Bipap Pressure too High?

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Bipap Pressure too High?

Postby sufferer15 » Mon Apr 25, 2011 3:17 am

Hi, I'm on a BIPAP 18/14 and it seems too high when I was on a lower CPAP setting before. Is this setting just a mistake? I think it's an auto setting with biflex 3 (What does biflex do?) thanks!!
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Postby sufferer15 » Mon Apr 25, 2011 3:33 am

I also noticed that my throat seems clogged and a little swollen in the morning- is that my tonsils?
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Postby CrohnieToo » Mon Apr 25, 2011 7:52 am

Your BPAP pressure setting of 18 and 14 means your inhalation pressure (IPAP) is set at 18 and your exhalation pressure (EPAP) is set at 14. Bi-flex at 3 gives you an additional somewhere around 3 cms of pressure relief on exhalation if needed.

Most likely that clogged, swollen feeling in your throat is due to dryness from the air pressure. You may well need to set the humidity higher on your BPAP humidifier. Your natural saliva and mucus secretions thicken as they begin to dry out and they don't excrete from your throat tissue as easily and well thereby causing the swollen feeling.
ResScan 3.10 - Resmed S8 ResLink & oximeter
ConTec CMS-50D+ oximeter - Philips EverFlo 5L Oxygen Concentrator
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Postby sufferer15 » Mon Apr 25, 2011 4:57 pm

I think I'm waking up every night after 3 hours when the pressure ramps up to high- will I do better on Bilevel like 12/4 or something?
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Postby CrohnieToo » Mon Apr 25, 2011 6:32 pm

I can't answer that. I have no idea what pressure you NEED to keep your airway open to prevent apneas from occuring and to stop any that slip by and get started.

Your titration study, your BPAP's data and your sleep doctor's and/or RRT's evaluation of that data and titration information coupled w/your experience so far has to be the determining factor for that.

You probably couldn't even breathe comfortably w/an EPAP of 4!!! You need a better understanding of how Bi-flex works, it is NOT the same as EPAP at all.
ResScan 3.10 - Resmed S8 ResLink & oximeter
ConTec CMS-50D+ oximeter - Philips EverFlo 5L Oxygen Concentrator
PR SystemOne BPAP Auto w/Bi-Flex & Humidifier - EncorePro 2.2.14.0
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Re: Bipap Pressure too High?

Postby robysue » Mon Apr 25, 2011 7:35 pm

sufferer15 wrote:Hi, I'm on a BIPAP 18/14 and it seems too high when I was on a lower CPAP setting before. Is this setting just a mistake? I think it's an auto setting with biflex 3 (What does biflex do?) thanks!!
You NEED to KNOW exactly what your machine's settings actually are: Guessing what they are is just not good enough. Even better, you should have a hard copy of your prescription in case you ever need it---such as if you have to suddenly replace the xPAP machine because it's been damaged while traveling for example.

If you believe the current settings MIGHT be a mistake, CALL the sleep doctor's office IMMEDIATELY and let them know. And CALL the DME to ask them what the settings ARE and what the prescription READS.

If you are UNCOMFORTABLE because your IPAP or EPAP pressure is higher than your old CPAP pressure USED to be, you need let the sleep doctor's office know this immediately. If the current pressure settings are CORRECT, you need to ask for help in learning how to adjust to the higher pressure. Be specific and let them know exactly how the higher pressure is bothering you. Be sure to mention the swollen and clogged throat as well---in case it's related.

If the sleep doctor's office confirms that your pressure settings really do need to be this high, but cannot provide you with any suggestions on how to learn to live and sleep with the new settings, then call the DME and ask for help from them too.

And have either the sleep doctor, his PA, his nurse, or the tech at the DME explain why you are now on a BiPAP instead of a CPAP because you NEED to UNDERSTAND this too.

And by the way, Bi-Flex is supposed to provide a bit of additional exhalation pressure relief beyond that already provided by dropping from the IPAP to the EPAP. This bit of additional exhalation relief occurs on the first part of your exhale. Bi-Flex is also supposed to smooth the transition between two pressure levels. Most people (particularly those with high pressures or large differences between IPAP and EPAP) find Bi-Flex makes breathing against the pressure feel a bit more natural. But Bi-Flex is a comfort setting and not everybody likes it.

