Please help with BIPAP settings

[cloudy]

Hi-I think I need a BIPAP tutorial for dummies. 

I have read several posts and watched several youtube videos, and still cannot understand how it works. It seems like the basics are never covered.  

My old auto CPAP was set 4 to 12. I usually used 10. Now I have an auto BIPAP. The DME always gets the settings wrong AND my doctor doesn't interpret the sleep studies carefully and I already found 2 mistakes! I called him to discuss the 2 mistakes but he is now on vacation.

It was programmed EPAP 4 to IPAP 16, pressure support min 0 max 4.

Can someone please tell me if my interpretation below is correct? And if this is auto BIPAP, why do I have to have 4 settings? Plus the Flex? Why would the upper limit be set so much higher than I used with CPAP? It's confusing.

My interpretation:
EPAP 4 means that the machine will default to 4 such as when I am awake, and the exhale pressure will never be higher than 4.
IPAP 16 means that the inhale pressure will never be higher than 16.
Min PS of 0 means?
Max PS 4 means that IPAP can go as high as 20? 

I read elsewhere that the PS is the difference between EPAP and IPAP, but my difference is 12, which does not equal 4 (the real difference). Though the videos don't specify if they are referring to min PS or max PS. 

[Sleepster]

IPAP is the pressure when you inhale.
EPAP is the pressure when you exhale.
PS is the difference between the two.

So if your IPAP is 16 and your EPAP is 12, then your PS is 4.

Your machine can vary the IPAP, the EPAP, and the PS.

I don't know the details so this is a guess, but you may have a minimum EPAP of 4 and a maximum IPAP of 16, but they vary in such a way that their difference is always somewhere between 0 and 4.

[cloudy]

It's auto BIPAP, so how could it be fixed at EPAP 4 and IPAP 16?
Are those the 2 pressures that I will be breathing at until it needs adjusted? With CPAP, I inhaled and exhaled at 4 until an event. I can't inhale at 16.

The difference of the 2 is 12, so why is the prescription for 0 and 4? 
And is the min PS or the max PS the difference of the 2?

Thanks

IPAP is the pressure when you inhale.
EPAP is the pressure when you exhale.
PS is the difference between the two.

So if your IPAP is 16 and your EPAP is 12, then your PS is 4.

Your machine can vary the IPAP, the EPAP, and the PS.

[Sleeprider]

Cloudy, with CPAP at 10, I think I would start your CPAP at the following settings:
Mode B Auto
EPAP min: 8.0
PS min: 2.0
PS max: 4.0
IPAP max 16.0

That gives you plenty of room to roam, and will be effective in preventing obstructive apnea and should be very comfortable. Be sure to download and use #Sleepyhead software, and we can dial you in further.

Basic BiPAP titration requires EPAP to be set at a pressure that prevents most obstructive apnea. Pressure support is used to treat hypopnea, flow limitation and snores. If the settings above leave you with any significant OA events, then the minimum EPAP pressure should be raised. If you have notable H, FL or S, then increase minimum PS. You could set IPAP max to 20 and probably never touch it as the machine's algorithm will only go as high as needed. With the auto pressure and variable PS, it will automatically do most of what is needed. I hope you will take my suggestions as I think it will give you effective and comfortable treatment, and I've been using these for a long time now. This will start your pressure at 10/8, and EPAP pressure will automatically increase if you have obstructive events, and PS will raise according to H, FL and S, but you won't exceed 16/14 or 16/12. Starting with a pressure of 4 and zero PS is a pretty lame setting for someone already adapted to CPAP.

Questions? Ask away.

[cloudy]

Very helpful, thank you. I didn't realize the max does not matter. 

I have mostly hypopneas and RERAs, hardly any true OSAs. Without using CPAP or BIPAP for the dx study last year, my events were the same as with using the machine at the most recent study. So now my events are worse using the BIPAP than with nothing last year. I'm having an acute breathing problem and no one is able to diagnose it (nothing shows on CT or Echo or pulmonary fx tests). My sleep efficiency was only 50% with the BIPAP at the study. I feel like I haven't slept in months.

I really appreciate your suggestions and see that the Sleepyhead software is free-that's great. 

Still don't understand the PS min and max, the purpose of them. Also wondering if 8 the pressure I will breathe at until I have an event? I'm worried about trying to breath at 8 since my default CPAP setting was 4.

