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The devil's in the details
#1
It's taken me six months of weekly tweaking, leading to some unexpected adjustments, to get my AHI consistently under 5 with my Philips Respironics System One BiPap device. I'm grateful for the assistance of expert users on this forum and some highly relevant archived posts to help me get to this point.

Ultimately, I found the "secret" to finding the sweet spot settings was reducing pressure to the lowest that would control obstructive events, while remaining low enough to prevent creation of central apnea events. Maintaining a low expiration pressure was also critical, as was the humidifier setting, believe it or don't. My average weekly and monthly AHI continued to swing up as high as 22 until I adjusted my BiFlex setting to "3" and System One resistance to "X1." These are not adjustments that are typically recommended or highly documented, but they were the icing on the cake for me to reduce and mostly eliminate "periodic breathing" episodes, and to keep my daily AHI below 5.

I take opioid pain meds every five hours, with a large dose of time release medication at bedtime, along with a single daily 1mg dose of clonazepam at bedtime, These present a confound for successful CPAP/BiPAP. Yet I have finally found success by systematically and slowly attending to some unlikely adjustments buried deeply in my machine. I've learned that settings, even for Auto BiLevel "BiPAP," are specific to each individual. What works for one person may not be the answer for you or me.

I'd like to make a suggestion to improve clarity in the Profile section, where we list our machine settings. I think it would be useful to have individual fields for every setting on each brand and model of CPAP machine, rather than the limited free-text fields currently in use. Such a feature could furnish more extensive information about each person's settings (if they choose to fill them in), and might help new users arrive at settings that work for them. For my Philips Respironics System One machine, these would be the fields I would want to see, and into which I would enter my current settings (seen in parenthesis here):

Mode (Auto BiLevel)
Min/Max Pressure (7/12)
PS (2/5)
Biflex setting (3)
System One resistance (X1)
Humidifier (4)

Again, just a suggestion for an already sophisticated and extremely helpful board, that has clearly been a huge help to me and to users all over the globe. Thank you!
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#2
Unless or until this is implemented, suggest you set the example you intend with your signature.

Mostly the people who would benefit from more specifics are the new ones who don't necessarily know the terms or the settings.
Sweet Dreams,

HerbM
Sleep study AHI: 49 RDI: 60 -- APAP 10-11 w/AHI: 1.5 avg for 7-days (up due likely to hip replacement recovery)

"We can all breathe together or we will all suffocate alone."
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#3
While adding all that information you forget to mention whether you have a heated humidifier, a climate line, and what humidifier settings you are using, ie., classic humidification, system one humidification, pass over humidification, etc.

Truthfully for the most part though when helping people these issues are always asked, whether it is needed in the profiles or whether people would enter it and or understand it I don't know for certain, but it's valid information that might help people help others. It can be entered now though as you have done, and as I did many moons ago.
If everyone thinks alike, then someone isn't thinking.
Everyone knows something, together we could know everything.
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#4
I too am in Pain MNGT and was on my dream machine many years prior to having daily opiate relief. Depending on amount, and how often your script is changed, you may find that settings once perfect, may need to change with your dosage. Due to a large amount of CAs, combined with the fact that my opiate use has been/will be long-term, it took the switch to an ASV machine to resolve my issues. I have been in pain MGNT for 4yrs now, and who knows the future?
*I* am not a DOCTOR or any type of Health Care Professional. My thoughts/suggestions/ideas are strictly only my opinions.

"Only two defining forces have ever offered to die for you. Jesus Christ and the American Soldier. One died for your Soul, the other for your Freedom."
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#5
Hi petemsw,

Thanks for sharing how the therapy has been going for you.

It is interesting and unexpected that you have been able to increase Pressure Support (PS) without causing too many Centrals.

If things change and you begin seeing too many Central events, I would suggest lowering the Max PS.

On your machine the PS very slowly automatically adjusts itself to reduce obstructive events like Flow Limitation and RERAs, so reducing the Max PS may occasionally prevent the machine from treating obstructive events as effectively but may also reduce the frequency of central events.

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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