Newbie needs help w/ Respironics S/T

Sleepy55 wrote: If anything, I think the timed back up rate...that BPM setting... is just getting in your way. That is...if you don't have a significant "centrals" problem, which I still don't think your diagnostic and titration sleep studies would have missed if they really were there. But I could be wrong. I'm sure not a doctor!

If you still happen to have your old BiPAP Plus around, another interesting experiment would be to see if you just might feel the same good effects you're enjoying now (including O2 staying up) by using the old machine at, say IPAP 16 / EPAP 12 ( or IPAP 17/ EPAP 13) instead of the EPAP 8 it was set at before. If you try that, I'd turn on bi-flex at 3 or 2..whatever felt smooth to you.

Even better, but unfortunately you don't have one, would be trying a BiPAP Pro II (the old model) or M series BiPAP Auto set for bilevel mode using the new higher EPAP. With either of those machines, a download of the data with Encore Pro or Encore Viewer would show AHI data.

Sounds like you're doing very well, Sleepy55. You may have to change your nickname, soon!

Rested Gal, you've been right all along Maybe you should be a doctor I'm planning to sell my Bipap Plus and my Goodnight 425 so I can try and buy an M Series Bipap Auto for travel. It will also give me the ability to gather AHI data. One small glitch is that I don't have an Rx for an auto bipap...

How's "Less Sleepy 55" sound for a new nickname?

No Problem Sleepy55,

I'm posting my results on 'Newbie on AVAPS', a couple of threads down from yours on this page. That way I don't jack your thread. Either way I win because I'm learning allot from you. I thought I had retired the AVAPS after a very short life. Thanks for the rebirth!

Banned

dsm wrote:Sleepy

RestedGal has nailed it well - have to agree completely.

Additional comments I would add include ...
> Bipap S/T does have adjustment for INSP that (IIRC) isn't available in the Bipap Pro so has that advantage
> Bipap Pro II adds detailed nightly data that the Bipap Pro & Bipap S/T doesn't offer
> Having a backup rate machine can be a psychological or even for some of us a physical plus - in my case nasal congestion caused me
to breathe slow & long through my nose & I ran one bilevel with S/T capability at a backup rate of 6BPM - it seemed to work well for me
& I was convinced it was helping me. I eventually learned to mouth breathe in a F/F mask when nasal congestion afflicted me & now find
I can use machines that used to give me trouble (e.g. Bipap Pro II switching to early when I had nasal congestion).

RestedGal's comment about the Bipap Auto (w Biflex) also matches my experience with one & I have no hesitation in recommending it.

DSM

DSM, I agree that having the backup rate can be a psychological and / or physical plus. It's comforting to know that if I don't spontaneously breath due to a bad OSA episode, that the machine will trigger a breath, even if only set for 6 or 8 BPM. I'm also a mouth breather due to bad allergies and sinus problems. I love my current ff mask!

Banned wrote:Hey Sleepy,

You are welcome to the Provider Manual for the Respironics AVAPS machine if you PM me with your email address. It would be the same Provider Manual for your Respironics S/T, although the AVAPS manual would include the additional PC (Pressure Control) Mode and Tidal Volume setting that is available with the AVAPS machine.

Banned

David, thanks for the offer of the provider manual! My email is wsfa@live.com

I'll check in on the AVAPS thread to see your progress.

Cheers,

Will

Lots mo better results from last night! My settings were IPAP 16, EPAP 13, BPM 8

After raising EPAP from 12 to 13 last night, my average total apnea count dropped 38 to 20! Here's how my other numbers changed:
Average Exhaled Tidal volume=went up to 483 from 480, Average Leak=stayed at 45, Average % Patient Triggered Breaths=rose to 99% from 98%, Average Peak Inspiratory Flow=Rose to 45 from 25, Average Breath Rate=dropped to 13 from 14, Oxigen saturation rose from 96% to 97%.

