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High or Low EPAP pressure
#1
My doctor recently prescribed my my pressures to be 15 EPAP and 21 IPAP and the machine to be set on the Bi-pap mode. I found that with my other underlying health conditions, I was having a very hard time breathing against 15cmH2O and my chest felt like I had been hooked up to an air compressor. I used the machine for four nights and I couldn't take anymore. My RT told me that she could not change the settings without a new prescription from my doctor. Because of the holidays and medicare and tricare compliance requirements, my RT is holding my S9 Autoset until after New Years. I tried these settings in my old ResMed VPAP Malibu in the auto mode and had the same problem. I lowered the EPAP down to 13.8 and the problem went away. however, my AHI number went from 2.6 up to 9.8 and I feel like dirt. Does anyone have any suggestions? when I get my S9 back, should I try it in the auto mode even though my doctor specifically said bi-pap? And what other numbers should I be loooking at when I start using the ResScan software??Oh-jeezHuh
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#2
Rambling as I think:
The difference between CPAP and bilevel PAP is the exhale difference. Many CPAPs have an exhale relief (EPR, x-FLEX, etc) but the most they go is 3. Meaning if your pressure is 12, your inhale is twelve and the exhale cannot be lower than 9. Bilevel PAPs however, can go more than 3. If you are having difficulty breathing out due to secondary lung condition, then that's when bilevel is used.

So using your Autoset would only give you 3 point difference. If the EPAP is 13.8, then the IPAP is 16.8 yet you still have events.

What you could do, since you are in compliance period, is use the bilevel for at least 4 hours a night then switch to the other with the lower pressure. This will allow you to get some sleep while also getting your body used to pushing against the pressure. Sit with it on during the day, too. You want to be compliant but yet at what cost? At the same time, you can also up the pressure on the older machine, a few dots a night. Like, .4 or .5 a night.

Call the doctor's office Wednesday or even tonight. Someone is on call. Be calm, cool, and collected. State the issue, the facts, what you have done, how hard you have tried, how long you've been doing this (overall, not just with this machine), and what you think ought to be done. Tell them that the DME is holding your other machine hostage and how unhappy you are about it. Acknowledge you are aware it is a holiday and that you apologize for disturbing theirs, but this is your health. Remember, be polite but assertive.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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
(12-24-2012, 02:11 PM)hunningsedaniel Wrote: My doctor recently prescribed my pressures to be 15 EPAP and 21 IPAP and the machine to be set on the Bi-pap mode. I found that with my other underlying health conditions, I was having a very hard time breathing against 15cmH2O and my chest felt like I had been hooked up to an air compressor. I used the machine for four nights and I couldn't take anymore. My RT told me that she could not change the settings without a new prescription from my doctor. Because of the holidays and medicare and tricare compliance requirements, my RT is holding my S9 Autoset until after New Years. I tried these settings in my old ResMed VPAP Malibu in the auto mode and had the same problem. I lowered the EPAP down to 13.8 and the problem went away. however, my AHI number went from 2.6 up to 9.8 and I feel like dirt. Does anyone have any suggestions? when I get my S9 back, should I try it in the auto mode even though my doctor specifically said bi-pap? And what other numbers should I be loooking at when I start using the ResScan software??Oh-jeezHuh

Hi hunningsedaniel,

I assume you will of course be getting in contact with your doctor soon to tell him about the unbearable chest pain experienced with the (apparently needed) higher pressure, in case he would want to have further tests run to verify there is no cause for alarm in that regard.

As you know, unlike EPR which *lowers* the pressure during exhalation, the VPAP machines use Pressure Support which *raises* the pressure during inhalation. So I suppose your VPAP Auto was set for fixed EPAP =15 with PS = 6, resulting in a fixed IPAP = 21.

So on the VPAP Malibu, if I understand you correctly, you tried EPAP =15 with PS = 6 (and your chest still hurt too much), and then you lowered the EPAP setting to 13.8 with PS = 6 (and your chest did not hurt too much). Please let me know if I am mistaken here.

Perhaps you are actually slowly getting used to the higher pressure. (After all, 13.8 is fairly close to 15.) Perhaps you would be able to inch the fixed EPAP pressure up little by little until you manage to reach the doctor-prescribed EPAP = 15 with PS = 6.

On the other hand, maybe it would be a good idea to request your doctor to have the S9 VPAP Auto put in Auto mode with EPAPmin = 13.8 and PS = 6 and IPAPmax = 21. The machine would keep PS fixed at 6 and would automatically adjust EPAP as needed between a minimum of 13.8 to a maximum of 15. With these Auto settings, perhaps the machine would be giving you as much pressure as you need but only during obstructive events when you need it. That, of course, is the whole idea behind Auto mode.

