First night on Bipap

[BustaTC]

Ok, I got my new Resmed S9 VPAP S yesterday and it was set by secondwind for me. I know how to access the hidden settings. My first night was not what I expected. The pressure seemed very high, I feel like I was up all night, but I know I got some sleep as I don't feel all that tired today. I slept for a little over 9 hours and kept the mask on the whole time. In the morning and during the night I noticed my lungs burned a little. Kind of the same feeling where you go out in the cold and shovel snow. Now that I have been up a few hours I still feel it a little but it is a little better. My guess is that it is because I am not used to the pressure on my lungs, is this normal after starting cpap/bipap therapy? The worse part is that my AHI was 84.3! This is bad. During my sleep study before therapy my AHI was 106. After they initiated bipap it went down to 8. What is going on? I did notice something. On my sleep study the sleep doctor recommended settings of 17/14 with EPR of 3. I noticed that the inspiration pressure was set to 17, but the expiration pressure was only set to 4 on the machine. Shouldn't the expiration pressure be set to 14? I know how to change this. Oh, I also am using the Resmed software to look at the data.

I am thinking that Secondwind accidentally set the expiration pressure wrong. I would appreciate if someone more experienced than me on this forum could let me know and if they agree, I can change the setting and see what happens tonight. My only worry is that it will be even more difficult to sleep because of the increased pressure. Thanks ahead of time for taking the time to read my post.

[justMongo]

Sounds like the settings do not comply with the prescription.
My Rx is 14/9 and that's how my machine was set -- and S8 VPAP S.
(I bumped it up by 0.6 cm-H20)
I hesitate to tell you to change pressures -- I can only say as described by you, your settings appear wrong.

[ChadIAm]

Ok, I got my new Resmed S9 VPAP S yesterday and it was set by secondwind for me. I know how to access the hidden settings. My first night was not what I expected. The pressure seemed very high, I feel like I was up all night, but I know I got some sleep as I don't feel all that tired today. I slept for a little over 9 hours and kept the mask on the whole time. In the morning and during the night I noticed my lungs burned a little. Kind of the same feeling where you go out in the cold and shovel snow. Now that I have been up a few hours I still feel it a little but it is a little better. My guess is that it is because I am not used to the pressure on my lungs, is this normal after starting cpap/bipap therapy? The worse part is that my AHI was 84.3! This is bad. During my sleep study before therapy my AHI was 106. After they initiated bipap it went down to 8. What is going on? I did notice something. On my sleep study the sleep doctor recommended settings of 17/14 with EPR of 3. I noticed that the inspiration pressure was set to 17, but the expiration pressure was only set to 4 on the machine. Shouldn't the expiration pressure be set to 14? I know how to change this. Oh, I also am using the Resmed software to look at the data.

I am thinking that Secondwind accidentally set the expiration pressure wrong. I would appreciate if someone more experienced than me on this forum could let me know and if they agree, I can change the setting and see what happens tonight. My only worry is that it will be even more difficult to sleep because of the increased pressure. Thanks ahead of time for taking the time to read my post.

I would call Secondwind and talk to one of the Respiratory Therapist and explain your AHI and the feelings you are having... Making unadvised changes could be bad... ask them to recheck the numbers and make sure it matches the prescription... people are Human and they may of made an error... Just ask...

[BustaTC]

Thanks for posting. I understand your hesitation, that is mine as well. I know what the prescription says, but just kind of wanted someone else's opinion. Thanks again, I think I will adjust it and see where I am at.

[PaulaO2]

I don't think the exhale could be 4. That's a jump of 13cm of pressure.

If you are using ResScan software, can you post a screenshot where it tells you want the pressure is?

[Peter_C]

I am with justmongo here, based on what you've said, I would say a goof happened, and the EPAP pressure is set way to low. Please double check what the Doc wrote, and what the machine says, and adjust as needed (writing down which settings you changed, and from what to what).

EPAP- pressure for everything but inhale
IPAP - pressure for inhaling
PS - pressure support - IPAP-EPAP=PS

Personally, am kinda confused on why using "EPR" with a bi-level machine, but as mine is too old, I have zero personal knowledge of "EPR" and it's features.

[BustaTC]

Last night I changed my bipap setting to 14/10 as I tried with the 17/14 settings and the pressure was too much. I set it down lower in hopes over time, I can work up to what I need. First of all it seemed it took me around an hour to fall asleep, but I actually feel like I slept most of the night! I just downloaded the data and was pleased with the results. My AHI dropped to 16.7! I know that isn't perfect, but it is much better than what I have seen in the past. Here is the thing. It appears my AHI for obstructive was 1.2 and for central was 14.7. During my sleep study I had some central apnea's but they were pretty much written off as a non-issue. By the sounds of it I am not sure if even working up to my prescribed setting of 17/14 will even be beneficial. Could it be because I am still getting used to the therapy? Any thoughts? Thanks again for the help.

[justMongo]

...Could it be because I am still getting used to the therapy?

For certain you need time to get used to the therapy. Both psychologically and physiologically.

[me50]

can you use the ramp to help you so hopefully you are asleep before your pressure gets that high?

[vsheline]

Here is the thing. It appears my AHI for obstructive was 1.2 and for central was 14.7. During my sleep study I had some central apnea's but they were pretty much written off as a non-issue. By the sounds of it I am not sure if even working up to my prescribed setting of 17/14 will even be beneficial.

Hi BustaTC,

I think whoever wrote the prescription meant Pressure Support (PS) instead of EPR. If EPAP=10 and IPAP=17, this represents a PS of 7.

I would suggest discussing with your doctor trying EPAP=10 and IPAP=13, and slowly increasing both pressures so that PS remains 3, the initially prescribed setting for PS.

Compared to EPAP=10 and IPAP=13, I think the only reason to slowly increase the pressures toward EPAP=14 and IPAP=17 would be to provide further protection against obstructive events, like obstructive apneas and obstructive hypopneas. (For example, in case you roll onto your back while asleep and need EPAP to be higher than 14.)

For some people, reducing PS (or EPR) can reduce the number of centrals.

For some people, increasing PS can improve sleep quality by eliminating something called RERAs (Respiration Effort Related Arousals), which are arousals caused by respiration effort but which are not accompanied by apneas or hypopneas. (Therefore, RERA events are not counted in the AHI.)

The number of centrals tends to reduce over the first weeks and months of treatment, as we get used to treatment. But if we had centrals in our original diagnostic study (when not being treated by CPAP) then there is less confidence that most or all the centrals will eventually go away, and a machine with a backup rate (such as the VPAP ST, VPAP ST-A or VPAP Adapt) may be needed to completely eliminate all centrals.

Take care,
--- Vaughn