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New Dreamstation Auto Bipap - lost on support settings
#51
RE: New Dreamstation Auto Bipap - lost on support settings
Thanks for all the info.  I'll try hard to digest it bit by bit

So you want 

EPAP - 9
PS MIN - 5
PS MAX - 7

Starting pressure will 14
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#52
RE: New Dreamstation Auto Bipap - lost on support settings
That sounds good. You got the settings right last time, but again feel free to post an image if you're uncertain.
Sleeprider
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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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#53
RE: New Dreamstation Auto Bipap - lost on support settings
Just a quick FYI
You said ". I had always assumed that the needed pressure was applied until it senses the beginning of exhalation."

that is how ResMed devices work. On ResMed there are controls where we can make it respond faster or slower if needed.
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#54
RE: New Dreamstation Auto Bipap - lost on support settings
   

Looks like some things got better and some got worse.

While researching auto bipap in general, I thought you set a min and max pressure range and it did it's thing within that range.  I had no idea that the space between min and max moved around all the time.  Still don't get that.  So when the machine reports 90% pressure of 20, when the pressure was actually no more than 15.6, it's reporting the max setting, not actual pressure, that data is worthless.
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#55
RE: New Dreamstation Auto Bipap - lost on support settings
We will have to talk to Sawinglogz who has developed the current Philips statistics print-outs. I find them confusing too. Looking at the graph and EPAP set statistics, we see that the EPAP min moved upwards quickly to a median of 12.3 and 95% of 13.0. IPAP moved entirely between 18 to 20 cm pressure. We can ignore the "Pressure" statistic. There is no doubt that the machine algorithm favored a higher pressure support, and was at 6 to 7 most of the night. Philips has a variable pressure support, while Resmed maintains a fixed pressure support, which I prefer, however when we find out what is comfortable for your wife, and works best, we will eventually set minimum PS and maximum PS the same, so that it is constant.

This session started with massive positional obstructive clusters. Once beyond that, the night was much more successful. What we an see is that higher pressure seems to stop those obstructive events, and that appears to occur at above 18/12 pressure(6). Before we make further suggestions, what was your wife's feedback on comfort? Was this more like what she experienced with the hospital vent? Last question for now, is she diagnosed with COPD or other pulmonary condition that explains her hypercapnea and airway resistance?
Sleeprider
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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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#56
RE: New Dreamstation Auto Bipap - lost on support settings
Nobody has actually printed COPD on any of her records, but medications with a nebulizer say they are all for COPD. May of 2020, she was told she had CHF. I guess I should have said she has been on oxygen since then, currently at 3 liters. She is/was extremely heavy. After her June hospitalization, she started losing weight.  Somewhere in the time Between June 29 and Oct 30, she developed this co2 issue, which landed her in the hospital twice more. We know her co2 was 77 when she last went in. We know they wouldn't usually release her with a high level, but they never checked it again. She was alert, the ER was packed, and they needed the bed.

Since her release 12-15, we have had 2 blood gas tests.  One was 56 and the last one, two weeks later, was 66. The goal is 40. She usually starts getting out of it at about 70.  But since June, she has lost 115 lbs. Doctors don't even mention it.  I'm sure her apnea needs change with this weight loss. She sys she feels fine, but we are both dismayed that all that weight loss hasn't provided any extra energy.

She said it felt more like she had been expecting. I think this machine has some more adjustments when it is placed in bi-level instead of auto.  I had always envisioned the auto being used to find out what ball park we are playing in, then bi level. Looks like the only thing auto does is make the min and max pressure setting move in relation to the actual pressure being delivered.
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#57
RE: New Dreamstation Auto Bipap - lost on support settings
I suspect she was ventilated with a BiPAP ST machine at the hospital. Since she tolerated the therapy pressure, and felt good with the added ventilation, I'm going to e recommend some changes consistent with hypoventilation syndrome and hypercapnea that I don't normally suggest for the average BiPAP patient. I'm hopeful pressure can be reduced with a collar, but this does not seem to be bothering her. We could move to S-mode which is fixed pressure, however the auto mode has been helpful in identifying the higher range and more effective. Have patience, as I tend to make recommendations conservatively, and needed to confirm her needs and how she feels with the therapy as we have moved up in pressure.

New settings:
EPAP min 12.0
Max IPAP 22.0
PS min 7.0
PS max 7.0

It would be immensely helpful if you or she can call the hospital and request a copy of the type of ventilator and pressure settings that were used. These records certainly exist, and would tell us where she was previously observed to respond best to positive pressure bilevel therapy.
Sleeprider
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____________________________________________
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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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#58
RE: New Dreamstation Auto Bipap - lost on support settings
Not sure how much more starting pressure she can take

Tonight is her actual sleep study. We’ll try these next time
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#59
RE: New Dreamstation Auto Bipap - lost on support settings
Is this sleep study a diagnostic or titration? If the study is intended to be diagnostic, you want to ask for a split study so she can be titrated to BiPAP after demonstrating her apnea. I hate to think of her having to sleep with no assistance at all, only to have to return for a second study to be titrated.
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.
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#60
RE: New Dreamstation Auto Bipap - lost on support settings
Getting either a Titration or a split study is a big deal. Good point Sleeprider.
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
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