BiPap Settings

I am not sure how to read this.. My sleep study suggested the following


Bilevel:

14 cm H20 IPAP and 9 cm H20 EPAP S/T mode at 12 bpm.


I'm sure the tech delivering the equipment will fill me in but I wanted independent feedback..

Thanks!

IPAP - inhale positive pressure
EPAP - exhale positive pressure.

You machine's supposed to be set to drop to a pressure of 9 cm/H20 when you exhale, so as to make exhaling easier, and to give you a pressure of 14 when you inhale.

It times your breathing at 12 breaths per minute.

More details in cpap.com's Bi-Pap FAQ

cpap.com FAQ wrote: Sometimes you will see a "ST" behind BiPAP, VPAP, or Bilevel. The ST stands for Spontaneous Timed. This means that if the user does not breath on their own, the machine will initiate a breath for them. This feature is very useful in treating central sleep apnea and a host of pulmonary disorders.

O.

O was right- higher pressure is IPAP-inhale, lower pressure is EPAP-exhale and 12 is your back up rate for the TIMED mode. I've been on BiPAP ST for almost 2 years- there are not many of us around on the boards who use ST's. Do you know what your diagnosis was? # of events per minute & type? I'm going to assume you either had significant centrals apneas ('forgetting' to breath) or you have another type of breathing disorder that needs the backup rate.

If you do a search for my name or click on my profile at the bottom of this message, you should find a lot of post with info about CSA & BiPAP ST....Rested Gal also has a post with links to ones on CSA in particular. Let me know if you have any questions or need info on the various BiPAP STs....I've tried a lot of them out and my favorite is my Respironics Synchrony BiPAP ST.

christine

I've been distracted with Rita last week and now finally am getting back into a normal mode. My equipment delivery was delayed last week. I am now getting setup tommorrow.

I have to find the papers from my study.. I'll post more specific info about the events later.

Thanks for your help.

Let me know how it goes...and if you have any questions, I'll try to help as much as I can. I remember when I started almost 2 years ago- there were no regular posters who used ST...and only a couple who even used BiPAPs at all. Which machine did they give you? If its a Synchrony ST I can help with the manual. BiPAP, especially ST, have extra settings that can affect how it feels and how well it is in synch with you. If it feels like you are fighting for the lead, something is not right. Personally, I can't stand a backup rate of more then 10- any faster and my & the BiPAP are always getting out of step.

Hopefully you won't have any more huricanes to deal with for a long time. I can't even imagine what it is like having always lived in the north...I'll take snow over huricaines any day.

Gosh.. I gues I have not asked my doctor enough questions. I don't understand much of this. Here are my stats as far as I can figure out.

Lowest SaO2 85%
Desaturation Index 30.6/Hr
NREM Desaturation Index 31.5/hr
REM Desaturation Index 24.5/hr

I also have limb movements.

Total #PLM 54
# PLMs with Arousal 0
Total # LM's 48
# LMs with Arousal 34

My total Sleep Continuty

Type of Arousals #/Index
Spontaneous 15/2.7
Apneas 59/10.7
Hypopneas 69/12.6
Snoring 21/3,8
Desaturation 0/0
Limb Movement 34/6.2
PLM 0/0
Effort Arousals 0/0
total overall 198 / 38.1

Hey, Christine, can I ask you, then - I had one central apnea during 96 minutes of sleep. It was probably the 71 second apnea, but I'm not sure. Would this qualify as central sleep apnea, or is CSA where it's happening all the time? Is it possible to have a single central event that happens mostly because of the obstruction, that's sort of tied to the OSA but wouldn't happen if the OSA were resolved by CPAP? More of my stat details are below.

I'm getting a BiPAP this week, which is why I'm asking now.

I know I should get this from my doctor, but I guess I'm asking now, here, so I can see if I should go bug him with this.


from my intro "Diagnostic results: total sleep time 96 minutes, all non-REM. Sleep latency 16 minutes. "Severe sleep-disordered breathing". 6 obstructive apneas, 1 central apnea, 131 hypopneas. Average duration of apneic periods = 13 seconds, longest = 71 seconds. Oxygen sat went from 97 to mean of 93 with lowest 86.5. Overall RDI = 86."

