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[Pressure] Dream Station Auto Bi pap configuration of pressure support function
#1
Question 
I have a new dream station auto bi pap and have been trying to find information relating to the 2 PS settings within the AutoB (auto bipap) Mode. I believe in this context the PS stands for pressure support. I'm hoping someone can explain how the 2 PS settings interact and impact the ipap and epap settings. Currently I have autoB enabled with ipap @ 15 and epap @ 7.5 and PS for epap @ 4 and PS for IPAP @ 7.5.

My AHI has been 4.5 - 7 on this machine with a IPAP 90 % pressure fluctuating between 12-13 and EPAP 90 % pressure 8-9.
Prior to dreamstation I had been using a resmed III st-a machine with manual settings ranging for ipap 12-16, epap 8-12 and backup rate of 10-11 bpm. I have a central apnea that cycles, changes, has episodic severe bouts of apnea, that respond to pressure adjustments which is why my doc is trying me on this auto bi pap . Been on bipap for roughly 3 years.

Any explanation relating to how the 2 PS settings interact with the ipap and epap settings would be appreciated. I have looked at the clinicians manual and could not find any info that explained their function - if someone knows of any resource information or a literature source that would also be appreciated. Thanks
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#2
Hi dangood_47,
WELCOME! to the forum.!
Good luck to you with your CPAP therapy, hang in there for answers to your questions.
trish6hundred
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#3
(10-20-2016, 11:34 PM)dangood_47 Wrote: I have a new dream station auto bi pap and have been trying to find information relating to the 2 PS settings within the AutoB (auto bipap) Mode. I believe in this context the PS stands for pressure support.
Yes, PS stands for pressure support. The pressure support is the difference between IPAP and EPAP. On the DreamStation BiPAP Auto, the machine can independently adjust the IPAP and EPAP pressures. Hence there are two PS settings.

The PS Min setting is the smallest difference between IPAP and EPAP that the machine is allowed to use. The PS Max setting is the largest difference between IPAP and EPAP that the machine is allowed to use.

Quote:I'm hoping someone can explain how the 2 PS settings interact and impact the ipap and epap settings. Currently I have autoB enabled with ipap @ 15 and epap @ 7.5 and PS for epap @ 4 and PS for IPAP @ 7.5.

With your settings here's what's going to happen:

When you turn the machine on without using the ramp, your pressures will be:
  • Starting EPAP = min EPAP = 7.5
  • Starting IPAP = min EPAP + min PS = 7.5 + 4 = 11.5

In general the machine will increase the pressure as follows:
  • If IPAP - EPAP < max PS and you have flow limitations, RERAs, or clusters of hypopneas, the machine will increase the IPAP, but it will leave the EPAP pressure alone.
  • If IPAP - EPAP = max PS and IPAP < max IPAP and you have flow limitations, RERAs, or clusters of hypopneas, the machine will increase both the IPAP and the EPAP by the same amount.
  • If IPAP - EPAP > min PS and you have snoring, or clusters of OAs or clusters of both OAs and hyponeas, the machine will increase the EPAP, but it will leave the IPAP pressure alone.
  • If IPAP - EPAP = min PS and IPAP < max IPAP and you have snoring, or clusters of OAs or clusters of both OAs and hyponeas, the machine will increase both the IPAP and the EPAP.

With your settings, your machine can use the following EPAP/IPAP pressure combinations:
  • EPAP = 7.5 and IPAP = 11.5, 12, 12.5, 13, 13.5, 14, 14.5, or 15
  • EPAP = 8 and IPAP = 12, 12.5, 13, 13.5, 14, 14.5, or 15
  • EPAP = 8.5 and IPAP = 12.5, 13, 13.5, 14, 14.5, or 15
  • EPAP = 9 and IPAP = 13, 13.5, 14, 14.5, or 15
  • EPAP = 9.5 and IPAP = 13.5, 14, 14.5, or 15
  • EPAP = 10 and IPAP = 14, 14.5, or 15
  • EPAP = 10.5 and IPAP = 14.5 or 15
  • EPAP = 11 and IPAP = 15

Quote:My AHI has been 4.5 - 7 on this machine with a IPAP 90 % pressure fluctuating between 12-13 and EPAP 90 % pressure 8-9.
Can you give a breakdown of the AHI into OAI, CAI, and HI?? You can't get this off the machine's LCD nor can you get it off the PR web tool. But you can get it from SleepyHead. The most recent version of SleepyHead will work with your machine and it is well worth installing on your computer.

