAP where it is for right now. Remember, I'm also just getting used to the feel of the BiPAP which is quite different than the CPAP. So many variables.

There are physiological reasons for wanting to somewhat limit the spread between IPAP and EPAP. He said that I should never set the spread to more than 10cm, but since my machine limited the spread to 8 anyway, it should be OK. I have it set to 5, but from what I can tell from the charts, the spread has never been more than 4.

As I mentioned, I am almost never on my back, the numbers from my first night were exceptional in that I don't expect to be on my back much. For instance, last night I left the settings alone and my 90%s were IPAP 11 and EPAP 8; maximums were 12 and 10 respectively, and my AHI was 2.0 (OA being 1.4, H = .5 and FL 0). Nearly the entire night was at 10/8, which as I recall was the same pressure snoredog chided me about when I set my own CPAP pressure and said it seemed to be working well. I kinda knew that pressure would be close because as I had posted earlier, during my titration PSG that was the number they had titrated me to while I was on my side. The higher number occurred when they asked me to go supine.

Anyway, not perfect but I don't think I'll be changing any numbers very quickly. When I do start to experiment (and I will!) I will likely move the minimum EPAP up a bit and see what happens, but that will be after at least a few nights of therapy at the current settings. One or two nights does not a pattern make!

But whadoIknow? I'm just a dog lover.

PS Your explanation of EPAP needing to be high enough to prevent the closure of the airway at the *end* of the exhale is nearly exactly how he explained it to me.