Help with BiPAP Pressures for RERAs
Hi Apnea Board!
I was diagnosed about 9 months ago, with an AHI of 12 and RDI of 23. The doctors prescribed me an APAP machine that reduced my apnea and hypoapnea events, but not my RERAs, therefore my symptoms persisted. (pressures with the APAP were min 7, max 12, EPR of 3)
Recently I switched to a BiPAP hoping that my fatigue will improve by reducing the RERAs with a higher Pressure Support. (pressures are EPAP 10.5, IPAP 6.0, PS is 4.5)
In the Lab, my RDI reduced from 23 to about 18, so that is an improvement.
I only slept with the BiPAP for 2 days, but I generally feel better already. Although I am wondering if improvements can be made in my treatment.
If someone has the time to analyze my Oscar data I would be very thankful!
Have a good day!
RE: Help with BiPAP Pressures for RERAs
Your pressure settings are too low. You need to raise your EPAP to 10 and your IPAP to 15. Right now, you are at your highest setting all night. That's why you need to raise the settings.
You have a small amount of Positional Apnea. PA shows on your charts where Obstructives and/or Hypopneas are clustered together. A flatter pillow would probably be enough for you to solve this. PA is caused when your chin drops toward your chest, causing a restricted airway, much like a kinked hose causes restricted water.
Again, welcome, and best wishes for achieving great therapy and comfort!
RE: Help with BiPAP Pressures for RERAs
Thanks for the help!
I suspected the pressure settings were too low, but I didn't realize my chin could block my airway this much. Thank you for pointing that out.
I am definitely going to try a flatter pillow, great suggestion!
RE: Help with BiPAP Pressures for RERAs
Also, your back up rate is set to 20. That may or may not be a little bit high.
It is up to you if you want to keep it there. If you want to experiment, lowering it to 15 and see if you like it better or not. Your tidal volume is a bit lower since your breathing rate is at the high end of normal.
I don't want to mess with your therapy if you like it like this; but just a suggestion if you want to try it and compare it to your settings now.
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
RE: Help with BiPAP Pressures for RERAs
The Lab Sleep Test showed that I had a BPM of about 21, so the doctors wanted to match that. I will probably end up reducing it by a bit and see if I feel any better. Thanks!
RE: Help with BiPAP Pressures for RERAs
Thank you for that information. At least they had a legitimate reason for setting it at 20.
Probably a better suggestion would be to lower it to 19 for a night and try that. Then if you want, 18, etc. Stop and reverse any time you feel therapy getting worse. (And on the flip side, you could even go up to 21 just for the sake of experimentation). I had to tweak ventilator settings many times in the past: so slower, smaller changes are easier to tolerate during experiments).
Download OSCAR
OSCAR Chart Organization
Attaching Files
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
RE: Help with BiPAP Pressures for RERAs
That's what I am currently doing - 19 feels pretty good - and also with my pressures. I reached an EPAP of 7 and IPAP of 11.5, and already my AHI is about 0.5.
I feel much better compared to the last months with the APAP.
Thank you all for your help!
RE: Help with BiPAP Pressures for RERAs
Sketchysleep, You are using a Philips BiPAP ST which is not your best choice. If you find a Resmed Vauto, we can get you into a better place for comfort and efficacy. A couple areas in your setup are in serious error. You are using a Fixed breath rate of 20, and need to change that to Spontaneous. With a fixed breath rate the machine controls your respiratory pace and does not respond to your spontaneous trigger and cycle times. BAD! You are using a set rise time with a Ti of 1.2 seconds. Again, stop that and just use BiFlex at 2. My suggestions for your current device:
Mode: BiPAP S
EPAP 6.0
IPAP 10.5
Flex: BiFLEX Setting 2
Humidity: Manual Setting 4
Ramp: Off
If there are other settings available to you in BiPAP S mode that you have questions about, please feel free to ask. The Philips is discontinued in the U.S. and I'm getting a bit out of practice with it. As far as other comments in this thread, I was a bit confused by Deborah K's suggestion of much higher pressure. It looks like you could possibly use a higher pressure range, but with BiPAP S/ST, especially in Fixed mode, we are not getting a good look at your potential results. Once you return to spontaneous settings we can tell a lot more about pressure needs.
