Please help with Bipap settings after heart surgery

[Gideon]

In Auto mode (VAuto) you have 2 main concerns

(Min) EPAP - What EPAP pressure eliminates most of the OA events - (then consider backing off 1 or 2 cmw for Auto mode post titration)
PS - What PS eliminates most of the Hypopneas, Flow Limits, RERAs - (This value will be retained)
and
(Max) IPAP - What is the Max IPAP to be allowed, Note that this can frequently be set to the machine's max

[bluemom51]

Thank you.  Yes, when I increase the PS to anything over about 2.4, the centrals increase (but I am willing to try again).   I agree about the leaks, as well as the mask does not feel comfortable anymore because of the steroid effects on increasing my face and neck size.  I have both nasal pillows and full face ones I can try, and I will do that.  

For years when I used just an auto cpap, I used a nasal pillows mask that was discontinued a few years ago - I have never found a comfortable mask since then....but surely there is something that would work.

[bluemom51]

Thank you.  Are you saying that the main base number it works off is the EPAP? - that everything keys off of that and the IPAP is just sort of there, not really doing anything? - that is where I have always been confused.  Guess I still am - the auto made perfect sense - don't know why I can't seem to understand the bipap.

[bluemom51]

Thank you. I could try that.  Yes, I have always worked on the health issues.  High dose steroids for 8 years is rough.  I have taken every med for restless legs.  For instance, Mirapex worked great for rls, but....after a 3-year 10k Ebay spending spree and 70 pounds added, it reversed itself and did not work anymore.  Any others have not worked.  The hip pain is a big issue now, but I cannot have hip replacement until I have lost weight, which is virtually impossible on high dose steroids (I have tried almost starvation, but until I can get below 5 mg, not much chance.)  But haven't given up - still trying.

[bluemom51]

Thank you!

[bluemom51]

Understood - thank you.

[bluemom51]

Thank you.  Starting to understand this a little - my suspicion that the IPAP was just "there" as a maximum, and the EPAP/PS is what it is adjusting off of.  Have a lot of things to try now, and will start slowly to determine which changes are best.

[sheepless]

do you have a sense whether it was min ps or max ipap you couldnt tolerate? and by tolerate do you mean effects of high pressure like leaks & aerophagia or increased centrals?

if increased ca, high or v. high trigger might compensate. if pressure is the problem, max ipap can be set lower. also, if lucky you might be able to reduce epap to allow a little more room for ps to do its job. maybe not though, given the weight gain & the relationship between weight & oa, but trial & evaluation is the only way to tell.

if in the end you consistently see more ca, and it gets worse w higher ps, you might be better off with asv.

meanwhile you may be able to better tune your vauto as suggested above.

[bluemom51]

Thank you everyone - I have many adjustments to try (slowly) as well as different masks.  I will check back in with the results and any further questions.  I appreciate all of your very informative comments!

[Gideon]

There is Min EPAP this is a setting
There is Max IPAP this a setting.
Pressures will always stay within these limits.
PS is a Setting unless it is on a variable PS machine which the VAUTO is not.
PS is simply the difference between inhale and exhale pressures
EPAP refers to the actual live current EPAP or Exhale pressure
IPAP refers to the actual live current IPAP or Inhale Pressure.
IPAP always = EPAP + PS.