Any info on how many obstructive apneas, central apneas, hypopneas per hour? What was the diagnosis?- OSA, CSA, Mixed Apnea? Plus the PLMD, of course. The good thing about PLMD is that sometimes it is caused by the apneas/airway restrictions somehow- my mom was like that....tons of PLM during her original study but hardly any during titration. She has very few apneas, except during REM sleep, but the PLM was fairly consistant throughout her first study. There are also some meds they can use- Miraplex is one- its used for Parkinsons disease. There are few others that can help too but one of the interesting things is that taking an iron supplement can help too. They have found that having a higher, within normal range, iron level can treat PLMD. Hopefully between BiPAP & meds the PLMD will not be much of an issue for you.

OSA can usually be fairly well controlled with xPAP; CSA isn't as easy to control, even with BiPAP ST. Sometimes central apneas can be a symptom of OSA, just like snoring can be. They usually don't prescribe BiPAP ST unless CSA is a significant problem- even the Medicare requirements for BiPAP ST state that you need a Dx of CSA, exclusion of OSA as the predominant cause of sleep disordered breathing, ruling out CPAP as effective therapy if OSA is a componant, O2 desats of less then 88% for 5 consecutive minutes, & significant improvement with BiPAP ST. Medicare will allow regular BiPAP for OSA, if it is proven to be medically necessary; but they state clearly that BiPAP ST is never medically necessary for a diagnosis of OSA only (they do cover BiPAP ST for some other breathing disorders that are not sleep related). I listed the Medicare requirements, but most other insurance companies use very similar requirements. That said, its pretty easy to infer that you have to have significant CSA, probably more so then OSA. Don't be surprised if it takes you more to get settled in on BiPAP ST. Like I said earlier, there are other settings besides IPAP/EPAP and backup rate on most BiPAP STs that can make a big difference. Not all DME/RT's understand the other settings so you may have to take the lead. Don't be surprised if you have a few bumps to work out early on before you get settled into using your BiPAP ST.

momexp5 wrote: I had one central apnea during 96 minutes of sleep. It was probably the 71 second apnea, but I'm not sure. Would this qualify as central sleep apnea, or is CSA where it's happening all the time? Is it possible to have a single central event that happens mostly because of the obstruction, that's sort of tied to the OSA but wouldn't happen if the OSA were resolved by CPAP?

In your case, you have less then 1 central per hour. I'm not a doctor, but based on the numbers its safe to say you probably don't have CSA. It is perfectly normal to have up to 5 or so centrals per hour, even more if you have OSA. 'Healthy, normal' people with no sleep disordered breathing problems have centrals apneas, just like they can have a few obstructive apneas. It is very normal to have centrals apneas as you fall asleep, when you transition from one stage of sleep to another, and when you move/turn over in your sleep. Take a deep breath and count to 10 slowly...that's a central apnea- its pretty normal during the day to have a few too. Pick up a heavy box- did you breath while you were lifting it? Ever remember being told to 'breath' as you exercise? The same thing can happen during the night as you move from one position to another- nothing to worry about.

A higher number of centrals is considered 'normal' if the person has OSA- central apneas can be a symptom of OSA, just as snoring is. Also, during a sleep study, the sensors may misread an obstructive as an central. Typically they don't get worried unless the central apneas are significant in number and consistantly throughout the night. To be diagnosed with CSA there needs to be a significant number of central apneas per hour that are not related to OSA. Even if its pretty clear a person has a lot of centrals and very few obstructive apneas they still start the titration with regular CPAP as the centrals can be obstructive apneas that were misread. In my case I had 63 central apneas per hour, 1.5 obstructive apneas, and 1 hypopnea per hour during my initial study and my sleep doctor had already said I would need to use a BiPAP ST, they still started my titration with CPAP, then regular BiPAP and finally BiPAP ST. In my case, I do have a few obstructive apnea, but well under the accepted 5 per hour to be considered 'normal' so I was not diagnosed with OSA or even Mixed Apnea, especially once it was clear CPAP wasn't going to control my apnea. Even BiPAP ST doesn't prevent or stop all of my centrals so I still have 30+ per hour...not what my doctor or I would like, but better then some of the other options for now. If you want to read more about centrals apneas & CSA, here is a good overview article: http://www.britishsnoring.co.uk/pdf/j11.pdf


Regular BiPAP are often used to treat OSA- especially if you need a fairly high pressure as the lower EPAP (exhale) pressure makes it easy to exhale. In some cases BiPAPs can do better at treating OSA then CPAP also, so you would have to ask your doctor why he is putting you on BiPAP specifically. Do you know which brand and model you will be getting yet?

Sorry...dupilcate message...

Wow, Christine, you know so much about this! Thanks for answering.

I'm going to try and get the DME to give me a BiPAP Pro 2 instead of the Plus that I think she's accustomed to issuing.