Cloudy, with CPAP at 10, I think I would start your CPAP at the following settings:
Mode B Auto
EPAP min: 8.0
PS min: 2.0
PS max: 4.0
IPAP max 16.0

That gives you plenty of room to roam, and will be effective in preventing obstructive apnea and should be very comfortable. Be sure to download and use SleepyHead software, and we can dial you in further. 

Basic BiPAP titration requires EPAP to be set at a pressure that prevents most obstructive apnea. Pressure support is used to treat hypopnea, flow limitation and snores. If the settings above leave you with any significant OA events, then the minimum EPAP pressure should be raised. If you have notable H, FL or S, then increase minimum PS. You could set IPAP max to 20 and probably never touch it as the machine's algorithm will only go as high as needed. With the auto pressure and variable PS, it will automatically do most of what is needed. I hope you will take my suggestions as I think it will give you effective and comfortable treatment, and I've been using these for a long time now. Questions? Ask away.

[Walla Walla]

You'll start with a inhale pressure of 10 and an exhale pressure of 8. As needed the inhale pressure will rise after it reaches 12 it starts to drag the EPAP up with it. So an example would be EPAP 11 IPAP 15. The max pressure you can get is IPAP 16 and EPAP 14. If the Min PS was 0 than you would start EPAP 8 and IPAP 8. Hope that helps explain how PS works.

[Sleeprider]

Cloudy, with the setting I provided you will start with an exhale pressure of 8 and inhale pressure of 10. From there the machine will automatically adjust. This starting suggestion was based on the fact you said your CPAP pressure was normally 10. That means the starting pressure of 4 was too low. Try this out and give it a fair chance. If you feel it is too high, then set EPAP min to 6.0 PS 2-4 and IPAP max 16. The end result will be about the same if you have obstructive events anyway, but the higher pressure is intended to prevent them. An EPAP pressure of 4 is very low, and based on your original post, is not a good starting point.

Since most of your problem is RERA and hypopnea, give these initial settings a try and let's see how it looks in a couple days. If RERA and hypopnea are relatively high, we would try higher pressure support, perhaps a range of 3-5.

[trish6hundred]

Hi cloudy,
WELCOME! to the forum.!
Good luck to you as you continue CPAP therapy and also with getting your machine fine-tuned to better meet your needs.
You have come to the right place for guidance.

[holden4th]

Cloudy, with CPAP at 10, I think I would start your CPAP at the following settings:
Mode B Auto
EPAP min: 8.0
PS min: 2.0
PS max: 4.0
IPAP max 16.0

That gives you plenty of room to roam, and will be effective in preventing obstructive apnea and should be very comfortable. Be sure to download and use [url=http://OSCAR Official Download Page ----> CLICK HERE ./]SleepyHead[/url] software, and we can dial you in further.

Basic BiPAP titration requires EPAP to be set at a pressure that prevents most obstructive apnea.  Pressure support is used to treat hypopnea, flow limitation and snores.   If the settings above leave you with any significant OA events, then the minimum EPAP pressure should be raised.  If you have notable H, FL or S, then increase minimum PS.   You could set IPAP max to 20 and probably never touch it as the machine's algorithm will only go as high as needed.  With the auto pressure and variable PS, it will automatically do most of what is needed.  I hope you will take my suggestions as I think it will give you effective and comfortable treatment, and I've been using these for a long time now.   This will start your pressure at 10/8, and EPAP pressure will automatically increase if you have obstructive events, and PS will raise according to H, FL and S, but you won't exceed 16/14 or 16/12.  Starting with a pressure of 4 and zero PS is a pretty lame setting for someone already adapted to CPAP.

Questions? Ask away.

That's a very good way of explaining it. I wasn't aware that you used EPAP to lower OAs and PS to lower H, FL and RERAs. I've got my PS set between 2.5 and 5.0. The max PS tends to be 4.5 and the 95% a bit lower. I've had a few good RERA results lately with these setting with last night being a record 0.13.

my settings, which might help Cloudy, are:

IPAP max 20.0

EPAP min 10.5

PS min 2.5

PS max 5.0

Cloudy, can I say that the pressure support settings make exhale so much more comfortable. I don't notice the 10.5 and as an experienced PAP user EPAP 8.0 shouldn't be a problem.

[reddogsuix]

With theses setting where would the flex setting be 0 being high and 3 being less resistant ?