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AHI of 8.2 with P.R. auto BIPAP
#1
I switched from Resmed S9 auto Cpap in June/2014 to P.R. System one auto Bipap with heated humifier and tube.
Max ipap 16
min epap 4
max pressure support 8
min pressure support 0
biflex setting 2
Last night my 90% pressure was 16.0 and 9.5.

Lately my AHI is 8 or 9.In the first few weeks with the P.R. it was less than 5.
With the Resmed S9, my AHI was less than 2.However I started getting central apneas so was switched to the BIPAP.
My ahi was ~31 without treatment.I am a 61 year old woman and have been on cpap/bipap therapy for 3 years.I also have controlled asthma, insomnia, and excessive daytime sleepiness.
I'm in the country for a holiday and don't have a card reader or access to technical support. I'm getting headaches in the early a.m. similar to what I had before treatment. Should I increase my max IPAP setting to 17? Any suggestions would be greatly appreciated.
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#2
Hi wnorm,
WELCOME! to the forum.!
Hang in there for answers to your question and best of luck to you.
trish6hundred
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#3
wnorm,

Do you remember what your settings on the Resmed S9 Auto were? And did you use EPR on the Resmed? If so, what was it set to?

You write:
(07-26-2014, 12:35 PM)wnorm Wrote: I switched from Resmed S9 auto Cpap in June/2014 to P.R. System one auto Bipap with heated humifier and tube.
Max ipap 16
min epap 4
max pressure support 8
min pressure support 0
biflex setting 2
Last night my 90% pressure was 16.0 and 9.5.
With these settings you are starting out the night with both EPAP and IPAP = 4cm, and given the 90% pressure levels, that may be way too low of a min EPAP pressure.

Rather than increasing the max IPAP from 16 to 17, you may be better off either increasing the min EPAP OR increasing the min pressure support so that your beginning IPAP pressure is (much) closer to what you actually need for controlling your obstructive sleep apneas.



Questions about SleepyHead?
See my Guide to SleepyHead
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#4
(07-26-2014, 12:35 PM)wnorm Wrote: With the Resmed S9, my AHI was less than 2.However I started getting central apneas so was switched to the BIPAP.
S9 can detect central apnea but only sleep study in a sleep lab can diagnose central apnea or other sleep disorders with certainty. BIPAP does not treat central apnea, usually BIPAP autoSV Advanced prescribed for mixed apneas, complex apneas, periodic breathing or central apnea

As for headache, at times I get headache in the morning due to one of the nostril get blocked (something to do with nasal cycle), not getting enough air through from the other nostril. I,m thinking getting an oximeter to check O2 levels during the night. Whats your leak rate, if leak rate goes above certain level and air escape instead of keeping the airways open will feel like not getting enough air to breathe

I,m not BIPAP user but like RobySue said, increase the minimum, for me starting at low pressure would feel like not getting sufficient air to breathe but this something best discuss with your doctor
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#5
(07-26-2014, 08:12 PM)robysue Wrote: wnorm,

Do you remember what your settings on the Resmed S9 Auto were? And did you use EPR on the Resmed? If so, what was it set to?

You write:
(07-26-2014, 12:35 PM)wnorm Wrote: I switched from Resmed S9 auto Cpap in June/2014 to P.R. System one auto Bipap with heated humifier and tube.
Max ipap 16
min epap 4
max pressure support 8
min pressure support 0
biflex setting 2
Last night my 90% pressure was 16.0 and 9.5.
With these settings you are starting out the night with both EPAP and IPAP = 4cm, and given the 90% pressure levels, that may be way too low of a min EPAP pressure.
j
Rather than increasing the max IPAP from 16 to 17, you may be better off either increasing the min EPAP OR increasing the min pressure support so that your beginning IPAP pressure is (much) closer to what you actually need for controlling your obstructive sleep apneas.

Thank-you for your response. My settings on the Resmed S9 were min 4, max 16, EPR 3, ramp 0,
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#6
(07-26-2014, 10:50 PM)wnorm Wrote:
(07-26-2014, 08:12 PM)robysue Wrote: Rather than increasing the max IPAP from 16 to 17, you may be better off either increasing the min EPAP OR increasing the min pressure support so that your beginning IPAP pressure is (much) closer to what you actually need for controlling your obstructive sleep apneas.