OK, now for tonight, I'll raise EPAP to 14, leaving IPAP at 16 and BPM at 8. I probably should raise IPAP to 17 but I don't want to adjust more than one setting at a time so I can know for sure what change made what difference. Hopefully, my apnea count's downward spiral will continue. Don't have much further to go! 20 looks pretty darn good considering a couple of weeks ago it was in the mid-100's

If I can get my apnea count to the low single digits, I guess I will need to buy or borrow a machine that can report hypopneas and AHI, so I can see if I need to adjust my IPAP upwards or leave as is.... someone pls correct me if this would not be important.

"Less Sleepy 55"

Less Sleepy 55 wrote:I'm planning to sell my Bipap Plus and my Goodnight 425 so I can try and buy an M Series Bipap Auto for travel. It will also give me the ability to gather AHI data. One small glitch is that I don't have an Rx for an auto bipap...

If you have a copy of your old Rx for "bipap", that's all you need for buying an M series BiPAP Auto from an online store.

The BiPAP Auto is first and foremost a "bilevel" machine (bipap machine) and can be operated as just a bipap. It happens to have an extra mode of opertion that can be turned on, or not, as you please, called "auto bilevel." But it is bilevel (bipap) machine, so a plain bilevel (bipap) prescription is all that's needed for the BiPAP Auto.

Less Sleepy 55 formerly known as Sleepy55 wrote:How's "Less Sleepy 55" sound for a new nickname?

Sounds like it fits you well.

Your too kind words don't fit me, but thanks.

Sleepy55 wrote: Lots mo better results from last night! My settings were IPAP 16, EPAP 13, BPM 8

After raising EPAP from 12 to 13 last night, my average total apnea count dropped 38 to 20! Here's how my other numbers changed:
Average Exhaled Tidal volume=went up to 483 from 480, Average Leak=stayed at 45, Average % Patient Triggered Breaths=rose to 99% from 98%, Average Peak Inspiratory Flow=Rose to 45 from 25, Average Breath Rate=dropped to 13 from 14, Oxigen saturation rose from 96% to 97%.

OK, now for tonight, I'll raise EPAP to 14, leaving IPAP at 16 and BPM at 8. I probably should raise IPAP to 17 but I don't want to adjust more than one setting at a time so I can know for sure what change made what difference. Hopefully, my apnea count's downward spiral will continue. Don't have much further to go! 20 looks pretty darn good considering a couple of weeks ago it was in the mid-100's

If I can get my apnea count to the low single digits, I guess I will need to buy or borrow a machine that can report hypopneas and AHI, so I can see if I need to adjust my IPAP upwards or leave as is.... someone pls correct me if this would not be important.

"Less Sleepy 55"

Well, after adjusting EPAP to 14 last night, my apnea count dropped from 20 to 19. Other indicators stayed about the same, including SPO2. Not as significant a drop as the past two days, but it nonetheless continues my downward trend. I think tonight I will adjust EPAP to 15 but will raise my IPAP for the first time from 16 to 17, so I can keep a minimum of 2 between IPAP & EPAP. BPM will remain the same at 8. We'll see what happens!

Sleepy

The balancing act is keeping epap CMs low enough to minimise mask problems and leaks while all but eliminating obstructive apneas.
You may well find that leaving epap at 14 and raising ipap by 1 is enough to proved very stable results.

It has been very informative to see the results of your careful experimenting. I know you must be feeling pretty good about what you
can achieve with a steady cautious approach to changes.

Good work

DSM

dsm wrote:Sleepy

The balancing act is keeping epap CMs low enough to minimise mask problems and leaks while all but eliminating obstructive apneas.
You may well find that leaving epap at 14 and raising ipap by 1 is enough to proved very stable results.

It has been very informative to see the results of your careful experimenting. I know you must be feeling pretty good about what you
can achieve with a steady cautious approach to changes.

