Got approved for a Respironics auto Bipap today

And picking it up tomorrow. I found out my new pressures are going to be exhalation of 8, inhalation of 20.

So I am going from APAP where my settings have been minimum 10, maximum 20 and been that way for years. With consistent 95th percentile excursions anywhere from the mid elevens to the thirteens if I use my Resmed S8 APAP. To consistent 90th percentile excursions into the mid 15s if I use my PR System One APAP, it has a more aggressive algorithm past a pressure of 10.

So if I understand this right, I will be inhaling 20? Exhaling 8? Whoa. Hopefully I wont get the stomach pain, but get the better energy levels and elevated mood from the increased pressure.

Are you getting a system one? The newer machines are quieter than the older ones. It will sound different that what you are used to instead of a steady hum it will change with inhalation and exhalation.

What is your Pressure support going to be at? That makes a lot of difference. I'm at EP 10 and IP 14 with a pressure support of 4 and most nights I stay between IP of 12 and 13 with a spike every now and then to 14.

Gerryk wrote:Are you getting a system one? The newer machines are quieter than the older ones. It will sound different that what you are used to instead of a steady hum it will change with inhalation and exhalation.

I think so, I know it is a respironics bipap auto. I really wont find out for sure until tomorrow. All my APAPs are premium, hopefully this will be a PR.

As far as quiet I am not really concerned about that. It does sound like Im being set back to the old set pressure deal though, even though it is a auto bipap. exhale 8 and inhale 20. Man, I hope I can handle that inhale pressure. I handle some fairly high pressures on APAP, well into the 15s and 16s. And beyond for periods, but not all night.

squid13 wrote:What is your Pressure support going to be at? That makes a lot of difference. I'm at EP 10 and IP 14 with a pressure support of 4 and most nights I stay between IP of 12 and 13 with a spike every now and then to 14.

I dont know. I am totally new to bipaps. Your mentioning of pressure support is the first Ive even heard of that term before. This is gonna be a learning curve for me. I know everything about regular CPAP and APAP, but zilch about bipap.

What is pressure support? There are tons of good reading about CPAP and APAP on the net, but not much about bipap. But then I have never really read up on bipap much until just in the last few weeks.

I was just like "wow, inhale pressure of 20, whoa." That is a big jump of sustained pressure for me. I KNOW I could never handle that on straight CPAP or APAP. Like, I could never handle a minimum APAP pressure of 13, 14 or 15. Much less 20.

If I went by my 90th percentile on my PR System One APAP, my straight CPAP pressure would be in the high fifteens. Probably 15.5 or maybe 16.

Huge difference between the older model Resmed S8 APAPs I am used to and the Resmed S9 APAP and the Respironics APAPs that treat apneas all the way to 20. The Resmed S8 APAPs wont treat apneas past 10, that is why my pressure is always lower on that machine than on either an S9 or a PR APAP.

Big learning curve here for me. Bipap. I gotta lose some weight, this is getting kinda ridiculous. Pressure of 20. Wow.

Here is a post to read about BiPap viewtopic.php?f=1&t=69519&p=644512&hili ... to#p644512 and this is a good explanation of the difference between how pressure support works in the ResMed and the Respironics machine by a member called jnk. The below is what jnk said.
"I think you may misunderstand the differences between the two machines and how each machine must be set. They are both good autobilevels, but you can't set either of them up correctly by attempting to use the numbers that were used on the other brand of machine. You have to think about the numbers and translate them for how you want the other brand of machine to run.

As an illustration, think of inhale and exhale as being two dancers. On the Respironics dance floor in the Respironics world, the two dancers dance two different dances without caring what the other dancer is doing. You simply set the size of the dance floor and you tell the dancers the maximum distance they are allowed to get from each other during their separate dances (there is an automatic minimum to keep them from bumping into each other), and they each do their own thing. Sometimes they dance close to each other, and sometimes they dance far apart. That distance varies. On the other hand, on a ResMed dance floor in the ResMed world, the two dancers do the same dance and are always the exact same distance from each other, but they can still roam the full dance floor, as long as they do it together. So if you mistakenly set the fixed distance of the dancers to be the same size as the dance floor, you keep the dancers from moving at all.

