My BPAP won't let me exhale

SleaplessInHouston
My BPAP won't let me exhale.
It's a Respironics Pro 2 BPAP set to 11/7. I can inhale but as soon as I try to exhale, it starts fighting me. It "pops" on and off trying to blow back into my mouth. The mask has exhale holes, but the BPAP fights so hard that I must remove the mask so I can breath!

I took the BPAP into the store, and it tested out with correct pressures, but I still can't use it.

I reset the pressures to 11/11 to make it act like a CPAP, but that made no difference. I did this because the CPAP in my sleep study was wonderful! I had the best sleep in months. I set it to 7/7, but there was no improvement.

I set "bPAP" to "bFle", but it just pops a lot faster when I exhale.

All I want to know is - Is the machine broken? Or am I just too stupid to know how to make it all work?

First of all... from what you've written... it doesn't appear to be broken.

What level did you have the biflex on?

SleaplessInHouston wrote:All I want to know is - Is the machine broken? Or am I just too stupid to know how to make it all work?

Hi,

This sounds really odd. Can you tell more of the story? How did you get this machine, why was a BiPAP picked if you are on such low pressures, who set the machine up, and how long have you had it?

My suggestion is to try a different machine. If you don't need BiPAP, I'd suggest a CPAP or an APAP.

I think what is happening is that something about your breathing pattern is tricking the machine into thinking that you are having an event, and the machine is trying to jump start your breathing. I could trick my BiPAP Auto machine into doing this by taking 2 deep breaths in a row, then pausing for about 5 seconds. The machine would pop me about 6 times trying to get me to breathe. It felt odd at first, then it became a game until I got bored with it. To make matters worse, my Respironics machine would cut me off after breathing in for 3 seconds. I like to take fewer but deeper breaths, but the BiPAP Auto wanted me to breathe faster and shorter. The net result is that I'd have to take deep breaths to catch up from time to time, and the jump start would kick in.

I kind of got use to this behavior, but I like my new Resmed machine a lot more. It is so smooth compared to the Respironics machine. I'd love to try one of the new PR System One machines to see if that is any smarter than the BiPAP Auto machine.

Another possibility is that you are having issues with leaks, and the machine is attempting to maintain pressure despite a high leak rate.

See if you can get a loaner machine from your DME that is a different brand or a different model. I suspect that will make a difference for you.

In the mean time, I'd suggest going back to the pressures that were identified in your titration study, and then try to learn to breathe with the machine rather than fighting the machine. Try shorter breaths, pace yourself, and don't pause between breaths. After a while, you will relax, and this will come more natural to you. I am not thrilled with what I read about you trying what seems like a number of random settings. If you don't get things set just right, you can either get no therapy from the machine, or you can do more harm than good.

-john-

Go through the setup menu and write down EVERY option and setting that's in there as it's configured now.
Then, bring them back here and post them. Someone may have an idea.


Den

I personally find BiPAP with Bi-Flex enabled very comfortable, but I know of at least two very experienced cpap/autopap users (for whom cpap and autopap work fine) who tried BiPAP with and without bi-flex on and couldn't find any setting that suited them. The BiPAP just didn't gee and haw well with something about their breathing.

Hope you get it worked out or are able to use another type of machine successfully.

I'm one of the two mentioned by Rested Gal. BIPAP is Respironics's name for a bi-level machine: one that identifies when you start exhaling, and drops to a lower pressure. I has such trouble with the Resprionics machine that I could not use it for more than 2 hours. And this is after 4 years of successful therapy. The Respironics BIPAP was simpy incapable of understanding my breathing pattern, and did not respond properly - it went absolutely nuts.

Insist on trying a bi-level machine from another company. ResMed has a bi-level machine (called VPAP), Sandman has one (called Duo). Don't let anyone try to force you to use a machine that is not right for you. Even if the Respironics machine worked great for 99.99% of the population, you may be that once case in 10,000 for which it does not work, and you have every right to recieve proper therapy as do the other 9,999. Make that clear to your doctor or DME.

I am presently using a ResMed Auto, and it identifies my inhale to exhale switch perfectly.

Good luck,

O.

Thanks for all of your timely answers. I will get my husband to type in all the technical info later. I want to emphasize that the exhale problem is immeadiate. I cannot complete an exhale on the first try or any later breath. The mask only leaks when I am trying to force an exhale.

