Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

New Dreamstation Auto Bipap - lost on support settings
#41
RE: New Dreamstation Auto Bipap - lost on support settings
That's it!  Best of luck tonight, the machine should feel right. If you can help her deal with the chin-tuck, it should be exceptional.

[Image: attachment.php?aid=29250]
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.
Post Reply Post Reply






Donate to Apnea Board  
#42
RE: New Dreamstation Auto Bipap - lost on support settings
Bingo, you got them in. That matches.
BTW EPAP 7 is that starting pressure you were trying to find. If the auto part has not elevated pressures, EPAP 7 is where it all starts. PS 4 adds to EPAP 7 this gives 11 IPAP. These are the lowest respectively with these settings. But when the auto algorithm pushes it up, EPAP and IPAP will slide up some as it's needed to answer events.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#43
RE: New Dreamstation Auto Bipap - lost on support settings
   

Last night.  Nothing but universal size collars in town that are too tall. Have one ordered coming Friday.  I really don't think this is something she'll do unless a doctor says so.  I'll just have to be sure and bring up positional apnea to him.
Post Reply Post Reply
#44
RE: New Dreamstation Auto Bipap - lost on support settings
This is looking a bit better. We can wait for the collar, but it looks like a higher minimum EPAP will be needed The median pressure in this session was 14.4/10.4. How was reported comfort? The next pressure change will be to increase minimum EPAP to 9.0, with no changes to other settings.

Very few doctors are onboard with the soft cervical collar, and this is something that has worked for dozens or hundreds of members here and on other apnea forums. Collars don't pay the bills, and I'm not aware of a medical study that has evaluated their efficacy...they just work. Just a few examples are in the wiki, but we routinely see it works. Just give it a fair chance. Your wife's positional obstructive events are not the most severe we have seen, and they will respond to this simple, inexpensive non-invasive too;. She would not be the first one to be skeptical or think this sounds uncomfortable. I would encourage you to just try it. Most people have no trouble at all with the comfort, and since it solves the problem, they continue using it. Some even learn a new posture, and eventually don't need it. Chances are if you discuss a soft cervical collar with the doctor he will simply insult those that recommended it. The good news there is an alternative. Tracheostomy.

Please try to include the standard view charts in your post:
Events
Flow Rate
Pressure
Snore
Leaks
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.
Post Reply Post Reply






Donate to Apnea Board  
#45
RE: New Dreamstation Auto Bipap - lost on support settings
I get it. I’ll keep pushing it. Still trying to understand. Why the pressure increase?
Post Reply Post Reply
#46
RE: New Dreamstation Auto Bipap - lost on support settings
We did not get a chart with either flow rate or pressure, but the summary statistics indicate the median pressure was 10.8. A minimum EPAP pressure of 9.0 is a conservative response to that. One of the characteristics of Philips machines is that the pressure increases tend to be reactive rather than preventative. When the median and 95% pressure are significantly above the set minimum pressure, it demonstrates the current minimum pressure is too low.
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.
Post Reply Post Reply
#47
RE: New Dreamstation Auto Bipap - lost on support settings
Okay. I know she was struggling to exhale at times with her original cpap setting of 12. We were at 11, including pressure support. Won’t this make that 13 including support?

   

Just realized my screenshot error.
Post Reply Post Reply






Donate to Apnea Board  
#48
RE: New Dreamstation Auto Bipap - lost on support settings
The difference is the pressure support. CPAP is fixed pressure with inhale equal to exhale pressure, but BiPAP gives an apparently lower exhale pressure. The actual pressure of CPAP is very very low. Even with the machine at 20 cmH2O, that is only 0.284 psi. It is equivalent to exhaling at a depth of less than 8-inches in water. The pressure is in large part a mind-game, and using pressure support to lower exhale pressure makes it seem like less. Even with the minimum EPAP pressure of 7.0, her 95% pressure was 17.6/13.7, higher than the CPAP pressure that was a perceived exhale problem. It is the apparent or perceived pressure that creates comfort or discomfort.

Once she has a collar, the pressure won't rise as much, and the 7.0 minimum may work to keep her airway open.
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.
Post Reply Post Reply
#49
RE: New Dreamstation Auto Bipap - lost on support settings
She has definite memory of how it felt for the hospital bipap.  She's skeptical of our effectiveness at this point.  Her main complaint is that it doesn't seem to be blowing. She's used to the pressure of 12, and your new setting will wind up at 13.  I think she'll be happier tonight.  I'm guessing that the numbers prove she can exhale against these pressures.