You also write
I also noticed that my throat seems clogged and a little swollen in the morning- is that my tonsils?
In addition to Chronie's suggestion about the humdifier, I'd report this to BOTH my PCP and my sleep doc if the situation does NOT straighten itself out in a day or two. Or if it's uncomfortable enough to make you feel like you can't breathe. Or if the throat actually gets sore. Could be the BiPAP without enough humidity. Or it could be something else---allergies, a nasty virus, or some variation on strep throat all come to mind. You need a doctor to diagnose it if it doesn't get better on its own.
current settings Min EPAP = 4, Max IPAP = 8 and Rise time = 3

8/1/2010 sleep study results:
AHI = 3.9 [AHI = (#OA +#CA + #H w/desat) per hour]
RDI = 23.4 [RDI = (#OA +CA + #H w/desat + #H w/arousal) per hour]
Dx: Moderate OSA
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Postby sufferer15 » Wed May 04, 2011 1:04 am

I am waking up because the pressure is too high, theoretically wouldn't EPAP of 4 be the best since it lets you breathe out easily? thanks so much
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Postby Daniel » Wed May 04, 2011 3:16 am

sufferer15 wrote:I am waking up because the pressure is too high, theoretically wouldn't EPAP of 4 be the best since it lets you breathe out easily? thanks so much


As advised by others....YOU should talk to your sleep doctor about this.
Your sleep doctor is in possession of all your medical records and id best placed to advise you.

Daniel.
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Postby sufferer15 » Wed May 04, 2011 11:03 pm

my sleep doc says that I need the high pressure according to my sleep study but I seem to wake up all the time on the high pressure at 14 min EPAP- it seems ok during the ramp time
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Postby robysue » Fri May 06, 2011 2:55 pm

sufferer15 wrote:my sleep doc says that I need the high pressure according to my sleep study but I seem to wake up all the time on the high pressure at 14 min EPAP- it seems ok during the ramp time
Report this problem to your sleep doctor's office.

As to why you've been prescribed such a high pressure: It has to do with your titration study---at lower pressures, too many events were still happening.

During a titration study, the tech increases pressure using a particular algorithm. The basic part of which is: If two or more obstructive events occur in a five minute period, the pressure is increased by 1 cm and the tech waits for five minutes to see how your body adjusts. If additional events occur during that five minutes, then the pressure is increased again by another 1cm and the tech again waits for five minutes to see what happens. But if no additional events occur during the five minute waiting period, the pressure is left at the new setting unless (or until) more events occur.

If central apneas start to show up or if there is evidence that the current pressure setting is triggering arousals, the algorithm then has a process by which the tech lowers the pressure by 1cm at a time to try to find the best compromise between effectively eliminating the obstructive events while minimizing the problems caused by the introduction of centrals or additional arousals.

And here's the basic rationale behind why the sleep doc's don't like to set people up with wide open AUTO ranges that start at 4cm: Most OSA patients need significantly more pressure than 4cm to control their apnea (over half of OSA patients will have a titrated pressure need of 10cm or more). And for the vast majority of patients in this category, starting out at 4cm will allow way, way too many events to occur before the AUTO algorithm manages to increase the pressure to something close to therapeutic levels. So the patient's apnea will NOT be properly controlled and therapy will be ineffective both in terms of treating daytime OSA symptoms and in prevention/minimization of comorbidity conditions. And in addition to that very real medical reason for not wanting patients' machines to be left in AUTO starting at 4cm there's a comfort issue that affects compliance as well: Many (if not most) OSA patients feel as though they are not getting ENOUGH air at very low pressures of 4 or 5cm. And these folks are higher risk of abandoning CPAP if their machine is left starting at 4cm for the long term.
current settings Min EPAP = 4, Max IPAP = 8 and Rise time = 3

