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Help with Bipap settings
#1
Hi all,

I'm new to the board and cpaps/bipaps and was hoping for some advice on setting a new bipap that I have coming next week. For reference, I have included my sleep study attached here.

Anyway, my story is that I was prescribed an F&P sensawake auto CPAP at 11cm and could not stand the feeling of exhaling against the pressure. The highest pressure I can tolerate is 7cm or so although would prefer even lower. I asked the place that did my sleep study for a bipap but they said that was a big process with insurance and that they don't even have an appointment to see me until late January.

So I took things into my own hands and bought a very cheap Respironics M-series Auto bipap (DS700 I think). It arrives next week but I want to be sure where to set this thing.

Should I use the auto feature and if so, what should my mins and maxes be? Or should I set constant pressures for IPAP and EPAP? I'm hoping someone can look at my study and make an informed recommendation so I don't have to wait weeks.

Thanks so much.
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#2
G'day Seth, welcome to Apnea Board.

You've included quite a lot of personal information in your sleep report. If you're comfortable with that, fine; but most people wouldn't like to have all that information out in the public realm. Let me know if you want it deleted.
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


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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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#3
The sleep report seems to include a fair bit of boilerplate text and has missed a couple of important points - primarily the susceptibility to central apneas under CPAP pressure. I assume this is the reason pressure wasn't increased above 10cm, though that is manifestly not high enough to control your obstructive apnea. There is no indication of posture - sleeping on your back or side can often result in quite different apnea outcomes, but this part of the report is blank. I would also query the cardiac analysis - an average heart rate of 1.5 beats per minute must be very close to clinically dead!

Apart from all this, I'm surprised you can't tolerate a pressure higher than 7. That is really very low and I would have though that any averagely fit 38 year old could manage that. (I'm a pretty unfit sixty-something and don't have any problem with pressure in the high teens). How long did you persevere before deciding you couldn't hack it? Or are there other health issues at play which might be affecting this?

As far as I recall, the F&P machine doesn't have any sort of expiratory pressure relief (EPR or Flex) such as found on the Resmed and Philips machines - that might be sufficient to overcome your problem without the expense (out of pocket) of buying a bipap. On the other hand, EPR can sometimes exacerbate pressure-induced central apnea, which is potentially a big problem for you.

My opinion at this point is to try and cancel the purchase of the bipap and go back to your clinic prepared for a deep and meaningful discussion of your situation and all the options.




DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


Bed

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
If your insurance is good, I would recommend that you obtain the Airsense 10 Autoset CPAP. This new machine will be far superior to the M-Series BiPAP. The Airsense 10 offers up to 3 cmH2O pressure relief during exhale (EPR). So your exhale pressure is always 3-cm less than the inhale pressure. In your case, you could set a range of 7.0 to 11.0 and your pressure wlll be 7/4 to 11/8. This is effectively bilevel therapy. In addition, the auto algorithm will actively address any obstructive apnea and hypopnea. Best of all, the Resmed Airsense 10 will give you full efficacy data. The M-Series will not.

I used a M-Series from 2008 to 2012 and ended up with nearly 20K hours on it. I never regretted moving on. That machine is too old to be very useful IMO. If you can find a DS760 Auto BiPAP, that would provide data and would also be a good option. The Resmed Auto CPAP is a less expensive machine, normally covered for those with CPAP needs, and it provides excellent exhale pressure relief.
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#5
Deepbreathing, I didn't even think about that but yes please delete. I have attached a copy without my info here.

I got the sense that the place I went to wasn't the greatest and it seems surprising that they missing so much. Given the amount of central apneas does that mean the PAP won't work properly no matter what? As for the sleep position and heartbeat, not sure what happened with the data there. I remember be flat on my back and not sleeping that much that night but who knows if I moved.

Sleeprider, is the M-series a bad unit? I made an impulse buy since I saw it with the humidifier for $37 shipped!!! Yes, $37. So I figured I could try it out and couldn't go wrong.

But it seems that everything takes so long with this place/insurance and I would love some sleep until my next appointment. Also, I admittedly did not try the F&P for more than a week or so. My sleep was so bad with the machine and it made me feel so claustrophobic on exhale. After that I started experimenting with lower pressures which didn't work.


Attached Files
.pdf   Seth Rosenberger sleep study no personal info.pdf (Size: 85.62 KB / Downloads: 27)
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#6
And BTW, what do the central apneas mean for treatment? Is cpap still most appropriate for me?
Also, I remember being very restless from the sleep study - could that cause centrals?
Lastly, no other health issues at play here.
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#7
The problem for you with the M-Series is that it cannot distinguish between a central or obstructive apnea. That is important information for you, especially when you introduce varying IPAP and EPAP pressure, which in a few people can cause CA (not that common, but be aware of it). The M-Series records its data on a Smartcard which will require a card reader that s about twice as expensive as what you paid for the machine.

I had no complaints with the M-Series other than it is now a legacy machine that should be retired. Give it a try, but I still think your easiest path is to go through the doctor to get the Resmed Airsense 10 Autoset. If your insurance has high deductibles, then we might look at something else, but you should qualify for the Resmed without a sleep study or any further delays.
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#8
What is CA?

So I'll ask for the Resmed when I go to the next appointment in 3 weeks. If they can't supply that machine, is there another that I should ask for that is more appropriate?

I really want exhale relief or bilevel but what other features are a must for me?

Thanks for answering what are probably simple questions.
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#9
CA - central apnea or open airway apnea.

Central sleep apnea occurs because your brain doesn't send proper signals to the muscles that control your breathing. This condition is different from obstructive sleep apnea, in which you can't breathe normally because of upper airway obstruction. Central sleep apnea is less common than obstructive sleep apnea. It can be caused in some cases by a higher ventilation exchange rate resulting from the use of bilevel, where IPAP is greater than EPAP. This higher exchange of gasses can purge CO2 resulting in reduced respiratory drive.

Mixed sleep apnea: Mixed sleep apnea is a combination of both obstructive and central sleep apnea symptoms. Some patients being treated for obstructive sleep apnea with the use of CPAP machines develop symptoms of central sleep apnea upon PAP therapy. This phenomenon had long been noticed in sleep labs, but had not been previously researched. In 2006 researchers from the Mayo Clinic conducted a study of 223 sleep apnea patients and found that 15% of sleep apnea patients who were believed to have OSA in fact had mixed sleep apnea.

During CPAP treatment for the patients believed to have OSA, the patient's airways were successfully splinted open and free from obstructions, but the patients continued to have difficulty breathing while asleep. Their symptoms of OSA shifted to symptoms of CSA while CPAP therapy was being administered.
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#10
Thanks for the info.

What doesn't quite make sense to me though is if bi-level therapy can cause CA, then why is a bipap prescribed for those with CA?
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