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Need help setting up 'new' BiPAP machine
#1
I have been on CPAP for several years with a basic Respironics machine (pre-2007) with a single pressure value (7 cm) and a ramp feature (pressure starts low at power-on and gradually increases to 7 cm over several minutes).

I recently procured a pre-2007 Respironics BiPAP Auto with BiFlex that I would like to use. I have downloaded the manual for this machine (thanks, apneaboard.com!) so I am aware of the various parameters that I need to set (IPmax, PS, etc.). I also understand what each of these parameters do, but, since I did not have them on my original CPAP machine, I am not sure how to set up these new parameters.

Can anyone provide some conservative guidance on where to start? I assume that my current 7 cm value would be a starting point for my nominal IP value, but I am not sure if this is even the right approach.
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#2
I just answered a post you had in relation to back sleeping, and the inability to do it.

I'm not an expert with the BiPap machines, but what I do think I would do is set the max IPap to something like 11, and the PS to 6 or 7. Then I'd see what the results show.
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#3
Have to ask: Why did you pick a BiPap?
Are you going to try to run it like an auto machine that seeks optimal pressure near your 7 cm-H2O setting?
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#4
(03-29-2015, 05:05 PM)justMongo Wrote: Have to ask: Why did you pick a BiPap?

I was made an offer I couldn't refuse.

(03-29-2015, 05:05 PM)justMongo Wrote: Are you going to try to run it like an auto machine that seeks optimal pressure near your 7 cm-H2O setting?

I am not sure what to do. I like the idea of BiPAP (reduced exhalation pressure) and I really like the 'BiFlex' feature that backs off the pressure at the onset of exhalation.
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#5
There is a very simple titration protocol recommended by Respironics for users moving from CPAP to BiPAP. Since you were at a CPAP pressure of 7.0, your starting pressure for auto-BiPAP would be Auto mode, EPAP minimum 4.0, EPAP max 7.0, PS-min 4.0, PS-max 6.0. This setting will start off at 4.0/8.0 EPAP/IPAP, and will allow the auto to raise the EPAP and IPAP as needed up to 7.0/13.0 based on events. Note this recommendation is adapted from http://www.sleepdx.respironics.com/PDF/T...otocol.pdf See page 12. If you strictly follow the protocol you would start at EPAP min 4.0, PS 4.0-8.0 and IPAP max 25.0. Based on your existing CPAP pressure, I think that is a bit too wide open.

A more complex recommended titration protocol, used by sleep therapist is shown at this link. Using data it would take several nights to work through the protocol to the final pressure setting. https://www.sleepapnea.com/downloads/100...fGuide.pdf See Page 11.

I moved from Auto CPAP to auto BiPAP this year and had very good results, but there are many ways to approach your settings. First, your Auto BiPAP can be operated in CPAP mode. This would give you similar results to your existing therapy. You can also operate the unit in auto mode, but with more conservative pressure support (PS) of 1 or 2 cm. In other words, set EPAP at 7.0 like your CPAP and add pressure support so IPAP pressures are higher and more supportive. How you set up the new machines really depends on why you're doing this and what you want to accomplish.

Whatever you choose to do, expect that there will be an adjustment period. AHI events, will likely increase at first. Your older BiPAP does not differentiate CA events, but in my experience with the HS760 BiPAP a lot of events during the adjustment period are clear rather than obstructive. Ask any questions you have and I'll try to help. Do you have a smart card and data card reader?
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#6
(03-30-2015, 09:04 AM)Sleeprider Wrote: There is a very simple titration protocol recommended by Respironics for users moving from CPAP to BiPAP. Since you were at a CPAP pressure of 7.0, your starting pressure for auto-BiPAP would be Auto mode, EPAP minimum 4.0, EPAP max 7.0, PS-min 4.0, PS-max 6.0. This setting will start off at 4.0/8.0 EPAP/IPAP, and will allow the auto to raise the EPAP and IPAP as needed up to 7.0/13.0 based on events. Note this recommendation is adapted from <link> See page 12. If you strictly follow the protocol you would start at EPAP min 4.0, PS 4.0-8.0 and IPAP max 25.0. Based on your existing CPAP pressure, I think that is a bit too wide open.

A more complex recommended titration protocol, used by sleep therapist is shown at this link. Using data it would take several nights to work through the protocol to the final pressure setting. <link> See Page 11.

I moved from Auto CPAP to auto BiPAP this year and had very good results, but there are many ways to approach your settings. First, your Auto BiPAP can be operated in CPAP mode. This would give you similar results to your existing therapy. You can also operate the unit in auto mode, but with more conservative pressure support (PS) of 1 or 2 cm. In other words, set EPAP at 7.0 like your CPAP and add pressure support so IPAP pressures are higher and more supportive. How you set up the new machines really depends on why you're doing this and what you want to accomplish.

Whatever you choose to do, expect that there will be an adjustment period. AHI events, will likely increase at first. Your older BiPAP does not differentiate CA events, but in my experience with the HS760 BiPAP a lot of events during the adjustment period are clear rather than obstructive. Ask any questions you have and I'll try to help. Do you have a smart card and data card reader?

Thanks for the tips and links.

My BiPAP machine has a Respironics SmartCard (not SD). I have looked for a reader (Mako 3500), but I can't find one. I am also concerned about finding software for it that will work on modern pcs (Windows XP or 7).
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#7
I have a Mako 3500 reader from my retired M series. It works fine and Windows 7 seems to recognize it right off. You need to get EncoreBasic, and the most recent version is served up right here on Apneaboard. http://www.apneaboard.com/forums/Thread-...hines-only
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#8
(03-30-2015, 09:04 AM)Sleeprider Wrote: There is a very simple titration protocol recommended by Respironics for users moving from CPAP to BiPAP. Since you were at a CPAP pressure of 7.0, your starting pressure for auto-BiPAP would be Auto mode, EPAP minimum 4.0, EPAP max 7.0, PS-min 4.0, PS-max 6.0. This setting will start off at 4.0/8.0 EPAP/IPAP, and will allow the auto to raise the EPAP and IPAP as needed up to 7.0/13.0 based on events.

I programmed my 'new' BiPAP machine last night. The bi-level was immediately noticeable. Without card-reading capability, I am not sure what transpired during the night, but I appeared to 'accept' the new titration.

I am now working on finding a card reader.
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#9
You know, what you feel as results are more important than any data. Data is just validation. Glad it worked for you.
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#10
Sleeprider - thanks for the great advice, links to valuable resources and verification that my to-be-acquired card-reader will probably work for me.

I have been a member of this site for less than three days and have made huge strides in improving my CPAP situation. I love this site. Time to make a donation, I guess.
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