Can't fall asleep with BIPAP machine

ghart999 · Post by **ghart999** » Mon Jun 09, 2008 10:51 am

Hi all. Finally got around to using my machine. Its a bipap. Even when I have the minimum pressure set to 4.5 when trying to fall asleep I find myself having apnea events right as I drift off to sleep. For some reason the machine isn't kicking in or something as it makes me take a big deep breath on my own. Never have this issue when I am not using the mask.

Heck I never know I have apnea events when sleeping.

Any thoughts? Should I up the minimum pressure setting? When I was on standard cpap, my pressure was 20, so I have severe apnea. But I thought I was supposed to start at the lowest setting with BIPAP and let the machine compensate when it needs to.

Thanks all.

ww · Post by ww » Mon Jun 09, 2008 12:07 pm

Why don't you fill out your equipment (text format) so others can see what you have to be able to assist. Also did you have a bi-pap titration, and if so can you post the results or did you just purchase a bi-pap?

I did go back and find that the last time you posted your were titrated at 22/18 on a bipap. Did someone set up the bi-pap for you? The reason I ask is the starting pressure is WAY too low to do any good.

Unless you have been using a CPAP or BI-PAP daily for the past 7 months, you are not paying enough attention to the seriousness of Apneas on your health. Please post daily until you get the settings figured out and decide if your machine supports software and analysis of daily apnea events.

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CPAPopedia Keywords Contained In This Post (Click For Definition): Titration

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CPAPopedia Keywords Contained In This Post (Click For Definition): bipap, Titration, CPAP

dsm · Post by **dsm** » Mon Jun 09, 2008 3:56 pm

We would like to help you but we need some info to analyze and comment on. There is next to nothing in your post for anyone to work anything out.

1) What model Bipap is it 'tank' M-series (it is a Respironics brand I assume)

2) What are your prescribed titration settings ?

3) Are you accessing the nightly data from a datacard and software or off the panel on the machine ?

4) Are you changing your settings ?

etc: etc: etc:

Good luck

DSM

Actually, on re-reading your post, it seems you have a serious misunderstanding as to what a Bipap is ? - did a doctor prescribe this or did you just buy it and try it without any recommendations ?

Your last para implies you think it is an AUTO ?

D

#3
Also, If you were titrated at 20, then you yourself set the epap (if this is what you have done) to 4.5 shows a level of misunderstanding that leaves me worried about offering advice.

D

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

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

betty303 · Post by **betty303** » Thu Jun 12, 2008 2:16 pm

Where are you? If you let us know what machine you have we can start to help you.

ghart999 · Post by **ghart999** » Fri Jun 27, 2008 3:01 pm

Hi again. So sorry for the delay.

Yes I was prescribed an M-Series Bipap Auto w/ Bi-flex after numerous encouragements from different forums that a standard CPAP with a titration of 20 is insufficient.

I was titrated for bipap at 22/18. The machine came set wrong and my DME has since gone belly up. I thought I was under the impression that with bipap auto I should set to minimum for everything and just let the machine compensate as I have apneas. But after doing this I was finding myself having them right before falling asleep and the machine would not compensate as I thought.

Should I set the machine to 22 inhale and 18 exhale no matter what or do I let the auto feature be used?

Thank you all.

If you need more info please let me know.

Wulfman · Post by **Wulfman** » Fri Jun 27, 2008 3:09 pm

If it were me, I'd at least start with the titrated pressures (22/18 prescribed), probably use the Bi-Flex setting of 2 and see how that goes. If you have the Encore software to monitor your therapy, you will be able to establish some "benchmarks" to determine the quality of your therapy and whether you want to try other settings or ranges.

Den

ghart999 · Post by **ghart999** » Fri Jun 27, 2008 3:21 pm

Wulfman wrote:If it were me, I'd at least start with the titrated pressures (22/18 prescribed), probably use the Bi-Flex setting of 2 and see how that goes. If you have the Encore software to monitor your therapy, you will be able to establish some "benchmarks" to determine the quality of your therapy and whether you want to try other settings or ranges.

Den

OK. I will give that a try. Thank you.

The problem is I have yet to even fall asleep with the machine on, so nothing useful from the data card can be provided yet. But I did purchase the card reader and software.

Wulfman · Post by **Wulfman** » Fri Jun 27, 2008 3:38 pm

ghart999 wrote:
Wulfman wrote:If it were me, I'd at least start with the titrated pressures (22/18 prescribed), probably use the Bi-Flex setting of 2 and see how that goes. If you have the Encore software to monitor your therapy, you will be able to establish some "benchmarks" to determine the quality of your therapy and whether you want to try other settings or ranges.

Den
OK. I will give that a try. Thank you.

The problem is I have yet to even fall asleep with the machine on, so nothing useful from the data card can be provided yet. But I did purchase the card reader and software.

I can understand your situation as my sleep doctor prescribed me with a pressure of 18 on CPAP. I DID try it for about an hour and decided that I had to find something lower to start with......and did, but I had the software to check my results. I actually didn't have any problem sleeping back then with almost ANY pressure.....I was SOOOOO tired and worn out. On the other hand, I had doubts about my sleep doctor's prescription.