In other words, for the Respironics machine, you set the maximum IPAP and minimum EPAP (the size of the dance floor), then you set the MAXIMUM pressure support, or maximum distance allowed between the two separate pressures (dancers). For the ResMed, you similarly set a maximum and minimum (the dance floor), but then you set the ACTUAL pressure support, the fixed distance (or, difference) between inhale pressure and exhale pressure for the night. On that machine, those two pressures increase and decrease TOGETHER, NOT SEPARATELY, moment to moment, during the night (since the two do the same dance together).

It seems that the person who set up your machine didn't understand that difference between the two machines and set up the ResMed as if it were a Respironics. That is incorrect. If you want the ResMed to run as an auto, make sure the pressure support number is a number LESS THAN the distance between Max IPAP and Min EPAP so the dancers have some room to move. If the machine isn't set up correctly, it is the person who set it up who has kept the machine from running as an auto. That is not a limitation of the machine; it is a limitation of the person who set it up. That person was confused. So don't blame ResMed.

As for which approach to autobilevel dancing is best, I don't know. I just know the two approaches are different and that before you set up one brand after using another brand, you had better learn something about dance floors and choreography in the other world and translate from one to the other, if you want to see a dance."

I was thinking about it and Im wondering if my sleep doctor really means a range of 8 to 20, in auto mode on this bipap. If that is what he is wanting to do then that would mean he is reducing my minimum pressure two points. I'd be so sleepy and tired I could not function.

I wont find out til Tuesday, if that is what he is wanting to do I will be so mad. It would mean he was not listening to me at all and I have a sleep doctor who I have a major communication problem with. I told him I cannot tolerate a set pressure past 10. But I could probably tolerate a pressure of 11 or 12 on an auto bipap.

If I decrease below 10, I become so tired Im almost drunk feeling.

In Auto mode the PR S1 Auto bipap has a default PS of 2 cm...and it really will only be apparent while you are awake and the IPAP will be 2 cm above your 8 cm min EPAP setting. Should be quite comfortable.
Once you fall asleep and events start triggering the IPAP and EPAP...the pressures will increase per the pressure support setting allowances and as it needs to go up.

So while awake...you won't see 20 cm but you will see 8 EPAP and 10 IPAP..

Jnk's explanation as to the roaming ability of the pressure support is a good one. It will roam about as needed within its parameters and IPAP and EPAP will vary depending on the need sensed by the machine and the limits set in pressure support.

Pugsy wrote:In Auto mode the PR S1 Auto bipap has a default PS of 2 cm...and it really will only be apparent while you are awake and the IPAP will be 2 cm above your 8 cm min EPAP setting. Should be quite comfortable.
Once you fall asleep and events start triggering the IPAP and EPAP...the pressures will increase per the pressure support setting allowances and as it needs to go up.

So while awake...you won't see 20 cm but you will see 8 EPAP and 10 IPAP..

Jnk's explanation as to the roaming ability of the pressure support is a good one. It will roam about as needed within its parameters and IPAP and EPAP will vary depending on the need sensed by the machine and the limits set in pressure support.

All I need to know is this.

Would an 8 minimum on an auto bipap make me feel about the same as an 8 minimum on a regular APAP? Or am I comparing apples to oranges? In other words is an 8 minimum on autoBipap totally different than an 8 minimum on APAP? Id think they would be the same, as this is all based on centimeters of water pressure and centimeters of water is centimeters of water, period.

An 8 minimum on a regular APAP and I feel like death the following day. If the 8 minimum setting on auto bipap is roughly equivalent to 8 minimum on APAP, I got major problems and have a serious communication problem with my sleep doc. Maybe he wrote it like that just to get it through the insurance better or something?

Or is 20 my inhalation and 8 my exhalation, like I originally was thinking? I could see that, that would make some sense to me. More pressure on inhalation and way less on exhalation to relieve stomach pain.

Stressed out now

I should mention, I am already very comforable on the regular APAP Im on. All that happened was I hit my pressure threshhold that I can tolerate without beaucoup side effects. I cant tolerate sustained pressures beyond 10. Up to 10, I am perfectly good to go and comfortable, a pressure decrease is NOT needed. The problem is sustained minimum of 10 does not seem to be strong enough anymore and I have been experiencing bad fatigue and stuff in the last few months.

God, an 8 minimum and I would be a zombie.

