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Bipap question
#21
Thanks for your input. It is looking like I am going to be
stuck at a 95% pressure of 20. My ahi average is around 3.7.
here are my questions:

1. Should I try a bilevel?
2. Will I need a sleep study?
3. How hard is it to get acclimated to a bilevel?
4. Since I seem to tolerate the high pressure, can I use the
bilevel just like my apap .ie let it tell me how high I need?
5. Which bilevel machine do you recommend?
6. This high pressure tendency makes me uneasy. I am
pretty small (5'3", 122 lbs). What is this high pressure doing
to my insides? I have had 2 hernias in the last couple years
(Belly button area) -I'm thinking there is a link to using cpap!

note to vaughn- got the tennis ball on so back sleeping doesn't
seem to be an issue.
2010 sleep study 63 AHI, 2014 3.0
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#22
Correction: delete question #4 - lots of painful gas today.

Thanks for your input.
2010 sleep study 63 AHI, 2014 3.0
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#23
The Resmed S9 VPAP auto is the auto titrating bilevel machine. You set the difference between IPAP and EPAP and that stays constant. The IPAP and EPAP move up and down together but with the same difference within the Min EPAP- Max IPAP range that you set
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#24
(05-26-2014, 07:10 AM)readyforsleep Wrote: It is looking like I am going to be stuck at a 95% pressure of 20. My ahi average is around 3.7.
here are my questions:

1. Should I try a bilevel?
2. Will I need a sleep study?
3. How hard is it to get acclimated to a bilevel?
4. Since I seem to tolerate the high pressure, can I use the
bilevel just like my apap .ie let it tell me how high I need?
5. Which bilevel machine do you recommend?
6. This high pressure tendency makes me uneasy. I am
pretty small (5'3", 122 lbs). What is this high pressure doing
to my insides? I have had 2 hernias in the last couple years
(Belly button area) -I'm thinking there is a link to using cpap!

note to vaughn- got the tennis ball on so back sleeping doesn't seem to be an issue.

(05-26-2014, 01:26 PM)readyforsleep Wrote: Correction: delete question #4 - lots of painful gas today.


1. Your AutoSet when using EPR operates very similarly to the bi-level ResMed S9 VPAP Auto, with the main difference being that the VPAP Auto can be adjusted to have more than 1, 2 or 3 difference between the IPAP pressure and the EPAP pressure.

I suggest you turn on EPR set to 1, which means EPAP will be 1 less than IPAP. This will slightly lower your tendency to swallow air, so that would be an improvement.

Setting EPR to 1 may also tend to increase the amount of central apneas and/or Periodic Breathing.

But during the initial months of therapy, as our bodies become more acclimated to breathing against pressure, the tendency of EPR (or of "Pressure Support" used on bi-level machines) to cause central events tends to gradually diminish. So the bad experience you had when using EPR earlier might not reoccur.

After a few days with EPR set to 1 (and watching the data closely), if that did not cause an obvious increase in central events, I would suggest setting EPR to 2 for a few days to see if it reduces air swallowing. If that turns out well, then you could try setting EPR to 3 for a few days. After that, if you would like to try a larger difference between IPAP and EPAP, you would need a bi-level machine, and I would certainly recommend an Auto bi-level such as the S9 VPAP Auto or the PRS1 (Philips Respironics System One) BiPAP Auto with heated hose.

If You find that EPR still causes unstable breathing, then I don't think a standard bi-level machine will be usable in your case. For example, if you found that an EPR of 3 is needed to control aerophagia but that it would cause the CAI (average number of central apneas per hr) to be higher than 5, then an ASV machine may allow better treatment, but maybe not.

The main problem is the high EPAP (occasionally maxing out at 20). This cannot be treated with the ResMed ASV model (S9 VPAP Adapt), because the S9 VPAP Adapt only allows EPAP as high as 15. The Philips Respironics ASV model (PRS1 BiPAP autoSV Advanced) can treat an EPAP of 20, but ASV can be harder to get used to than standard bi-level, and you wouldn't know until you tried it whether you would prefer it or not.

In your case, I suggest investigating the effect of sleep position on aerophagia and on how high your pressure adjusts itself. See if your sleep position can be changed to lower how much EPAP pressure you need. The less pressure you need, the less pressure your Auto machine will use. Our pressure needs can be influenced by whether our chin points left or right or up or down or straight forward, the angle between head and shoulders, as well as by whether we are sleeping on our back or side or half on our stomach. Different pillow sizes could be tried. (I use only a very small neck pillow, under my head not neck.)

You may need to videotape yourself while sleeping to see what positions are best or worst. Maybe a bed which allows the head to be elevated would be best. I think you are likely to be able to find some way to lower your pressure needs and reduce aerophagia by investigating the effect of your sleep positions.