Good work

DSM

DSM, that sounds like a reasonable suggestion. I'll leave EPAP alone tonight and raise IPAP by 1 to 17. That agrees with my strategy up to date of only changing one item per night. And yes, I do feel pretty good about the results from the careful and patient tweaking. Of course, would not have dared try this experimentation without the advice and encouragement of folks like yourself on this forum!

Well, I've been out of town for a week and a half without internet access, but still got to experiment with my settings. These are my results:

10/24 -10/25 18-15-8BPM Apnea count averaged 40.
10/26 19-14-8BPM Apnea count rose to 114 and patient triggered breaths dropped to 96%
10/27-10/28 16-14-8BPM This setting had the lowest apnea count in S/T mode
Oxyen levels remained above 95% under all the above settings.

10/29-11/2 16-14 BiFlex mode (no backup rate). Average BPM 13, Aver. Tidal Volume 520, 100% Patient Triggered Breaths, Aver. Peak Flow 25,
Aver. Leak 45, Aver. Apnea Count 12.8, Oxygen levels averaged above 95%.

So, Rested Gal was right, looks like I don't need a backup rate. I'm going to leave the backup rate turned off from now on and will try minor only a few minor changes in settings (17-14, 17-15) to see if Apnea Count averages drop from the current 12.8. Will continue to monitor oxygen levels.

Anyone have any suggestions on how to lower my average leak rate?

I'm still planning to purchase a Respironics M Series Bipap Auto.

Sleepy55

Re leaks - just have to keep experimenting with them too. I haveb't used an F&P mask so can't offer any useful suggestions.

DSM

dsm wrote:Sleepy55

Re leaks - just have to keep experimenting with them too. I haveb't used an F&P mask so can't offer any useful suggestions.

DSM

DSM, thanks. The mask is pretty tight on both sides of mouth but kinda loose around the forehead to avoid red welt on forehead. I'll try minor adjustments and see.

Sleepy55

I actually have an F&P full face mask but never used it because I couldn't get a good fit around my mouth.

Good luck with experimenting.

The only thing I can add is that I recently switched from a UMFF to a quattro mask & found it very leak resistant compared to the UMFF.

DSM

Progress Report - I have been increasing the IPAP / EPAP every one to two nights, while keeping the backup timed rate "off". Apnea count keeps dropping

When I started this project of "tweaking" my new Respironics Bipap S/T, my Doctor prescribed settings were 16 IPAP, 8 EPAP and 10 BPM. My apnea count was two to three hundred and patient triggered breaths were at 83%. Blood Oxygen levels were in the mid to high 80% range. Now, I have turned off the timbed backup rate and gradually decreased the 6cm gap between IPAP and EPAP to 2, and increased IPAP to 20 and EPAP to 18 (no timed backup rate). My results from last night at 20IPAP / 18EPAP: Tidal Volume 530, 100% Patient Triggered Breaths, Peak Flow 25, Leak Rate 55, Apnea Count 2, Blood Oxygen 97%.

I had almost identical positive results the previous night while set to 19 IPAP and 17 EPAP, but my wife reported heavy snoring while on my back, so I increased to 20 over 18. I was out of town last night so I don't know if I snored or not. I'm back home now so we'll see over the next couple of nights if I'm still snoring or not. While addressing my apnea is very important, it's also important to address my snoring for the sake of marital harmony. Otherwise I'll be sleeping in the guest room

Starting to see light at the end of the tunnel...

Well, I finally found a setting that reports 0 Apneas! IPAP 22 IPAP & EPAP 20 w/ backup rate turned off. By slowly increasing both IPAP & EPAP, I've been able to get used to the higher pressures. Never thought I could stand an EPAP above 14.

My Encore report for last night shows: Breath Rate of 13, Tidal Volume 470, 100% Patient Triggered Breaths, Peak Flow 25, Leak Rate 55, Apnea Count 0. My SPO2 remains around 97%. My wife does not recall if I snored or not. I'm going keep these settings for a few nights to see if my wife reports any snoring. I ordered a foam insert for my mast that will hopefully help in lowering the leak rate.

Sleepy55