What I wanted was a higher sustained pressure than 10, but without the sustained pressure side effects. I thought that was what my sleep doc understood.

The 8 cm minimum EPAP is only there to start the night with and it will increase as the pressures drive up the need just like your APAP does.
So both your EPAP and IPAP will vary as needed to address the events. They will both adjust.

Example...EPAP 8.....IPAP max 20....pressure support of say 5... EPAP and IPAP will never be more than 5 cm apart.... so if events drive your pressure up EPAP will push IPAP up or IPAP will drag EPAP up and it can't ever be more than 5 cm apart....so if you need 20 IPAP..EPAP won't ever be lower than 15.
It might be closer to 20 but won't ever be farther away than 5.
From what I have read it is the type of event that drives either EPAP up or IPAP up.
So EPAP either pushes IPAP up or IPAP will pull EPAP up but they won't ever be farther away than whatever Pressure support setting is...they do vary and can be closer but never further apart than the PS setting.

8 cm is the highest Pressure support setting. If set at 8 cm...EPAP and IPAP can't ever be farther away than 8 cm...they can be close though depending on what the machine senses that it needs to do.

Does this help clarify things a bit more?

Minimum EPAP does need to be close enough to give things a good headstart just like APAP minimum but you have more room for variation due to pressure support and IPAP playing into things.

You might start out the night at the 8/10 combination while awake but if you need 16 or more to address the events...EPAP and IPAP will both go up to address the issues. But hopefully not stay up there any more than is needed and with EPAP being lower than IPAP the chances for aerophagia are lessened.

I am going to ask the RT tomorrow when I pick this thing up.

Let me clarify this, EPAP=exhale Pressure? AND IPAP=inhale Pressure?

If my pressure settings are EPAP of 8, that means I start out exhaling a 8 centimeters of water. And my IPAP of 20 will mean that my inhale will be 20 centimeters of water pressure?

And it is in auto mode and adjusts for everything?

If so, that would be fine and sounds "good" to me.

Im totally confused.

If on the other hand, the thing is set up for a free ranging "automode" of 8 to 20 centimeters of water but on a bipap machine, would this mean that my beginning IPAP would be 8 and my beginning EPAP would be 6? I read these respironics machines in automode will automatically drop two points on exhale, whereas in fixed mode they are adjustable for about anything. And my maximum pressure would be an IPAP of 20 and EPAP of 18? And it would "range and increase from the minimum 8 to whatever maximum?

This is what I am confused about, what I am going to be getting.

Pugsy wrote:The 8 cm minimum EPAP is only there to start the night with and it will increase as the pressures drive up the need just like your APAP does.
So both your EPAP and IPAP will vary as needed to address the events. They will both adjust.

Example...EPAP 8.....IPAP max 20....pressure support of say 5... EPAP and IPAP will never be more than 5 cm apart.... so if events drive your pressure up EPAP will push IPAP up or IPAP will drag EPAP up and it can't ever be more than 5 cm apart....so if you need 20 IPAP..EPAP won't ever be lower than 15.
It might be closer to 20 but won't ever be farther away than 5.
From what I have read it is the type of event that drives either EPAP up or IPAP up.
So EPAP either pushes IPAP up or IPAP will pull EPAP up but they won't ever be farther away than whatever Pressure support setting is...they do vary and can be closer but never further apart than the PS setting.

8 cm is the highest Pressure support setting. If set at 8 cm...EPAP and IPAP can't ever be farther away than 8 cm...they can be close though depending on what the machine senses that it needs to do.

Does this help clarify things a bit more?

Minimum EPAP does need to be close enough to give things a good headstart just like APAP minimum but you have more room for variation due to pressure support and IPAP playing into things.

You might start out the night at the 8/10 combination while awake but if you need 16 or more to address the events...EPAP and IPAP will both go up to address the issues. But hopefully not stay up there any more than is needed and with EPAP being lower than IPAP the chances for aerophagia are lessened.

Suddenly Worn Out wrote:Let me clarify this, EPAP=exhale Pressure? AND IPAP=inhale Pressure?

Correct.

Suddenly Worn Out wrote:If my pressure settings are EPAP of 8, that means I start out exhaling a 8 centimeters of water. And my IPAP of 20 will mean that my inhale will be 20 centimeters of water pressure?