You may find it necessary to limit the Max Pressure in order to reduce aerophagia, as long as that does not cause AHI to raise too much, or cause obstructive apneas to to last too long. I think obstructive apneas lasting longer than 45 seconds or a minute would be especially alarming.

Since your machine is already maxing out at 20 cm H2O pressure, I suggest you invest in a wrist-mounted recording Pulse Oximeter, such as are sold by Supplier #19. Supplier List link is located at top of every forum page. Or, if your doctor will write a prescription for the one particularly-expensive oximeter which can plug directly into your machine so that ResScan will display your Oxygen level and pulse rate along with the rest of your machine's data, and if your insurance will preauthorize it, great, but the lowest price I've seen for those is around $1,250 online, and far more economical options exist. (No prescription is needed to buy a Pulse Oximeter if paying for it out of pocket.)

But whatever you do, whether using an APAP or bi-level, I recommend you make sure your machine remains an Auto model capable of automatic adjustment of at least the EPAP pressure. Otherwise you will not be able to easily see the effect on your pressure needs (of whatever you do to reduce your pressure needs).

2. Whether you would need an overnight bi-level titration study before you could get a bi-level machine depends on your insurance and your doctor. Maybe required, or maybe not.

3. You already have what is effectively a limited bilevel device, if you are able to use EPR. See if your system can tolerate EPR.

4. Some models, yes. Would need to be a bi-level Auto model.

5. I think the PRS1 BiPAP Auto is better in some ways than the S9 VPAP Auto because as well as EPAP being able to auto-adjust across a range, also PS is able to (slowly) auto-adjust across a range on the PRS1 BiPAP Auto. Likewise. I think the PRS1 BiPAP autoSV Advanced is better in some ways than the ResMed S9 VPAP Adapt.

6. It takes about 70 cm H2O to equal the pressure of just 1 psi (pound per square inch). A normal strong cough creates many times the pressure of your machine's highest setting. Even when you are just blowing up a balloon the pressure will be several times the highest pressure your machine will produce. People who have had a tendency to have "spontaneous pneumothorax" (collapsed lung caused by normal activity like coughing) are advised not to use CPAP, but not because CPAP would itself cause a collapsed lung, only because if a collapsing lung is already in progress the use of CPAP would tend to accelerate the collapse.

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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#25
Thank-you. My tweaking will continue. Somehow my sleep
position must have been different with the nasal pillows - my
pressure needs were lower.
2010 sleep study 63 AHI, 2014 3.0
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#26
One night using a epr of 1 and raising my mattress and my
95% pressure went down to 17. Hope this trend continues...
2010 sleep study 63 AHI, 2014 3.0
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#27
Update -
1. EAP=3
2. Pressure 16-20
3. Tennis balls on back
4. 95% pressure number =20
5. Variable AHI 2.7 - 5
6. Centrals minimal

Listen to me, I actually know what I'm talking about!

I just reached 16 as my low pressure on Monday, so I don't have
alot of data under by belt. But, I see the doctor on Friday. I'm going to ask
to try the Auto Bipap. Still feeling muddled until mid afternoon.
2010 sleep study 63 AHI, 2014 3.0
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#28
(06-11-2014, 06:36 AM)readyforsleep Wrote: Listen to me, I actually know what I'm talking about!

That's great that you have learned the terminology and now, because you have become actively involved on your own behalf, are now in a position to ask better questions of your doctor, and to better understand the answers from your doctor, and to be a better advocate on your own behalf.

I think it is now clear that you would benefit from a bi-level auto-titrating machine (such as the ResMed S9 VPAP Auto or the Philips Respironics System One BiPAP Auto with heated hose) to optimize your therapy and to minimize aerophagia.

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.
Reply
#29
(06-11-2014, 06:36 AM)readyforsleep Wrote: Update -
1. EAP=3
2. Pressure 16-20
3. Tennis balls on back
4. 95% pressure number =20
5. Variable AHI 2.7 - 5
6. Centrals minimal

Listen to me, I actually know what I'm talking about!

I just reached 16 as my low pressure on Monday, so I don't have
alot of data under by belt. But, I see the doctor on Friday. I'm going to ask
to try the Auto Bipap. Still feeling muddled until mid afternoon.
Hi readyforsleep,
Good goin', I knew you would catch on, keep up the good work and good luck to you at your Dr. Apointment.
trish6hundred
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#30
(05-17-2014, 12:18 PM)readyforsleep Wrote: On a typical night I butt against the 20 pressure level a couple times a night.
Pulling data from my S9 auto for the last 30 days:
Pressure 18.8
Leak 19 L/m
AHI 3.7
First of all, congrats on a good job maintaining excellent leak rate especially at such high pressure

18.8 is 95% percentile which means pressure was at or below this number for 95% of the night, not all night long

Keep an eye on flow limitation (FL), the machine increase pressure in response to FL which in some instances can the push pressure as far as can go, something to talk with the doc about


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