8/1/2010 sleep study results:
AHI = 3.9 [AHI = (#OA +#CA + #H w/desat) per hour]
RDI = 23.4 [RDI = (#OA +CA + #H w/desat + #H w/arousal) per hour]
Dx: Moderate OSA
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Posts: 1330
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Location: Buffalo, NY
Machine: PR System One BiPAP Auto
Mask: Swift FX for Her
Humidifier: System One Heated Humidif
Year Diagnosed: 2010

Postby sufferer15 » Wed May 11, 2011 1:25 am

I still can't sleep I keep pressing the ramp button and the pressure gets too high for me to fall asleep
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Postby CrohnieToo » Wed May 11, 2011 7:38 am

1] You are confusing us. First you say you "wake up all the time on the high pressure at 14 min EPAP- it seems ok during the ramp time"
2] And then you say you "can't sleep I keep pressing the ramp button and the pressure gets too high for me to fall asleep"

We can NOT advise you as to what pressures you need. It is up to you to contact your DME provider and your sleep doctor for assistance for this. It is beyond our power to help you out w/the actual pressure needs and settings.
ResScan 3.10 - Resmed S8 ResLink & oximeter
ConTec CMS-50D+ oximeter - Philips EverFlo 5L Oxygen Concentrator
PR SystemOne BPAP Auto w/Bi-Flex & Humidifier - EncorePro 2.2.14.0
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Postby robysue » Wed May 11, 2011 9:54 am

Seconding ChronieToo's comments: You really do need to talk with the sleep doc about your problems getting or staying asleep with the new BiPAP and the new pressure settings.

But one thing I will comment on: It would help us here figure out if USING the RAMP itself might be an issue if you would tell us clearly:

1) How long is the RAMP period?

2) What are the STARTING pressures for your RAMP?

I believe that you are using the PR System One BiPAP. The default RAMP settings on the PR System One BiPAP are IPAP = 6 and EPAP = 4. Since your prescribed therapeutic pressures are IPAP=18 and EPAP=14, a pretty substantial pressure increase is needed to get up to your full pressure settings. It could be that what's keeping you awake is the rate of increase in pressure from 6/4 to 18/14 over the RAMP time. If the ramp time is set to it's maximum setting of 40 minutes, the increase in EPAP is about 1 cm of pressure per 4 minutes of time and the increase in IPAP is a bit greater than that. And pressure increasing at a rate of 1 cm of pressure per 4 minutes of time is pretty noticeable. And if the RAMP time is less than 40 minutes, that rate of increase is even larger, and hence the rate of increase in pressure is even more problematic.

On the PR S1 BiPAP, the PATIENT set up menu allows you to change the INITIAL pressure for the Ramp, but it will not allow you to change the ramp time. So I would suggest that since you were able to tolerate your old straight CPAP pressure, use THAT pressure as the starting RAMP EPAP pressure. This will decrease the total needed increase in pressure, which in turn will decrease the rate of increase in pressure, which may well make it much easier to get and stay asleep.

What was your old straight CPAP pressure?
current settings Min EPAP = 4, Max IPAP = 8 and Rise time = 3

8/1/2010 sleep study results:
AHI = 3.9 [AHI = (#OA +#CA + #H w/desat) per hour]
RDI = 23.4 [RDI = (#OA +CA + #H w/desat + #H w/arousal) per hour]
Dx: Moderate OSA
User avatar
robysue
 
Posts: 1330
Joined: Tue Aug 24, 2010 6:47 pm
Location: Buffalo, NY
Machine: PR System One BiPAP Auto
Mask: Swift FX for Her
Humidifier: System One Heated Humidif
Year Diagnosed: 2010

Postby sufferer15 » Thu May 12, 2011 3:27 am

it was 10 on CPAP. I think I need to increase the ramp time. Should I have my 02 concentrator on 5/5? the other thing is that I wake up with the mask off so maybe I need to duct tape the mask? thanks very much
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Postby sufferer15 » Thu May 12, 2011 4:05 am

the ramp was 20 minutes- so is this disease really lifelong? it won't be better if I lose weight? has my brain and organs been damaged?
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