Glad to hear you have the software.

In any case, before experimenting with the Auto settings, I'd at least try the straight pressure settings. If you do decide to try lower settings, I'd keep at least a 3 or 4 cm range difference between the IPAP and EPAP settings in the beginning.
Remember.....the EPAP setting (ultimately) should be of a sufficient pressure to eliminate your Apneas.

Den

dsm · Post by **dsm** » Sat Jun 28, 2008 4:33 am

ghart999

The Bipap Auto is one of the better OSA machines. But if you were set for 18/22 you are making a big mistake to set it lower than say 15.

The Bipap Auto sets the gap between Epap (breathe out pressure) and Ipap (breathe in pressure) automatically. It starts at 2 CMs gap and adjusts this gap during the night as circumstances require.

If you go too low on the base pressure (Epap) the machine will take too long to raise pressure whan you have apneas & the usual outcome is feeling the therapy isn't working.

I have used the older tank style Bipap Auto but not the M-series one so am assuming the settings are the same.

DSM

GumbyCT · Post by **GumbyCT** » Sat Jun 28, 2008 7:21 am

If your machine is set to 4.5 it is no wonder you are having trouble.

The auto will adjust and compensate - however comma - it will take time to adjust. You are best served if you set your Min press (EPAP) to the lowest pressure required to keep your airway open, that is EPAP. IPAP is the Max. pressure.

You can set it 2-3cm lower but not 17-18cm lower. It's just too far to travel. There is also an auto Ramp feature if you are having trouble getting used to the pressure. So set that at 12-14 but be aware that you may also have events during the ramp up period. Use your software to check each day how you are doing until you see things smoothing out.

Hope That Helps (HTH),
GumbyCT

tnmom · Post by **tnmom** » Sat Jun 28, 2008 8:52 am

boy 4.5 is really low-- I have found that I can't have it any lower than about 7, or I feel like I am not getting enough AIR, if that makes sense..

Guest · Post by **Guest** » Mon Jun 30, 2008 9:31 pm

Thanks again all. I just got back from camping for 4 nights and am anxious to try this at 18-22 with ramp up starting at 15.

Snoredog · Post by **Snoredog** » Mon Jun 30, 2008 11:00 pm

ghart999 wrote:Hi again. So sorry for the delay.

Yes I was prescribed an M-Series Bipap Auto w/ Bi-flex after numerous encouragements from different forums that a standard CPAP with a titration of 20 is insufficient.

I was titrated for bipap at 22/18. The machine came set wrong and my DME has since gone belly up. I thought I was under the impression that with bipap auto I should set to minimum for everything and just let the machine compensate as I have apneas. But after doing this I was finding myself having them right before falling asleep and the machine would not compensate as I thought.

Should I set the machine to 22 inhale and 18 exhale no matter what or do I let the auto feature be used?

Thank you all.

If you need more info please let me know.

My opinion:

You need to STOP trying to set up the machine to blow the top of your head off, toss out the PSG for the time being, I doubt that titration you had was any good to begin with. 20/18 is an idiotic setting especially for that machine, it is probably a good thing the DME where you got it went out of business.

First, decide what you want to do;

-do you want to sleep? or
-do you want to set pressure up so high you cannot sleep?

Starting off at 20/18 is stupid. Set up the machine so you CAN SLEEP and forget about it taking care of every last apnea event that comes along. IF you want to sleep and allow the machine to do its job, set it up as follows:

Set the machine in BiFlex Auto mode,
set Biflex=2
set IPAP Max=25
set EPAP Min=8
set PS=4

and sleep with it, the machine with the above settings will start at the following when you turn it on:

EPAP will come up to 8.0 cm pressure,
IPAP will come up 2 cm higher at 10 cm pressure,
Biflex will start at 2

If you have an apnea, it will bump up EPAP to 9.0 and push IPAP up to 11, have a hypopnea and IPAP will rise when it needs to. Start snoring and both may go up.
If you need 25/23 it will go up there IF needed, but you don't have to tolerate that pressure falling asleep or trying to get there.

With the above settings, the machine will Start at a lower pressure so you can fall asleep, don't worry about those sleep onset events, the Minimum pressures will blow through those, try and relax when they happen.

Allow the machine to do its job, setting the machine up as a CPAP or a plain jane Bipap is your problem, give the machine the correct range to work in and the Auto algorithm will take care of things on its own. Use those settings and it will result in minimum pressures being delivered and it will pull pressure down as events subside.

With those pressures, sounds like to me you have a big ole tongue lodging in the hole at the back of the throat, try to keep that tongue planted in the hard palate and mouth closed if you can, sleeping on your side would make things much easier for you as well. Don't use a too thick a pillow.

A conventional "nasal" mask is your best approach to therapy, will take more pressure with a full face and a nasal prong mask won't be able to handle the pressure.

Try those settings let us know how it goes.