If you used straight fixed bilevel mode yes.

But with Auto mode....EPAP and IPAP are not fixed. They both will auto adjust.
If minimum EPAP is 8...you will get 8 on exhale and 10 on inhale the 2 cm difference is added...not subtracted.

If your minimum EPAP was 10....your IPAP would be 12 if in auto mode while starting out the night. This is only in auto mode.

I have an image of one of my reports....EPAP minimum 10 cm....IPAP maximum of 20. I started out the night with EPAP of 10 and IPAP of 12 while awake and it didn't need to go do much of anything until around 5:30 in the morning. If you can't see 5:30 to past 7:00 AM...right click image and choose "view image" to see the ending of the night. My changes aren't as dramatic as yours might be. I hit 17 cm briefly...EPAP got drawn upwards. This is the only one I have showing auto mode. I changed to straight bilevel 9EPAP and 13 IPAP after this.

OK, now I know exactly what I will be dealing with tomorrow. It depends on if Im in fixed mode or auto mode...whatever my sleep doctor ordered. You explained to me the difference between the fixed and auto bipap mode well in this last post. Thanks. I now feel more relaxed. So, if I get there tomorrow and am told it is in auto mode and the minimum EPAP is 8, my actual inhale pressure will be 10, so it wont be that different.

OK, I feel like I am sorta oriented now to what I will be getting. Thanks. Im so dependent on my gear that I get bad anxiety if I think my pressure is going to be decreased below 10, because everytime Ive tried to do that, my symptoms come back. And I feel awful. All it takes is a small jump of sustained pressure past 10 and I get bad stomach pain, but if I use C-Flex or A-flex, the stomach pain goes away on 10.5 or 11. But C-Flex and A-Flex feel "weak" to me and dont pack the punch straight pressure gives me.

All Im trying to do is get a higher pressure, but without the higher pressure side effects. On Auto mode, it sounds like I could tolerate an EPAP of 10 and IPAP of 12 no sweat. I can talk to my doctor if things are not GTG with the EPAP 8, IPAP 10 auto mode, IF that is what Im getting and not getting fixed mode.

Pugsy wrote:

Suddenly Worn Out wrote:Let me clarify this, EPAP=exhale Pressure? AND IPAP=inhale Pressure?

Correct.

Suddenly Worn Out wrote:If my pressure settings are EPAP of 8, that means I start out exhaling a 8 centimeters of water. And my IPAP of 20 will mean that my inhale will be 20 centimeters of water pressure?

If you used straight fixed bilevel mode yes.

But with Auto mode....EPAP and IPAP are not fixed. They both will auto adjust.
If minimum EPAP is 8...you will get 8 on exhale and 10 on inhale the 2 cm difference is added...not subtracted.

If your minimum EPAP was 10....your IPAP would be 12 if in auto mode while starting out the night. This is only in auto mode.

I have an image of one of my reports....EPAP minimum 10 cm....IPAP maximum of 20. I started out the night with EPAP of 10 and IPAP of 12 while awake and it didn't need to go do much of anything until around 5:30 in the morning. If you can't see 5:30 to past 7:00 AM...right click image and choose "view image" to see the ending of the night. My changes aren't as dramatic as yours might be. I hit 17 cm briefly...EPAP got drawn upwards. This is the only one I have showing auto mode. I changed to straight bilevel 9EPAP and 13 IPAP after this.

I can't imagine them doing fixed bilevel mode with 8/20. Talk about blowing you up like a balloon....
With your history..I would bet on auto adjusting mode.

Now that your panic has subsided..if you are bored you might enjoy reading how I came to be on bilevel myself. viewtopic/t71442/viewtopic.php?f=1&t=71 ... te#p656179

Don't get in a panic when you read about Resmeds way of pressure support when in auto mode. Theirs is fixed and not roaming like Respironics. For your history of aerophagia...having the machine maybe keep the pressure support lower and only increase as needed would likely decrease the aerophagia probably a better than a fixed pressure support for your situation. It would be what I would want to use if I was in your situation.
I don't have aerophagia problems though. I just like the comfort that the difference between EPAP and IPAP offers..much more like normal breathing. First time I ever tried it....took me 30 seconds to say "I gotta have one of these" All explained in my little thread there.