In order to understand why your AHI is running between 4.5-7, but your 90% pressures are not hitting the max IPAP = 15 and the max EPAP = 11, we need to see the breakdown of the AHI into the components. If a substantial chunk of your AHI is made up of CAs, that might explain why your AHI is still running above 4.5, but the pressure is not maxing out during the night.

Quote:Prior to dreamstation I had been using a resmed III st-a machine with manual settings ranging for ipap 12-16, epap 8-12 and backup rate of 10-11 bpm. I have a central apnea that cycles, changes, has episodic severe bouts of apnea, that respond to pressure adjustments which is why my doc is trying me on this auto bi pap . Been on bipap for roughly 3 years.
Because your machine is just a plain old PR DreamStation BiPAP Auto, it will just ignore CAs. That's because it does not have an ST mode and hence it cannot be programmed to "trigger" inhalations when your breathing slows down too much or becomes too shallow.

By the way, what did your AHI run on the Resmed III ST-A? And why has your doc switched you to the DreamStation rather than something like a PR System One BiPAP ST or BiPAP AVAPS machine or a Resmed AirCurve 10 ST or AirCurve ASV machine? All of those machines can be programmed to respond to your CAs by using the IPAP to attempt to trigger inhalations.

At any rate, if you are interested in "mimicking" the old Resmed III settings of IPAP 12-16 and EPAP = 8-12 as close as possible on the new machine, you ought to use something like:
  • Min EPAP = 8
  • Max IPAP = 16
  • Min PS = 4
  • Max PS = 8
But even with these settings, the PR DreamStation BiPAP Auto cannot try to trigger inhalations like your old Resmed III would do by drastically increase the IPAP over a as few as 3-4 breaths if your respiration dropped below your backup rate. Because it's just a plain old Auto BiPAP, the DreamStation cannot attempt to "trigger" inhalations if your breathing slows below your old backup rate. That might explain why your AHI is running as high as it is.
[/quote]

Questions about SleepyHead?
See my Guide to SleepyHead
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#4
Thanks, wow, I 'm very thankful and pleased with your response, so helpful and so complete of a reply. Your information will be very helpful in both tweaking my current settings but also giving me a more complete understanding to how the PS settings interact and control the EPAP/IPAP in auto mode.

I had a sense that the vendor rep (Para health professional) was not familiar with the machine or some of the settings as bipap is not something they usually deal with - the settings they chose initially weren't even close to current and i had a horrible initial experience in auto bi pap mode with horrible results- ahi initially in double digits and symptoms to match until I started tinkering with PS settings. I actually went back to my old machine for several weeks . I tried to return the dream station after my initial attempts thinking the lack of back up rate was the issue after trying it . They have refused saying they couldn't because they had already submitted the funding appplication to our provincial health ministry.

What was interesting about my initial experience with this machine is I received it in auto mode as per my dr's script with the PS settings at O and 4 and tried it for 2-3 days and had abysmal results and sleeps - AHI in double digits. I then opted to try the manual bi pap mode using my previous settings from Resmed machine and had incredible success for about a week and a half - ahi was 3 or less consistently, best I had ever experienced in 4 years with cpap/bipap, functionally was feeling great and then all of a sudden my AHI spiked without any machine setting changes nor situational changes - I experienced horrible fatigue, fragmented sleep etc and I thought the machine had malfunctioned. Took it back and had machine checked and the vendor said it was fine . After the initial experience I believed purchasing machine was a mistake and stopped using. Tried to return machine but they have refused. I only mention this as my initial sporadic use with long gaps in use will be reflected in the data when I upload here when I get a chance to.

