Finding optimum settings for Respironics System One (60 Series) RemStar BiPAP Auto

[vinitwins]

Hi,

I've bought my dad (72 yrs) a BIPAP machine and the technician has set it up based on his initial sleep tests (he was diagnosed severe SA of around 80!)

I have also installed Sleepyhead to check the daily readings -- the AHI average for the past 7 days is around 9, which seems a little high.

What data do I need to post here, so some of the more knowledgeable members can help me find the optimum settings for the machine?

Some additional information:
Machine: Philips Respironics System One (60 Series) RemStar BiPAP Auto with Bi-Flex
Mode: Auto Bi-Level (Variable PS)
Min EPAP 4.0 Max IPAP 14.0 PS 5.0-8.0 (cmH2O)
Bi-Flex x2

Thanks,
V

[DeepBreathing]

Namaste vinitwins. Welcome to Apnea Board.

Please download and install #SleepyHead software. This will allow you to see in great detail what's happening with your father's breathing throughout the night. You can attach a copy of the daily chart to a post here and we'll try to interpret it and provide some advice. (Remembering of course that we are not doctors, but we have had a lot of practical experience with apnea).

On this page you'll find links to the download page, beginners guide and suggestions for organising the charts to show the most useful information: http://www.apneaboard.com/wiki/index.php...SleepyHead

[Sleeprider]

The settings your dad is using looks like a wide-open guess on the part of the doctor. I'm sure it will be easy to identify a more effective range once we see the data. Please look at the Organize Sleepyhead Charts link in my signature for a tutorial on posting an effective chart.

[vinitwins]

The settings your dad is using looks like a wide-open guess on the part of the doctor. I'm sure it will be easy to identify a more effective range once we see the data.  Please look at the Organize Sleepyhead Charts link in my signature for a tutorial on posting an effective chart.

Thank you for your response.

I tweaked the doctor's settings based on your recommendations in another post by myself last night itself and it helped. So thank you again.

I am posting 2 images:
1) Sleep data for 9th April (machine set by doctor)
2) Sleep data for 10th April (machine set by myself).

I would greatly appreciate your feedback.

Best,
V

[ajack]

I would have min epap 7 and open the max epap or ipap to whatever the max is.
Or if you wish to take it slower, you can have min epap 7 and ipap 18. Depending what pressure your dads needs, he may find wide open too much of a shock. If the machine needs 25cm for example.
I would keep the PS where it is for now.
Either way, this will open the machine up and will give a better idea on settings going forward.

This is the philips titration guide for an overview
https://www.sleepapnea.com/downloads/100...fGuide.pdf

[Sleeprider]

The higher pressure cut the AHI in half compared to previous settings. I think we need to keep moving along this path. Lets move EPAP min to 8.0 and PS min to 4.0. All other settings can remain the same. It is pretty clear your dad benefits from higher pressure support, and still needs the EPAP to keep his airway patent. Respiratory statistics look pretty good, but we are targeting OA with higher EPAP and H with higher minimum pressure support.

[vinitwins]

The higher pressure cut the AHI in half compared to previous settings.  I think we need to keep moving along this path. Lets move EPAP min to 8.0 and PS min to 4.0.  All other settings can remain the same.  It is pretty clear your dad benefits from higher pressure support, and still needs the EPAP to keep his airway patent.  Respiratory statistics look pretty good, but we are targeting OA with higher EPAP and H with higher minimum pressure support.

Thanks for your feedback. 

It's almost his bedtime, and I've set up the machine:
Epap min 8
Ipap max 16
Ps 4 - 8

Will post his sleep data in 8-10hrs.

Best, 
V

[ajack]

That has the machine choked to a max pressure of 16. The IPAP really needs to be lifted.
As sleeprider said, EPAP will need increasing as you go, till the OA resolve.
I was referring to the second chart, where you had a min PS5. I too think your dad needs more than PS3 and may need more than 5. As a floor for tidal volume.

[vinitwins]

That has the machine choked to a max pressure of 16. The IPAP really needs to be lifted.
As sleeprider said, EPAP will need increasing as you go, till the OA resolve.
I was referring to the second chart, where you had a min PS5. I too think your dad needs more than PS3 and may need more than 5. As a floor for tidal volume.

Thanks for the reply. 

I'll post my dad's sleep data in a couple of hours. Hopefully we're on the right track. If needed, I'll increase the IPAP to 18 as you have suggested and the PS to 5-8.

Best, 
V

[vinitwins]

The higher pressure cut the AHI in half compared to previous settings.  I think we need to keep moving along this path. Lets move EPAP min to 8.0 and PS min to 4.0.  All other settings can remain the same.  It is pretty clear your dad benefits from higher pressure support, and still needs the EPAP to keep his airway patent.  Respiratory statistics look pretty good, but we are targeting OA with higher EPAP and H with higher minimum pressure support.

AHI has gone up again. I'm lost again...

Should I now set the machine to:
EPAP: 8
IPAP: 18
PS: 5-8

Await your feedback.

Thanks,
V