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The devil's in the details
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petemsw Offline

Members

Posts: 12
Joined: Jul 2014

Machine: Respironics System One 60 Series BiPAP Auto
Mask Type: Full face mask
Mask Make & Model: Quattro FX
Humidifier: Respironics System One
CPAP Pressure: Auto BiLevel 7/11, PS 2/4
CPAP Software: SleepyHead

Other Comments: BiFlex setting 3, System One resistance X1, Humidifier 2

Sex: Male
Location: Virginia Beach VA

Post: #1
The devil's in the details
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!
(This post was last modified: 01-03-2015 09:03 AM by petemsw.)
01-03-2015 08:49 AM
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herbm Offline

Preferred Members-2

Posts: 852
Joined: Jan 2014

Machine: ResMed AutoSet S9
Mask Type: Oral
Mask Make & Model: ResMed Airfit P10 Nasal Pillow
Humidifier: ResMed H5i
CPAP Pressure: 11-16
CPAP Software: ResScan SleepyHead

Other Comments: Backup Mask: Innomed Hybrid FFM -- Oral+Nasal Pillows

Sex: Male
Location: Austin, TX

Post: #2
RE: The devil's in the details
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."
01-03-2015 12:42 PM
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Galactus Online

Advisory Members

Posts: 1,384
Joined: Jan 2014

Machine: Phillips Respironics System One PRS1 DS760P Auto BiPAP
Mask Type: Nasal pillows
Mask Make & Model: ResMed Airfit P10 Nasal Pillow
Humidifier: System One Heated Humidifier + Climate Line
CPAP Pressure: E/I 13/20 PS 4/7 BiFlex 3
CPAP Software: SleepyHead EncoreBasic

Other Comments: Sleep can be a good thing.

Sex: Male
Location: USA

Post: #3
RE: The devil's in the details
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.
01-03-2015 12:52 PM
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Peter_C Offline

Advisory Members

Posts: 1,308
Joined: Sep 2013

Machine: System One DS960HS
Mask Type: Full face mask
Mask Make & Model: Mirage Quattro "MED"
Humidifier: Attached
CPAP Pressure: Auto mode-script is:15/3/3
CPAP Software: EncoreBasic Other Software

Other Comments: Severe obstructive sleep apnea 1999/Just got an ASV machine

Sex: Male
Location: Akron, Ohio USA

Post: #4
RE: The devil's in the details
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."
01-03-2015 01:35 PM
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vsheline Offline

Advisory Members

Posts: 1,907
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #5
RE: The devil's in the details
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.
01-04-2015 01:22 AM
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