Spetzal's therapy thread (Help needed with DreamStation BiPap)

[Sleeprider]

As far as I'm concerned, you can go to auto mode with an EPAP of 9.0 and let it max at what you find tolerable. Our objective is twofold; comfort and efficacy.

[Gideon]

In response to your PM requesting my feedback, I pretty much agree with Sleepriders suggestions.

You have a positional element that especially in your case will not resolve with pressure. I think you could use a PS of 3 and a slightly higher EPAP, try. 0.4 increase with a max pressure to provide a difference of 3.

Most of what I'd like to have you try puts you in the range where you say your pain is too much.

BUT. You have an issue with higher pressures so I'll go along with Sleepriders lower settings.

Please see an ENT to see if they can find the source of your pain. Could it just be congestion?

[spetzal]

Sleep rider, what im understanding from you is potentially switching from fixed to Auto BiPAP, with a max IPAP of 12 (max no pain setting) and a min EPAP of 9? What would the “pressure up” and “pressure down” settings be?

Wouldnt this be bad, as ive already determined that a constant CPAP pressure of 10 is the minimum needed to sleep without waking choking?

[spetzal]

Gideon, its not a congestion issue.  Here are the procedures performed during my sinus surgery: bilateral total ethmoidectomy, bilateral madillary antrostomy, septoplasty (deviated septum).

Aside from fixing my septum, courtesy of a broken nose, the doc basically did the ol’ “rotor rooter” on my sinuses.  Consequently, any BiPAP IPAP over 12 causes pain, and any EPAP using in conjunction over 10 does the same.  Example:  12/10 is pain free, 12/10.5 is problematic

“Pain” equals shooting pain straight into my sinues, inner ears stuffed and burning, entire head/sinues burning, disorientation, irritability, etc.

Got my heated tubing in today, and also a new soft cervical collar to replace that frustrating “Eliminator” off Amazon.  See how tonight goes at 12/10 and post in the morning.  Depending on that, will play a bit and see if the heated tubing makes any difference.

[spetzal]

Results from last night, 12/09
Theres a full night overview, followed by a close look at one event, followed by a look during the non-event period
Im ignoring everything before 20:20 (had new soft cervical collar too tight) and after 00:04 (just laying on stomach awake)

In general terms, I feel noticably better today.  Not enough sleep, but thats due to back/muscle/neuropathy pain.


Thoughts on data?

[Sleeprider]

There is still noticeable flow limitation, so I would like to see PS 3 fit into your settings by reducing EPAP min to 8.0 or 9.0, Leave max pressure at 12.0 and be sure PS min and PS max are set to 3.0. Mode should be Auto-BiPAP.

[spetzal]

Sleeprider, double check me plz?  This seems simplistic/straightforward, but i recognize my brain is still foggy to some degree.

Edit:  be aware the BiFlex feature is currently set to “off” and when enabled has a range of 1 to 3

[spetzal]

Sleeprider, have changed settings per your recommendation and awaiting your confirmation.

Im struggling to understand the situation after reading the ResMed document discussing BiLevel and PS.  We know that a EPAP of 10 keeps me from waking up choking while NOT eliminating OA.  I dont understand the reasoning behind recommending auto bipap with a EPAP of 8 or 9?  Of course the PS min/max is in play also, and im unsure about this…..am i correct in saying that by using a ps max 3 and ps min 3, you are simulating the ResMed function of a fixed PS, which Philips doesnt use?  And that this will temporarily increase the EPAP of 8 or 9 by 3cmH20 as needed to help eliminate OA and hypopneas?  And by setting an EPAP lower than 10, it helps with a more consistent, even flow rate?

[Sleeprider]

Looks good. As an option you can use EPAP 8.0 and have some auto-pressure, but this will deliver a constant 12/9 pressure (PS 3).

[spetzal]

I dont understand that in relation to the new settings you suggested and ive implemented in post# 27.  What is the practical difference from the new setting (auto bipap ipap12/epap9 with ps max 3 and ps min 3) vs the one you just referenced?  The “auto pressure” comment is throwing me.

Please explain?