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Dreamstation Auto Bipap Setting Questions
#1
I've used a Remstar Auto Bipap with with the pressures set at the minimum of 4 and a maximum of 20 since 2010.

However, I just got a brand new Dreamstation Auto Bipap (not even used yet) and have a few questions about the set up.

Smart ramp is selected, but the DME also selected the ramp time which I think voids the use of Smart Ramp because she set a minimum and maximum IPAP and EPAP. Is that correct? She set IPAP and EPAP pressures at 23/9 and said that after ramp time is up the pressure would go to the minimum pressure of 9 and then up when needed during the night. I don't want more pressure than I need. At my initial sleep study in 2005, my pressure was titrated to 12 during events, but the events were always only during REM sleep. Should I set the IPAP and EPAP pressures at the minimum of 4 and leave the maximum at 23 and let the auto machine do what it is designed to do? When my dr. wrote the prescription, he said he put a pressure on the prescription because the insurance would be more inclined to authorize the machine without a hassle.

I have AHI enabled and will check that after a few nights on the machine. Also is the Dreammapper app sufficient to get enough information about progress or is software downloaded from the smart card really needed? Thank you.
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#2
Hi lawlipop,
I'll let someone more knowledgeable with bipap settings to advise, but I can't imagine that setting the minimum at 4 would be beneficial.

Dreammapper isn't going to give you or us the data we need to see to advise you.
Download the SleepyHead software. This will give you the best way to track your therapy.
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#3
The missing information on your prescription information is the pressure support, or difference between IPAP/EPAP that is maintained. The Dreamstation Auto BiPAP does not operate differently from the previous generation PRS1 60 Series BiPAP Auto. In auto B mode, there should be a minimum and maximum PS setting. Your profile shows a single pressure, and that would be CPAP, not BiPAP. Without knowing what your settings really are, it's not possible to really comment.

Using the old auto BiPAP from a minimum EPAP of 4 with whatever your pressure support was, and a cap on IPAP is less than ideal, assuming you are treating obstructive apnea issues. The best measure of effectiveness is to monitor your treatment through data. Download SleepyHead and install it on a computer. You can then upload your old data if you still have the SD card from your previous machine, and compare it to the data now being collected by the Dreamstation.
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#4
Hi lawlipop,
WELCOME! to the forum.!
I wish you good luck as you continue your CPAP therapy and with your new machine.
trish6hundred
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#5
(01-02-2017, 01:13 AM)lawlipop Wrote: .... She set IPAP and EPAP pressures at 23/9 and said that after ramp time is up the pressure would go to the minimum pressure of 9 and then up when needed during the night. I don't want more pressure than I need. At my initial sleep study in 2005, my pressure was titrated to 12 during events, but the events were always only during REM sleep. Should I set the IPAP and EPAP pressures at the minimum of 4 and leave the maximum at 23 and let the auto machine do what it is designed to do?

Hi lawlipop, welcome to Apnea aboard.

If your original CPAP titration pressure was 12 then 9 sounds about right as the Min EPAP.

Especially with PR machines (which are somewhat slow to increase EPAP) it is best to have the Min EPAP not less than 3 lower than the 90% pressure. Your machine will keep track of the 90% pressure measured each night.

The 90 percentile pressure is the pressure the mask was at or lower than, for at least 90% of the night (session). It is also the pressure the Mask was at or higher than for at least 10% of the night.

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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#6
The only thing written on the prescription is:
Max IPAP 23 Min IPAP 10
Max EPAP 22 Min EPAP 9

The Pressure Support blank is not filled in by the physician - just left blank.
Should I call him to inquire?

I have looked into the provider therapy and it is on Bpap.
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#7
(01-02-2017, 07:56 PM)lawlipop Wrote: The only thing written on the prescription is:
Max IPAP 23 Min IPAP 10
Max EPAP 22 Min EPAP 9

The Pressure Support blank is not filled in by the physician - just left blank.

Quote:I have looked into the provider therapy and it is on Bpap.

Since Min EPAP and Min IPAP are separated by 1, Min PS is 1.

Perhaps Max PS was left as its default value. I think the setup manual (Provider Guide) would say what the default value is for Max PS. Setup manual available for free download here:
http://www.apneaboard.com/adjust-cpap-pr...tup-manual

The therapy mode should be in BiPAP Auto, I think.
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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#8
Yes, I'm sorry, the therapy mode is AUTO BiPap.

I'm going to look again to see if I can find the pressure support under the provider therapy and will post if I find it. Also, wouldn't the MAX pressure support also be 1 since the difference between the Max IPAP of 23 and the Max EPAP of 22 is 1?

I'm trying to learn. Thanks.
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#9
(01-02-2017, 08:18 PM)lawlipop Wrote: Also, wouldn't the MAX pressure support also be 1 since the difference between the Max IPAP of 23 and the Max EPAP of 22 is 1?

Not necessarily.

If Max PS were to be 8 and if the present EPAP happens to have self-adjusted to 15, the PS would be allowed to self-adjust high enough to result in an IPAP of 23.

If the present PS were to be 8 when the present EPAP is 15 (resulting in IPAP being maxed out at 23) and the machine were to see obstructive events and want to raise EPAP to 16, it would go ahead and increase EPAP but at the same time would decrease the present PS to 7 in order to maintain IPAP no higher than the Max IPAP setting of 23. That is, EPAP has higher priority than PS.

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#10
On the Respironics auto BiPAP machines, PS can be variable. On Resmed it is fixed. I always used a min PS of 2, and max PS of 5, and that gave a lot of comfort and would automatically change higher for hypopnea. Understanding basic bilevel titration as suggested by Philips Respironics is just good background information for understanding how your machine works. Read pages 11-12 of this guide http://incenter.medical.philips.com/docl...%3d9792335

EPAP, and pressure support each have their purpose in titration and use of bilevel. I just think it helps to understand the guideline the pros use. For you, PS min is for comfort. PSmax gives the machine the ability to increase support for hypopnea and flow limitation. It should raise EPAP for OA events.
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