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Min/Max PS Settings - Help please!
#1
I've been using my new Respironics System One 60 Series Auto Bipap machine for four weeks. My sleep doc set the machine for Auto Bi-Level with settings of 13/25 and PS Min/Max both at 0. My AHI ranged from 15 to 45 with these settings, with several central apnea incidents per night. Lowering my Max IPAP gradually down to 17, my AHI now ranges between 4 and 12 and the centrals, while still occurring, have been reduced.

Is 0 the correct setting for Min and Max Pressure Support? And am I on the right track?
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#2
I would call your doctor's office and ask them why it's set to zero. Pressure Support (PS) is the difference between the two pressure levels. Having two pressure levels is what makes it a BiPAP instead of a CPAP, so setting the PS to zero essentially turns the BiPAP into a CPAP.

Did you adjust the IPAP down to 17 or is that something the doctor did?
Sleepster
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#3
(08-20-2014, 08:57 PM)Sleepster Wrote: I would call your doctor's office and ask them why it's set to zero. Pressure Support (PS) is the difference between the two pressure levels. Having two pressure levels is what makes it a BiPAP instead of a CPAP, so setting the PS to zero essentially turns the BiPAP into a CPAP.

Did you adjust the IPAP down to 17 or is that something the doctor did?

I made the adjustment. My sleep doc relies on his sleep lab tech to make the machine adjustments and both of them seem relatively clueless. The tech would wash his hands of me if he knew I was in the clinician setup area. But I do have two pressures -- 13 for EPAP and 17 for IPAP.
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#4
Hi petemsw,
WELCOME! to the forum.!
Hang in there for more responses to your post and best of luck to you with getting your machine set up to what works best for you.
trish6hundred
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#5
(08-20-2014, 08:57 PM)Sleepster Wrote: Pressure Support (PS) is the difference between the two pressure levels. Having two pressure levels is what makes it a BiPAP instead of a CPAP, so setting the PS to zero essentially turns the BiPAP into a CPAP.

It turns it not into a CPAP but rather an APAP like the PRS1 REMSTAR Auto, with a Min pressure setting and a Max pressure setting, and with only Flex for exhalation pressure relief.
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
(08-20-2014, 09:02 PM)petemsw Wrote: But I do have two pressures -- 13 for EPAP and 17 for IPAP.

13 is your minimum EPAP.
17 is your maximum IPAP.

PS equals IPAP minus EPAP.

With a PS of zero, your IPAP equals your EPAP. So you effectively have an auto CPAP (APAP) set at a range of 13 to 17.

Lowering your maximum IPAP to 17 is probably not a good idea, and if your sleep tech is as picky as you say, he's not going to like it. For how long did you have the machine before you changed the IPAP?

You really need to look at the data taken before the change to see what was going on. If your pressure never rose above 17 then that's fine, but if it did that's an indication that the higher pressure is needed to treat obstructions.

The centrals, on the other hand, tend to subside during the first few weeks, especially if you (temporarily) lower the pressure a bit.

Does the higher pressure bother you in any way?
Sleepster
Apnea Board Moderator
www.ApneaBoard.com


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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#7
What is the breakdown of your ahi? OA's vs CA's, etc. It does appear you got good results by dropping the range a little, which could be explained by reducing leakage as much as anything, so what is your leakage doing, and what is your average pressure doing?

Personally I like a tighter range such as your 13/17 versus the 13/25. In the end what that range really should be will be a result of sliding the bottom up, the top down, or any number of things to get your ahi to the sweet spot.

And, anytime you change anything you should run for a few days before you get too excited about the results.
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#8
[Image: useless.gif]

Post some graphs from sleepyhead... it will help show what's going on.
You can upload them to a photo site like photobucket and post them inline using the [img] and [/img] tags
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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#9
Money 
(08-20-2014, 11:25 PM)trish6hundred Wrote: Hi petemsw,
WELCOME! to the forum.!
Hang in there for more responses to your post and best of luck to you with getting your machine set up to what works best for you.

Thank you, trish6hundred!
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#10
(08-21-2014, 03:10 AM)Sleepster Wrote:
(08-20-2014, 09:02 PM)petemsw Wrote: But I do have two pressures -- 13 for EPAP and 17 for IPAP.

13 is your minimum EPAP.
17 is your maximum IPAP.

PS equals IPAP minus EPAP.

With a PS of zero, your IPAP equals your EPAP. So you effectively have an auto CPAP (APAP) set at a range of 13 to 17.

Lowering your maximum IPAP to 17 is probably not a good idea, and if your sleep tech is as picky as you say, he's not going to like it. For how long did you have the machine before you changed the IPAP?

You really need to look at the data taken before the change to see what was going on. If your pressure never rose above 17 then that's fine, but if it did that's an indication that the higher pressure is needed to treat obstructions.

The centrals, on the other hand, tend to subside during the first few weeks, especially if you (temporarily) lower the pressure a bit.

Does the higher pressure bother you in any way?

Sleepster, thank you for your reply! At a Max IPAP setting of 25, during a five day period my highest auto IPAP pressure was 21, and my centrals only appeared when the IPAP pressure was between 17 and 21. That's why I felt it would be safe and possibly sensible to lower the MaxIPAP setting to 17. And while I tolerated the higher pressure, I awoke from time to time to the sound of leaks which required mask adjustment. Even prior to using CPAP, I have always had difficulty going back to sleep after being awakened. Under these circumstances, do you still feel that 17 is too low for the MaxIPAP setting? Multiple incidents of centrals occurred when the pressure exceeded 17 for several days in a row.

The prescription that came from my sleep study's CPAP/BiPAP test night was EPAP=8, IPAP=13 using fixed settings. When that setting only got me from a pre-PAP AHI of 85 to the 35-40 range, my sleep doc and his tech put my machine into Auto BiPap mode with the MinEPAP of 13 and MaxIPAP of 25, the highest setting on my machine. With the understanding that you are not a physician and cannot prescribe settings, would you be able to suggest a MinPS and MaxPS setting for me so I can take advantage of this machine's full ability, settings that you might expect to see given my MinEPAP=13 and MaxIPAP=17? I can handle explaining the adjustments to my sleep doc by showing him what was happening between visits and why I made the changes I did. He and his tech are clearly in over their heads anyway, given their oversight with the "0" Min and Max PS settings, and I may have to change docs in any event because of that.
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