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[Treatment] Need help titrating BiPAP
#1
Need help titrating BiPAP
Hello all, I am new on this forum. I suffer from sleep disordered-breathing, these were my last scores on my sleep study 
AHI - 5
RDI - 11
I started with a CPAP (ResMed AirSense 10) which I tried for 10 weeks. It helped slightly on some days but it reached the point where I actually started feeling worse and it turned me into a nervous wreck during the day (I think I just had exhale intolerance). So I ended up switching to a BiLevel machine, in specific the ResMed AirCurve 10 VAuto. I've been using it for 3 weeks now, and while I find it significantly more comfortable than the CPAP, I still usually wake up destroyed/exhausted. I had a handful of days where I experienced some success and actually woke up feeling refreshed (which feels amazing, I missed that feeling), but it doesn't seem consistent. I tried some different settings and started taking notes as to what settings I had and how I feel on a day-to-day basis. 
Some more info:


-EPAP usually 6-7
-IPAP tried range of 11-14
-Trigger - pretty much always set to Very High
-Cycle - I tried Very High, High, Medium, and Low
TiMax -  3-4s
TiMin - 0.1-0.5s

Other things I tried:
-elevating head of bed ~6" with textbooks (didn't notice improvement)
-soft cervical collar (I thought maybe some of my problem is positional from chin tucking, but the collar is very hard to fall asleep with)

Does anybody have advice as to what settings to consistently wake up feeling refreshed, instead of waking up destroyed most of the time?


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#2
RE: Need help titrating BiPAP
I use the same machine and I love mine. I don’t see you are using PS(pressure support), is there a reason?  If not I would add the PS and try increasing or decreasing it onhow you feel. I would start PS=3 and see how that works for you. 

PS helps with flow limits and H EVENTS.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#3
RE: Need help titrating BiPAP
(05-01-2021, 03:54 PM)staceyburke Wrote: I use the same machine and I love mine. I don’t see you are using PS(pressure support), is there a reason?  If not I would add the PS and try increasing or decreasing it onhow you feel. I would start PS=3 and see how that works for you. 

PS helps with flow limits and H EVENTS.

If I remember correctly, isn't Pressure Support just the difference between IPAP and EPAP, so if I have 7 EPAP/12 IPAP I would have PS of 5?
Or is there an actual setting somewhere on the machine to adjust the PS?
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#4
RE: Need help titrating BiPAP
Yes you set it by going to the clinician menu. There are complete instructions in the user guide download at the top of the site. 

The VAITO works a little differently than the autoset. With our machine the PS adds to the min pressure. So if you were set as follows:

Min 6
Max20
PS3

Your inhale pressure would be 9
Your exhale pressure would be 6
The max would raise to the amount you need for the machine to help obstructive events. 

The airsense has only 1, 2 or 3.(they call it EPR instead of PS) With ours it goes from one all the way to 8 with incremental of .2. So you have a high range of pressure support.
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#5
RE: Need help titrating BiPAP
staceyburke, it looks like originofstyx is already using PS of 5-6.

Originofstyx, I'd be curious to see a chart where you return all the trigger, cycle, and T1 settings to their defaults and use the VPAP Auto mode. In the S mode, you aren't able to see flow limitations, and I'm curious whether they are part of the explanation for your unrestful sleep. In Auto mode, try min EPAP of 6, PS of 5, and max IPAP of 12.

Please squeeze the following graphs into your screenshot, and be sure to show the full left panel:

Events
Flow rate
Pressure
Leaks
Snores
Flow limitations.

You can grab the gray bars that separate the graphs and push them up to make room. To close the calendar, click on the triangle next to today's date.
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#6
RE: Need help titrating BiPAP
Yes I was talking about VAUTO mode. Sorry I left that out - it changes the therapy!!
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#7
RE: Need help titrating BiPAP
(05-01-2021, 06:53 PM)Dormeo Wrote: staceyburke, it looks like originofstyx is already using PS of 5-6.

Originofstyx, I'd be curious to see a chart where you return all the trigger, cycle, and T1 settings to their defaults and use the VPAP Auto mode.  In the S mode, you aren't able to see flow limitations, and I'm curious whether they are part of the explanation for your unrestful sleep.  In Auto mode, try min EPAP of 6, PS of 5, and max IPAP of 12.

Please squeeze the following graphs into your screenshot, and be sure to show the full left panel:

Events
Flow rate
Pressure
Leaks
Snores
Flow limitations.

You can grab the gray bars that separate the graphs and push them up to make room.  To close the calendar, click on the triangle next to today's date.

Do you know what the default settings are for trigger, cycle, and T1? I got my machine used and don't remember what the settings were originally. I can try the Auto mode tonight and see what happens.
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#8
RE: Need help titrating BiPAP
Here you go:

Ti max 2.0 s
Ti min .3 s
Trigger med
Cycle med
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#9
RE: Need help titrating BiPAP
In the clinician menu there is a reset defaults. I have never done it but I remember seeing it
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed  Cervical Collar - Dealing w DME - Chart Organizing
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#10
RE: Need help titrating BiPAP
(05-01-2021, 07:39 PM)Dormeo Wrote: Here you go:

Ti max 2.0 s
Ti min .3 s
Trigger med
Cycle med

Thank you! I'll give it a try tonight and see what happens in Oscar.
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