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From BiPAP to Auto CPAP
#1
From BiPAP to Auto CPAP
I lived happily with a Respironics Bipap Auto M for 10 years and was just given a DreamStation Auto CPAP from my DME.  I posted here a few months ago and it was suggested that my settings really didnt warrant BiPap and the doctor agreed. 

I am on my 3rd night with the DreamStation.  My AHI is between 3 to 4.  With the Bipap I was able to keep it below 1. It would seem to me that its still a low value and it shouldnt matter.  I don't notice any difference in my sleep but I am exhausted in a way I havent been in a long time.  The pressure was set 5 - 15 so last night I upped it to 6, but didnt make a difference.


I know its early but I wondered if getting used to a different machine can cause fatigue, or could it be going from Bipap to Auto CPAP (which seems doubtful to me).

Has anyone else experienced this?

Thanks
Ellen
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#2
RE: From BiPAP to Auto CPAP
You need to post a sleepyhead chart. DS are very slow to react and some need a minimum pressure a little below the 90% pressure.

Cpap are for very normal functioning lungs. If you have any copd or obesity, you may need the breathing support the bipap gives.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#3
RE: From BiPAP to Auto CPAP
Ellenos, what were your BiPAP settings? I would have liked to see you on the Resmed Airsense 10 Autoset instead of the Dreamstation Auto because the Resmed has EPR (exhale pressure relief), which is like a bilevel with pressure support up to 3 cm. The Dreamstation uses Flex which briefly drops pressure at the beginning of inhale and exhale, but it does not keep the pressure low like a bilevel or the EPR on the Resmed.

If you can describe your old settings, we can perhaps get your new CPAP set up as closely as possible. Probably too late for the Resmed, but you might want to ask.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#4
RE: From BiPAP to Auto CPAP
Settings on Respironics BiPap were:

AHI = 0.5 (7 days)  0.7 (30 days)
Biflex = 2
Ramp start  4.0
Mode: Bilevel
IPap 10.0
EPap  8.0
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#5
RE: From BiPAP to Auto CPAP
For your Auto CPAP you should set minimum pressure to 8.0 and maximum pressure at 12.0 (it will only go as high as needed). Use AFlex at 2 to get similar rounding of the respiratory curve as your Biflex. I'm certain that your elevated AHI is related to too low pressure and the relatively slow response of the Dreamstation. If your current AHI is mostly hypopnea, we may need a bit more minimum pressure since you won't have the benefit of bilevel pressure support.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#6
RE: From BiPAP to Auto CPAP
[Image: M4PI5Pbl.png]
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#7
RE: From BiPAP to Auto CPAP
I'll stick with my previous suggestion of 8-12 with flex at 2. As you an see, the machine is not adequately responding with pressure increases when needed. I think you will find a minimum pressure of 8.0 is actually lower than your BiPAP since there is no IPAP pressure support on each breath. If you want to use ramp, keep the time short and consider using a minimum pressure of 6.0.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#8
RE: From BiPAP to Auto CPAP
Thank you so much!  I've changed to what you suggested - ramp is at 6, but time was set to 15 mins so I will change to 10.

The provider did say I would be trying this out since I originally had BiPAP. My doctor is wonderful and I am sure will write a different prescription if needed.
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#9
RE: From BiPAP to Auto CPAP
I use a bilevel, and I'm sure will hear that it is not "necessary" on the next renewal. However I have used auto CPAP since 2008 and know my results are better with the bilevel machine, and I am more comfortable. I actually have two machines, with one purchased from Craigslist. I don't see the current free-market price (Amazon) for a new Dreamstation BiPAP Auto DSX700T11 at $777 as too large of an obstacle to continuing to use BiPAP in the future should my insurnace decline to cover one. I simply won't be dictated to with regard to my needs as long as I can afford the alternative.

Getting off my soap box, I think you can be successful in using auto CPAP vs BiPAP, and there is no doubt that you will be clinically treated; you may just not be as comfortable, or as well treated as you might be on the slightly more expensive machine. I hope you find a level of treatment and comfort comparable to what you are accustomed to, and I'll be glad to help. To be completely honest, I don't support the idea of prescribing this downgrade to you; however if you had been issued a Resmed Airsense 10 Autoset CPAP, your bilevel settings could have been duplicated with an auto CPAP machine. That can't be done with the Philips.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#10
RE: From BiPAP to Auto CPAP
Thank you much for your honesty.  I am going to push for the change to BiPAP, I don't see why my doctor wouldnt go along with this since my original sleep study showed the need.  We had agreed to give this a try.  I was originally going to pay for the machine myself, but I finally found a doctor and a DME who were willing not to force me into a new sleep study.

Last night I was down to 1.5 AHI with the settings you recommended.  The pressure felt wonderful !
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