With respect to why the switch of machines, it comes down to partially a funding issue here in ontario canada with respect to how bipap machines with backup rates or the Asv machines are funded, or more aptly , not funded for individual purchase. Part of the pros and cons of a publically funded heathcare system - but for the record the pros far exceed the cons, despite what a certain mr. Trump might suggest about canada's health system (:.

In their wisdom, our province's assistive devices program will not fund the purchase (or so I have been told) of true bi level or ASV machines but will now at least fund an auto bipap like the dream station auto bipap. For the more expensive ST or ASV machines, a client has to access those through another source (a community ventilator equipment pool )where you are "loaned a machine" but there is little choice in which machine you can get, and unfortunately what they have, isn't ideal for my purposes . I tried my private extended heath insurance( a major carrier here) and like our gov't they will only fund cpap but not bipap or ASV. I have also met resistance from my dr with respect to prescribing me an ASV device despite my inconsistency with even the resmed 3 st machine. My AHI and the functional fatigue symptoms and fragmented sleep with the resmed machine have been highly variable and I constantly have to tweak my pressures during my severe apnea episodes- AHI as low as 3 and as high as 9 but during good times in 4-6 range.

Also related to the switch in machines is I am trying to get back to back country camping, wilderness canoeing something i havent done since being on cpap. I'm also recently retired and doing more international travel to areas that are not well developed from an infrastructure perspective , and plan on moving to a rural area with an unstable power supply . My older Resmed III ST machine is too heavy, bulky for my travel and outdoor recreation needs and is not very DC friendly. I just purchased a light weight lithium battery and it is more compatible with the dream station that the res med unit.

With the funding issue in mind and my lifestyle choices , my dr and I discussed trying the dreamstation as an alternative and to some extent an experiment. The good news is since I have been giving the dream station another try this month in auto mode , and tweaking the PS settings my AHI is going down or at least they have in the last 3 nights with my AHI now 3- 4. What I don't know is whether this is due to my going through a good period with my apnea- coupled with the tweaks in settings .

More and more I believe my apnea has an episodic pattern to it with severe bouts lasting 3-7 days typically where my AHI will spike, i'll experience severe fatigue, fragmented sleep, insomnia etc. and after adjusting my pressures things start to settle back down. So what I don't know because I have just recently achieved some success with the dreamstation in auto mode is whether it will control my apnea on a longer term basis due to its dynamic auto pressure adjustment capabilities. However the lack of a backup rate is concerning so at this point I have the res med machine as a backup.

Regarding the data from the dreamstation, I do not have the sleepyhead software to do as you suggested but will get it and install and get that additional data you suggested in a few days. I do have the advanced respironics software. Something I haven't done is retrieved the data from the resmed machine as I don't have the serial cable to do so but think I should get one as it has more than a years worth of data on it and might be revealing to review/analyse.

Robysue, thank you so much for your act of kindness in providing such an excellent, thorough, informative and helpful response to my questions. Dan
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#5
As robysue suggested, download the free SleepyHead program. It will help you and us to better identify where your issues occur. Complex apnea is difficult to treat without the right equipment (asv) but we can help you to optimize what you have, and perhaps build a case for an upgrade. It starts with the data and correlations, and it's success is measured in how you feel and respond to various pressure and pressure support strategies.
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#6
Hi there, so I have downloaded software and reviewed results and have a quick question, is it desirable to post the results in some manner by way of a screenshot or upload the file as a csv file or just report on key numbers in narative form. The latter seems rather onerous given the numerous parameters and volume of data. Please note I'm a relative newbie to posting in this forum but also posting on forums in general. I have saved the data as a csv file and a screenshot but thought I`d check on protocol prior to posting. If a screenshot is desirable do I just add the file within attachment posting function, as I tried to do that and then when I used the preview function it didn`t appear as expected ?

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#7
A couple links to help you.

https://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

OpalRose
Apnea Board Moderator
www.ApneaBoard.com

How to Organize and Post ScreenShots

http://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/reference/tips/imgur

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