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+--- Thread: On Bipap trial, unsure where to go from here (/Thread-On-Bipap-trial-unsure-where-to-go-from-here)
RE: On Bipap trial, unsure where to go from here - Dormeo - 02-05-2022
I'm curious what the experts would think, but your results with PS of 4 are so good that I'm wondering whether you could lower your maximum IPAP to, say, 10, to see whether (a) it's more comfortable and (b) it keeps your flow limitations nice and low.
RE: On Bipap trial, unsure where to go from here - AlexB - 02-05-2022
Thanks Dormeo for that suggestion. I was wondering about lowering the pressure as well.
Sleeprider--So it sounds like I shouldn't touch the TiControls. Could adjusting the Cycle help? It's currently set to medium.
RE: On Bipap trial, unsure where to go from here - car54 - 02-05-2022
Did you notice that when you add the PS 4 to the bipap instead of PS 0 your minute ventilation and tidal volume increased while your respiratory rate decreased. I believe I have UARS and have noticed this when I use my bipap. I don't know the meaning of this, maybe someone can comment on it.
Also when I use my bipap instead of my cpap my respiratory rate chart smooths out drastically. I curious what your respiratory rate chart looks like before and after the added the PS.
RE: On Bipap trial, unsure where to go from here - Crimson Nape - 02-05-2022
Your Flow Limit really came down. Based off of your numbers, a PS of 4 seems to be working for you. You certainly can lower your IPAP max to 10. This will give you a new IPAP pressure range of 8 to 10. This may help you by narrowing any pressure changes. Some (me) are very sensitive to pressure changes and find a static pressure setting more tolerable. If you find the new settings still uncomfortable, we can always try a tighter setting. It is not like anything bad is going to happen.
Good job!
RE: On Bipap trial, unsure where to go from here - Sleeprider - 02-05-2022
Alex, there is no reason to change the cycle sensitivity from medium. I can't think of a time we have changed the cycle sensitivity, but might do it for someone not able to complete expiration and needing more time. FWIW, I use a high trigger and medium cycle.
Car54, the use of pressure support normally promotes a higher tidal volume. When combined with the same respiration rate, the minute vent will rise, but when respiration rate drops, as is normally the case, minute vent will stay the same. You're probably not interested in the equations for respiration rate x tidal volume / 1000 = minute vent, but if you are, let me know. The bottom line is minute vent drives respiration rate, and minute vent is a function to tidal volume (mL/breath) and respirations rate.
RE: On Bipap trial, unsure where to go from here - AlexB - 02-05-2022
Thanks for all the comments and encouragement! I'll try an IPAP Max of 10 and let you know what happens.
Car54, I think my numbers are tracking with the dynamic that Sleeprider is describing. Interesting, hadn't noticed that.
RE: On Bipap trial, unsure where to go from here - Geer1 - 02-05-2022
Turn ramp off, your starting pressure is very low so it is doing nothing but hiding your results.
When ramp is turned on the machine doesn't record apnea or flow limitations and because your ramp is set to 45 minutes and you shut off the machine multiple times in the night over half of the night is missing data.
The multiple shut offs look a bit odd but I see you have smartstart off. I am curious if your machine has a smartstop option? They added that to the new airsense model and I am curious if they may have updated new aircurves as well. If it is an option turn it off.
RE: On Bipap trial, unsure where to go from here - AlexB - 02-06-2022
Ok, thanks Geer1. I was wondering about that. I'll turn off ramp and check for those other settings.
I've attached last night's data. I was able to much better tolerate the therapy at the lower settings. I did inadvertently take the mask off for an hour, after being woken up by an event.
Looking at this data, should I gradually increase IPAP Max from here?
RE: On Bipap trial, unsure where to go from here - Crimson Nape - 02-06-2022
Good going! Now, with the hypopneas, OAs, and CAs being spaced out would indicate positional occurrences. If you wish to try it out, move both the EPAP and IPAP up by 1 cm, 6 and 11 respectively. If you just increase the IPAP alone, will open a wider window of pressure change which could be disturbing to you. This will maintain the same PS and range, but up by 1 cm across the board.
The bottom line; How do you feel?
RE: On Bipap trial, unsure where to go from here - AlexB - 02-06-2022
Thanks!
I felt great the first the half of the night. Overall, I feel a little more mixed, because it was harder to sleep after that--though things are definitely going in the right direction.