Although the VPAP Malibu does not call itself an Auto machine in its name, I think it has a similar mode (called VSet mode instead of Auto mode) and was an early version of the VPAP Auto. I don't have access to the VPAP Malibu Clinicians Manual to check, but perhaps you can. If the VPAP Malibu has settings named something like EPAPmin and IPAPmax, then I think it does have an older Auto mode which would operate similar to the VPAP Auto when set for EPAPmin = 13.8 and PS = 6 and IPAPmax = 21. So the VPAP Malibu would be a good back-up machine to keep.

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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#4
If your AHI gets high at EPAP of 13.8, you probably need a higher EPAP. I'd say to put up with what you can and see if you can raise the pressure as you get used to it.

What was your pressure before the change? Usually, you can adapt to the higher pressure after you get used to it.

The AutoPAP will probably not do much to help this out.

BTW, the S9 AutoSet doesn't do BiPAP.

BTW, "BiPAP" is a Respironics trademark. "Bilevel" is the generic term, ResMed uses the VPAP trademark.
Get the free SleepyHead software here.
Useful links.
Click here for information on the main alternative to CPAP.
If it's midnight and a DME tells you it's dark outside, go and check it yourself.
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#5
(12-25-2012, 12:53 AM)archangle Wrote: The AutoPAP will probably not do much to help this out.

BTW, the S9 AutoSet doesn't do BiPAP.

BTW, "BiPAP" is a Respironics trademark. "Bilevel" is the generic term, ResMed uses the VPAP trademark.

Hi hunningsedaniel,

Archangle is right. The "ResMed S9 Auto" is commonly understood to refer to the ResMed S9 AutoSet (or, if not fully data-capable, to the ResMed S9 Escape Auto), not to the ResMed S9 VPAP Auto which I think your machine actually is.

You call it a ResMed S9 Auto, and it clearly is a bi-level since the differerence between EPAP and IPAP is greater than 3, so I think it must be the ResMed S9 VPAP Auto like my machine.

So I think it would be less confusing to others if in your profile you were to put "ResMed S9 VPAP Auto". Or even just "S9 VPAP Auto".

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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#6
Isn't this backwards? Shouldn't the EPAP be 11 and the IPAP 15. 15 would be hard to breathe against. Can you download the clinical manual and check your pressures yourself? I'm pretty sure IPAP should be higher than EPAP.
Happy Day. Good luck,
Mary
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#7
(12-25-2012, 10:45 AM)zimlich Wrote: Isn't this backwards? Shouldn't the EPAP be 11 and the IPAP 15. 15 would be hard to breathe against. Can you download the clinical manual and check your pressures yourself? I'm pretty sure IPAP should be higher than EPAP.

Hi Mary, merry Christmas!

Right, EPAP is for exhalation, when a lower pressure makes it easier to breathe out against. IPAP is for inhalation, when a higher pressure makes it easier to breathe in.

In bi-level, the EPAP is always lower than the IPAP.

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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#8
(12-25-2012, 07:01 PM)vsheline Wrote: In bi-level, the EPAP is always lower than the IPAP.

Wouldn't it be more fun to try and confuse the machine by setting the numbers backwards!

Too-funny Dielaughing

Ren
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#9
(12-25-2012, 02:36 AM)vsheline Wrote:
(12-25-2012, 12:53 AM)archangle Wrote: The AutoPAP will probably not do much to help this out.

BTW, the S9 AutoSet doesn't do BiPAP.

BTW, "BiPAP" is a Respironics trademark. "Bilevel" is the generic term, ResMed uses the VPAP trademark.

Hi hunningsedaniel,

Archangle is right. The "ResMed S9 Auto" is commonly understood to refer to the ResMed S9 AutoSet (or, if not fully data-capable, to the ResMed S9 Escape Auto), not to the ResMed S9 VPAP Auto which I think your machine actually is.

You call it a ResMed S9 Auto, and it clearly is a bi-level since the differerence between EPAP and IPAP is greater than 3, so I think it must be the ResMed S9 VPAP Auto like my machine.

So I think it would be less confusing to others if in your profile you were to put "ResMed S9 VPAP Auto". Or even just "S9 VPAP Auto".

Take care,
--- Vaughn
Hi Vaughn. You were absolutely correct. My machine, now that I have finally gotten it back from my DME, is a S9 VPAP Auto and I have corrected my profile. My doctor agreed to change the settings to a different starting point. He changed the mode from spont to auto and set the pressures at IPAP: 21 and EPAP: 13 with a PS of 4.0. he also put the Ti max at 4.0. He said that the higher pressures could come later if they were still needed. Compliance is the big issue right now.My old numbers on a ResMed VPAP Malibu were very close to this and I was sleeping good. I was just amazed that my DME insisted on holding my machine hostage and refused to reset the pressures even after my doctor had faxed them a new Rx. He finally had to call their main office and threaten to take his business elsewhere in order to get their attention. I really hope that these new numbers work because I have no intention of going back to my DME anytime in the near future. Even though the machine is a rental under the Medicare Guidelines, they will have to bring the Sheriff if they want to get their hands on it again. GoodnightSleep-well
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#10
Glad it worked out for you! Please keep us posted on your progress.
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


Breathe deeply and count to zen.

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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