Sometimes when I am lying on my back I can feel a pop along with an inability to exhale. It was something I first noticed after starting treatment. If I am on my side, I never experience this, or if I have my head tilted back. I believe it to be an actual occurrence of apnea with my windpipe closing shut, and what we are trying to treat with our machines. My understanding is that CPAP, and the exhale pressure (epap) of BiPAP are supposed to be splinting or holding our breathing passages open so that we don't stop breathing. I try not to sleep on my back since the feeling is very disconcerting to say the least. Since I have very good numbers on my EncoreViewer print out and when using my machine in Auto mode I rarely went over my epap pressure of 10, I have not tried raising my epap pressure. I just sleep on my side. You said your machine is a Respironics BiPAP Pro 2. If so, it is a data capable machine and getting the card reader and software would be beneficial to see just exactly what is going on. Rested Gal and others here have helped me with advice after seeing my data. It is hard to diagnose the problem without the data.

Dale

Wulfman wrote:Go through the setup menu and write down EVERY option and setting that's in there as it's configured now.
Then, bring them back here and post them. Someone may have an idea.
Den

I 2nd the above configuration request.

Also I would like to start from the beginning - did this machine ever work for you?

And who set it up for you? Is it new or used?

Hi, Thanks for all the replies. I am Warren, husband of "SleaplessInHouston". Please let me tell you the story of our BPAP.
After the sleap study, the doctor prescribed a machine. His script asked for a Bilevel CPAP, preferably respironics set at 11/7 cm/H2O with 12 breaths/min backup. The store that provides this site is in Houston and we saw one there. It costs about $3000. Well we have no insurance and my wife is suffering from sleep deprivation so I looked for what we could afford. I knew that the only good sleep she has had was the night of the sleep study, July 3rd, and their machines were clinical CPAP - only one pressure at any time.

I found a used Respironics BPAP Pro 2 on craigslist for $100 and jumped for it. I learned how to set the pressures. It has a card. We took it to the CPAP store and they checked out the pressures and sold us filters, new tubing and a mask. I only wish that we could have set it up there and use it there while they watched.

Here are all the clinical settings.
BPAP ipap=11.0cm/H2O epap=7.0cm/H2O rise time=2 ramp=0:45 ramp start=4.0cm/H2O patient=0 light=1 nights=0

We have tried other settings in despiration, but return to these.

Thanks

SleaplessInHouston wrote:Hi, Thanks for all the replies. I am Warren, husband of "SleaplessInHouston". Please let me tell you the story of our BPAP.
After the sleap study, the doctor prescribed a machine. His script asked for a Bilevel CPAP, preferably respironics set at 11/7 cm/H2O with 12 breaths/min backup. The store that provides this site is in Houston and we saw one there. It costs about $3000. Well we have no insurance and my wife is suffering from sleep deprivation so I looked for what we could afford. I knew that the only good sleep she has had was the night of the sleep study, July 3rd, and their machines were clinical CPAP - only one pressure at any time.

I found a used Respironics BPAP Pro 2 on craigslist for $100 and jumped for it. I learned how to set the pressures. It has a card. We took it to the CPAP store and they checked out the pressures and sold us filters, new tubing and a mask. I only wish that we could have set it up there and use it there while they watched.

Here are all the clinical settings.
BPAP ipap=11.0cm/H2O epap=7.0cm/H2O rise time=2 ramp=0:45 ramp start=4.0cm/H2O patient=0 light=1 nights=0

We have tried other settings in despiration, but return to these.

Thanks

If that's in fact the BiPap Pro 2, it should have a mode setting called BFLE (BiPAP w/Bi-Flex). Change it to that (from BPAP), then, select a Bi-Flex setting of "2" or "3" to start with (the options are 1, 2 or 3). I THINK (from reading the manuals) that there is then no optional setting for "Rise Time" (which may be what the problem is with your wife's breathing efforts).

You also may want to consider some changes to the Ramp settings. That's a long time (ramp=0.45) to be stuck at such a low pressure. Most of us turn it off and just go with the full air flow. At the least, you could set it to "0.15" (15 min) and a higher starting pressure like "6".

Good luck and let us know how things go.


Den

so you were ordered a bipap ST and have a BIPAP S.....

hohum wrote:so you were ordered a bipap ST and have a BIPAP S.....

is what it sounds like, yes.

I 2nd the raise the ramp and reduce the ramp time. I would consider going a bit higher - like 8 on the ramp. Keep in mind the Ramp doesn't work until/unless you press the "Ramp Button". I think the Rise Time is also giving troubles and may be a bit too fast. I don't know enuff about the Rise Time Feature.

To me, it sounds as if there is more and significant parts of the medical history missing here. What other medical problems is she dealing with here?