Thank-you for your response. My settings on the Resmed S9 were min 4, max 16, EPR 3, ramp 0,

Hi wnorm,

As robysue suggests, it is usually best to only make one change at a time, gathering data (preferably for a couple weeks) between changes.

My suggestion would be to increase the Minimum EPAP setting first. I would suggest jumping it to 6, and, if that helped, later trying 7.

EPR in ResMed machines is a form of simple bi-level therapy (Pressure Support). Since EPR was 3, I would consider raising the Min Pressure Support to 1 or 2 or 3. (Later, after seeing how things are with a higher Min EPAP.) But keep in mind that raising Min PS may tend to reduce obstructive events at the expense of raising central events. If that turns out to be the case for you, I would suggest finding a happy compromise in the Min EPAP, Min PS and Max PS settings which minimizes the overall AHI but also takes into account (minimizes) how often long duration events are occurring, such as obstructive apneas lasting longer than 30 or 40 seconds, as shown in SleepyHead reports.

Raising Min EPAP would tend to reduce obstructive apneas and hypopneas, especially at the beginning of the night, before the BiPAP Auto has had time to slowly adjust itself to our pressure needs, or whenever we enter REM stage sleep or roll onto our back and our pressure needs increase.

Raising Min PS would likely feel more comfortable (since you have been used to EPR of 3) and would tend to reduce RERA (Respiration Effort Related Arrousal) events but may also increase central events. By the way, although some patients assume central apneas are somehow worse than obstructive apneas, in my opinion short central events are no more harmful/stressful (and perhaps are less harmful/stressful) than short obstructive events, so, in my opinion it is good to aim to lower the overall AHI without regard to how many are central versus obstructive.

Some general background info:

I think it is a common mistake that the bottom end of the pressure range is left at 4 cm H2O too long. Starting so low can often be helpful for first few days or weeks of CPAP therapy, until our chest muscles gain strength and we become accustomed to breathing against pressure, but I think many patients very quickly find it more comfortable and therapy is improved by having a higher starting pressure, such as 6 or higher. (A few PAPers prefer the minimum pressure to be close to their 90% or 95% pressure.)

In your case, the PRS1 auto-adjusting machines (including the BiPAP Auto) are much less aggressive (swift) in raising the EPAP pressure than ResMed auto-adjusting machines are. So every time we roll onto our back or enter REM stage sleep and our pressure needs increase, the ResMed machine would have responded more quickly.

But, on the other hand, the ResMed auto-adjusting machines treat the minimum pressure setting as a target which they are always slowly trying to return to, which the PRS1 models don't do. PRS1 tend to stay put once the pressure is high enough to adequately prevent obstructive events, but, again, PRS1 machines do not adjust as quickly when our pressure needs suddenly increase.

If feasible, to monitor how low your blood oxygen is dipping throughout the night, I suggest buying a recording wrist-mounted pulse Oximeter, such as are sold by Supplier 19. (Link to Supplier List is at top of all forum pages.)

Take care,
--- Vaughn


Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#7
(07-26-2014, 10:50 PM)wnorm Wrote:
(07-26-2014, 12:35 PM)wnorm Wrote: I switched from Resmed S9 auto Cpap in June/2014 to P.R. System one auto Bipap with heated humifier and tube.
Max ipap 16
min epap 4
max pressure support 8
min pressure support 0
biflex setting 2
Last night my 90% pressure was 16.0 and 9.5.
My settings on the Resmed S9 were min 4, max 16, EPR 3, ramp 0,
I would suggest changing min PS from 0 to 3. And leaving min EPAP alone for now.

That will start you out at IPAP = 7, EPAP = 4, which is a higher IPAP than you were starting with on the S9 AutoSet, but it will better mimic how the S9 AutoSet behaved once the pressure increased up that far.

If 7/4 is too much pressure to start the night with, then maybe try min PS = 2; that starts you out at IPAP = 6, EPAP = 4.

Questions about SleepyHead?
See my Guide to SleepyHead
Reply


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