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Newly diagnosed need help using bipap
#1
Rainbow 
Having a hard time adjusting to bipap. I just got the machine 10 days ago. I have little support from home health agency and my doc knows nothing about apnea. I have appt with sleep specialist Set 4th. I never saw my sleep study report so I know nothing but my pressure setting. 12/7. I recently changed it to 10/5 just so I could adjust more easily and get using it more quickly.
Any advice?
My main problem is breathing with a machine. While awake I can do it but how to sleep?
I bought a mask myself I like air fit pro P 10. Very light and easy to get on and if my nose is clear then I can use it.
My other "big" problem is that I take Seroquel for sleep at night 3 tablets, 25 mg. each. (I was prescribed those before actually diagnosed with OSA.)
I think they make apneas worse.
What do you all think?
Thank you for your help
Kim
Kimberly from HonoluluSleep-well
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#2
Hi kfujioka,
WELCOME! to the forum.!
Yeah, CPAP therapy can take some getting used to. Hang in there and someone who knows about the BIPAP machines will be along to help you, soon, I encourage you to just stick with it.
Best of luck to you with your CPAP therapy.
trish6hundred
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#3
(08-23-2014, 09:50 PM)kfujioka Wrote: Having a hard time adjusting to bipap. I just got the machine 10 days ago. I have little support from home health agency and my doc knows nothing about apnea. I have appt with sleep specialist Set 4th. I never saw my sleep study report so I know nothing but my pressure setting. 12/7. I recently changed it to 10/5 just so I could adjust more easily and get using it more quickly.
Any advice?

For some people (me for sure) 5 is too low a setting to be comfortable. At 5, I don't think I can get enough air. The other thing is your top end of 10 is only reached when the machine thinks it needs to do that. So I'm not sure you're really getting much comfort out of dropping it from 12. If you really needed 11 or 12 to control your apneas, then dropping it could make you less comfortable.

(08-23-2014, 09:50 PM)kfujioka Wrote: My main problem is breathing with a machine. While awake I can do it but how to sleep?
I bought a mask myself I like air fit pro P 10. Very light and easy to get on and if my nose is clear then I can use it.

The P10 is a good choice. Your airway will stay open just fine, even if your nose is not as "clear" as you would like. Sleeping with a mask is just a matter of doing it for a day or so until you get accustomed to it.
One trick with it is you may have better results if you use one pillow size larger than you think you should. For instance, if you use a medium, give the large a try. You might find they seal better and give you the feeling of more air flow.


(08-23-2014, 09:50 PM)kfujioka Wrote: My other "big" problem is that I take Seroquel for sleep at night 3 tablets, 25 mg. each. (I was prescribed those before actually diagnosed with OSA.)
I think they make apneas worse.
What do you all think?
Thank you for your help
Kim

Cannot help you with the sleeping tablet thing. I've never taken anything such as that so it's not something I have much knowledge about.
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#4
Welcome kfujioka, I suggest you speak to your Dr about getting off the Seroquel, I used to be on it and it sleeping pills can actually make your sleep apnea worse. If you are going off it you will need to taper down slowly. Seroquel shouldn't be used for long periods of time and it can be addictive. In small doses like you are on it it used for insomnia, in large doses it is used for schziphreania and other mental illness's.
The Bipap will take time getting used to, please ask any questions on here or write them down to speak to the sleep specialist on the 4th Sept.
Good luck and let us know how you go with the specialist Smile
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#5
I thought the 12/7 means the air I breathe on is 12 and the pressure is only 7 when I exhale. So when I changed it to 10/5 it meant the air I breathe in is 10 and when I exhale it is 5. Is that right on a bipap machine? (I am very new to this.) I only lowered it when I am practicing. I put it on 5 or 6 times during the day and lay in bed with it on. I haven't been able to sleep through the night with it yet. Tonight I will try.
Thanks for your help. I don't know so much yet.
Kimberly from HonoluluSleep-well
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#6
(08-23-2014, 10:26 PM)Tez62 Wrote: Welcome kfujioka, I suggest you speak to your Dr about getting off the Seroquel, I used to be on it and it sleeping pills can actually make your sleep apnea worse. If you are going off it you will need to taper down slowly. Seroquel shouldn't be used for long periods of time and it can be addictive. In small doses like you are on it it used for insomnia, in large doses it is used for schziphreania and other mental illness's.
The Bipap will take time getting used to, please ask any questions on here or write them down to speak to the sleep specialist on the 4th Sept.
Good luck and let us know how you go with the specialist Smile

Thank you. I think you are right! I see my psychiatrist Monday. (I have been reading on web about people get Apneas on Seroquel when they didn't even know they had it before. ) Also my husband is a medical researcher and he wants me off of it. I have to taper it slowly.