She described there being a rhythm to the pressures and that she adjusted her breathing to match. The longer time she was in sync like that, the faster she cleared the co2.  She was admitted 10-30 with a co2 of 88, and was in for 25 days.  We are hoping to avoid this again. I had always assumed that the needed pressure was applied until it senses the beginning of exhalation. When it dropped the pressure, she said it felt like it was breathing for her. I thought that meant the pressure dropped much farther than a few cm, which could give the feeling of it helping to exhale.  Max Pressure to min pressure. That's what we were hoping for because it helped the most when it felt like that to her.
Post Reply Post Reply
#50
RE: New Dreamstation Auto Bipap - lost on support settings
We need to clear the obstructive apnea, and we need positive end expiratory pressure (PEEP) to do this in combination with correcting the positional obstruction. Ventilation in the form of pressure support is what removes CO2. We can specifically target CO2, but this is really the purview of a clinical titration. Increasing pressure support to minimum 5.0 and maximum 7.0 will further reduce CO2, but we have no way of measuring it. In many people, higher pressure support can actually result in hypcapnea (low CO2) resulting in a loss of respiratory drive and central apnea. We can increase pressure support to the threshold of central apnea (apneic threshold), and know we have reached the maximum tolerated pressure support. The apneic threshold is characterized by an oscillation in the respiratory flow rate that we see in Oscar, and even some CA events. The higher pressure support will not bother her, it will just make inspiration and expiration feel easier.

Here is a quick read. https://www.emsairway.com/2020/08/31/ess...-of-bipap/
BiPAP, as the bilevel name suggests, delivers two different pressures, inspiratory positive airway pressure (IPAP) and a lower, expiratory positive airway pressure (EPAP). This allows a higher pressure to be delivered during inspiration, and a lower pressure during expiration, thereby reducing the work of exhaling. The difference between the pressures, a value called pressure support (PS) or Delta P, is directly related to tidal volume. (See Why Not BiPAP?). The greater the difference in pressures, the higher the patient’s tidal volume will be. The ability of BiPAP to increase tidal volumes and therefore, lower CO2 levels, is what most differentiates it from CPAP.

The weight of evidence supporting use of CPAP for virtually any type of acute respiratory distress encountered in the prehospital environment strongly suggests it is likely to benefit the majority of patients. BiPAP offers the same support as CPAP with the added ability to further decrease work of breathing during exhalation and improve tidal volumes thereby clearing more CO2 than CPAP. It is a reasonable alternative for patients who are unable to tolerate CPAP, those who require high CPAP pressures, and for patient’s whose respiratory failure is primarily related to hypercarbia (high CO2 levels).

Another read for Apneic threshold https://www.atsjournals.org/doi/full/10.....167.3.297

Remember you signed up for this homework. I just wish your wife would join you here on the forum. My point in this post is that we can target CO2 with your BiPAP machine, and we can interpret its effectiveness in removing CO2 by examination of the flow rate chart. Our first objective is to resolve the obstructive apnea that are clearly harmful to effective ventilation.
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.
Post Reply Post Reply






Donate to Apnea Board  


Possibly Related Threads...
Thread Author Replies Views Last Post
Question Is there a way to tell if I have a BiPAP or CPAP? astraith 9 152 Yesterday, 01:37 AM
Last Post: astraith
  [Pressure] Mysterious Sleepyhead/OSCAR periodic pressure ramps with DreamStation BiPAP ASV? chrisj 21 184 02-24-2021, 02:04 PM
Last Post: chrisj
  Help with Bipap settings bioshen7 11 212 02-22-2021, 01:52 PM
Last Post: SarcasticDave94
  Central Apneas from pressure support? djhvyc 4 218 02-18-2021, 07:50 PM
Last Post: Gideon
  Started BiPaP treatment, makes things worse. Struggling with the settings. ldinks 74 1,660 02-18-2021, 05:15 AM
Last Post: ldinks
  BiPAP on the way - help with first night? qoethe 2 116 02-16-2021, 10:13 PM
Last Post: qoethe
  [Treatment] Oscar data help bipap Moemah123 21 541 02-15-2021, 04:55 PM
Last Post: Moemah123


New Posts   Today's Posts






About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.