I am taking Valerian. And my doctor gave me gabapentan to help me feel sleepy. Do you know that one?
Kim
Kimberly from HonoluluSleep-well
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#7
I feel anxious about getting off the seroquel but I will do it to lessen the apneas. However I am just new to the CPAP so I can't use it all night yet. I am feeling quite desperate about having apneas all night but not yet able to use the machine. (I only sleep about 4 hrs a night, approx.) I can oy use machine for one hr cause I can't fall asleep with it on. I lay there concentrating on breathing with the machine. It seems so silly. After I get used to it and finally sleep with it, I'll have to write a comic short story on laying awake breathing with a machine. (When I did sleep study I used machine most of night but I
Laid there awake mostly.)
Kimberly from HonoluluSleep-well
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#8
One of the most important things is to relax about the apneas. You've had this for a long time and a few more nights until you get used to things will not make any great amount of difference. You know you can use the mask, so wear it when you go to bed. If you feel you are "concentrating" on breathing, that's ok too. It's not any worse than counting sheep, and breathing doesn't make nearly the mess sheep can.

So I'm going to give you my secret for making it work. This is a well guarded secret, so don't tell anyone. It's what I used when I first started. It's kind of a magic elixer in a way, but you don't have to drink it. Ready? Ok, here it is..... Repeat as you start the process: "The mask and I are one..... The mask and I are one...... The mask and I are one..." See how nicely boring --- I mean relaxing that is? Learn to enjoy your therapy, it is going to make your life better.

And by all means stay on your meds until or unless your docs have you do something different. The Bipap therapy will probably do just fine controlling your apnea regardless.
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#9
Thank you. It is like a mantra "the mask and I are one." I listen to mindfulness meditation tapes with John Cabot Zinn and your advice reminds me of the kind of peaceful words he speaks on his tapes.
Of course you are right that I have had this for awhile and a few more nights won't make much difference.
My friend uses a CPAP (has for years) and she imagines the ocean when she breathes with it.
Thank you so much.
Wise advice.
Kimberly from HonoluluSleep-well
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#10
(08-23-2014, 10:30 PM)kfujioka Wrote: I thought the 12/7 means the air I breathe in is 12 and the pressure is only 7 when I exhale. So when I changed it to 10/5 it meant the air I breathe in is 10 and when I exhale it is 5. Is that right on a bipap machine? (I am very new to this.)

Hi kfujiokam welcome to the forum!

Yes, if you have a straight bi-level prescription your machine may be set to operate in BiLevel therapy mode, and you would be right about the prescription being always 12 for inhale and always 7 for exhale. And in BiLevel mode, changing IPAP to 10 and EPAP to 5 would mean always 10 for inhale and always 5 for exhale.

In bi-level machines, a name for the difference between EPAP and IPAP is Pressure Support (PS). So one could also describe your prescription by saying your EPAP setting is 7 and your PS setting is 5, and this would mean that your IPAP was 7 plus 5 (which adds to 12).

Actually, your PRS1 (Philips Respironics System One) BiPAP Auto machine has 3 therapy modes to choose from:
1. CPAP mode (one fixed pressure all night)
2. BiLevel mode (EPAP sets exhale pressure and IPAP sets inhale pressure)
3. AutoB mode (Auto BiLevel mode, which has settings for Min EPAP, Max EPAP, Min Pressure Support, Max Pressure Support, and Max IPAP)

In AutoB mode, the exhale pressure EPAP is slowly automatically adjusted by the machine, raising EPAP above its Min EPAP setting only as much as needed to avoid/reduce obstructive events such as obstructive apneas, hypopneas, Flow Limitation and snoring.

In AutoB mode, as the EPAP is slowly automatically adjusted higher or lower (always staying within the limits of Min EPAP and Max EPAP), the present inhale pressure (IPAP) is always the sum of the present exhale pressure (EPAP) plus the present amount of boost called Pressure Support (PS):
IPAP = EPAP + PS

In AutoB mode, Pressure Support is given a range (Min PS and Max PS) for how much the pressure can be boosted above EPAP during inhale. The machine will automatically (but very slowly) adjust PS within this range to further minimize obstructive Flow Limitation while allowing EPAP to stay as low as feasible.

In AutoB mode, the Max IPAP setting limits how high IPAP is allowed to go, so the Max IPAP setting should be set at least as high as the MAX EPAP setting plus the Min PS setting.

Obstructive Sleep Apneas is usually highly positional, with the worst position usually being when we are in the "supine" position (flat on our back). If you take precautions to stay off your back while you are asleep, the pressure needed to treat your obstructive sleep apnea will be lower.

You may want to ask your doctor to change your prescription to specify a range for EPAP and a range for PS, and the modified prescription might be much easier for you to fall asleep with.

For example, you could ask your doctor to consider prescribing:
Min EPAP: 5 or a little lower
Max EPAP: 7 or a little higher
Min PS: 3 or a little lower
Max PS: 5 or a little higher
Max IPAP: sum of Max EPAP plus Max PS

In any case, you might find it is more comfortable for you if you adjust the Bi-Flex setting to zero (off) or 1 or 2 or 3. Many patients find that the larger the setting for flex is, the easier it is to exhale.

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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