First Night on Bipap-Pretty Rough

[bluemom51]

Hi - Finally received a Bipap after 2 Sleep Studies and many difficulties with the Sleep Doctor and DME.  Was excited to try it, but results were worse than I had hoped. Am also having issues finding a mask that will work and wonder just how much mouth breathing I am doing.  With the Auto S9 I seemed to average around 12-14 pressure with a setting of 9-16 and AHIs of 4-8.  In the 2nd Sleep Study on the Bipap, apneas was very low at about 14-16, so not too much difference.  The 2nd study said "the patient was titrated at pressures ranging from 8/4 cwp - 19/13 cwp."

The doctor that read the study concluded:
"A possible optimal pressure of 14cwp/9cwp was achieved: however supine sleep was not observed. (stayed on right side all night because of the wires-not typical-I move a lot). Due to the patient's Apneic severity while supine (in the first no machine at all study required by Medicare) a fully data capable auto BiPAP is recommended with a maximum IPAP = 25 cwp, a minimum EPAP = 9 cwp, maximum PS = 8 cwp, minimum PS = 4 cwp, Bi-Flex - 3, and heated humidification. A fully data capable auto BiPAP will accommodate for any additional severity the patient might experience in REM sleep and perhaps be more effective in eliminating snoring."

**Met with the Sleep Doctor and she felt the IPAP at 25 was too high, and the prescription she wrote was IPAP = 20, EPAP = 9, and a "pressure adjustment" of 5.  This confuses me because it's different that the sleep study recommendations.
The settings on my machine show: 
Max IPAP - 20
Min EPAP - 9
PS - 5
TI Max - 2.0s
TI Min - 0.3s
Trigger - Med
Cycle - Med

Last night on the machine it shows AHI of 3.9, Total AI of 3.6, and Central AI of 2.2 - I don't know how to correlate that to the Sleephead data of Clear Airway of 4.32, Obstructive of 2.95, and Hypopnea of .53, and an AHI of 7.79?

So some questions if anyone could help:

1 - Other than the IPAP of 20 being less than the study recommendation of 25, are the settings on my machine right based on your experience (I don't know what the Tis, Trigger, and Cycle are) (Also don't know where the "Minimum and Maximum PS" numbers are supposed to be on the machine )
2 - Should I change the IPAP to 25 even though it sounds really high for my history on CPAP?
3 - Should my pressure support be the 3 recommended or the 5 on the prescription or does it matter significantly?
4 - Do the Tis, Trigger, Cycle seem ok?
5 - Do you see any settings that should be changed to in any areas?
6 - I guess it's normal to have some problems switching from an Auto to a BiPAP - at first it felt like I could not breathe and I was hyperventilating and panicking, but I guess I fell asleep off and on - I remember tossing and turning and really struggling.



869FtyVl.png

https://i.imgur.com/869FtyVl.png

My husband and I really struggled with trying to get an image/link on here and I don't know if we ever succeeded in posting what is needed - please advise.  We got lost once the image was in Imgur and how to get the image/link over on the forum - the image kept overwriting the url and it wasn't clear if we needed to edit the url with another .png.  Anyway - we finally did this based on a posting by Sheepish suggesting  a click and copy method.  Let me know what you may need or how best to do it. My husband is great with computer stuff, but was also lost on the last steps as to what is needed - image or link or edited link or...

Thank you so so much if anyone can look at this and make recommendations.  Sorry for the long post, but I wanted to include what the sleep study showed and how the machine was set.  The Auto machines are really simple, but the BiPap at first seems complicated.  I appreciate your time and advice. Feeling lost and overwhelmed.

[ajack]

For a first night, that's not too bad, I can't say much more, I couldn't see much detail for the picture. I will guess and say when the data is clear that an increase in epap may be suggested. The Ti, trigger and cycle are default settings and will probably be ok, there may also be a rise time.

You could download resScan, that is the resmed program. Others may know if there is a glitch with your machine and sleepyhead.

from the top bar of sleepyhead, did you select.. view..take screenshot..then in your computer go to ..documents..sleepyhead date..screenshots..and click on the picture there to upload?
you then click on your name and go to ..images.,,and then copy ...Linked BBCode..that's the one down the bottom of the list.

[bluemom51]

I'm honestly not sure what we ended up doing.  we started with trying to follow the instructions from TNET Sleep Informational Site-Using Imgur to post your Charts, but we got lost on the second half part.  So that's when I found the post from Sheepish that said to right click and copy, and the right click and copy image location (or image address?)

Maybe someone can tell me what is confusing us and how to do it properly - I can get the image from Sleepyhead into Imgur and then we tried the large thumbnail and copy the code thing, and it would put an image on the forum post but it just didn't seem right to me.  I thought it was supposed to end up when something a member could click on and they could enlarge or move around on the image.  I truly have never been so lost with something everyone but me finds so simple and I know that to get help with this new BiPap I need to be able to post from Sleepyhead.  I will keep trying, but any clarification would help. On the instructions it looks like you're supposed to add .png someplace in the link or something.  I just feel like a failure that I can't understand or make this work - I agree it should be so simple....



I went back to Imgur, took a breath, and hit large thumbnail, then the linked bbcode and then copy and pasted it - I really think it may have worked - please let me know.  Glory Hallelujah.  If it worked, it is simple, and we were just overthinking things.

[ajack]

You aren't the first person to have trouble...WE ALL DID...but after the first one is right, it is easy going from there. right click copy isn't needed. when you have sleepyhead open, someone can talk you through it if needed

[trish6hundred]

Hi bluemom51,
Good luck with your new machine.

[Ockrocket]

Rough first night- week- month is not uncommon..

Be reassured that it does get better as you work out the fine tuning of the settings and mask adjustment and so forth. 

In the end it just becomes part of the daily routine of life. 

[ajack]

That second chart was better.
Honestly with the high median tidal volume and low breath per minute, I can't see a reason for PS:5 I would ask the doctor etc if you could change it. Given the number of CA I'd be tempted to have min epap 12 PS:3 (this is 15 and just under your median ipap number) and see if breathing out is comfortable at that pressure. If the CA weren't there in the original study, there is a good chance they will settle down within 12 weeks.

[DeepBreathing]

Hi bluemom51. Bilevel machines have three main pressure parameters:

EPAP (Expiratory positive airway pressure): The pressure applied as you exhale - this is the pressure which splints your airway open
IPAP (Inspiratory PAP): The pressure as you inhale
PS (Pressure support): This is the additional pressure the machine applies over EPAP to achieve IPAP. (EPAP + PS = IPAP).

On your machine you can set the minimum and maximum EPAP, maximum IPAP and PS. Note that PS is a single fixed number - your machine can't vary it during the night. Your machine will start at Min EPAP and adjust it as required in response to events and precursors (such as flow limitation and snoring). As the EPAP goes up, the IPAP will also go up by an equal amount. If you turn on the pressure graph in #SleepyHead you will be able to see how they rise and fall in concert.

Your sleep study report recommended a variable PS which your machine can't provide, which is why your doctor prescribed a fixed PS. I believe the equivalent Philips machine can provide the variable PS.

I can't explain the difference between the results shown on the machine and those given by SleepyHead. SleepyHead doesn't calculate these results, it just receives and reports what the machine tells it, though there is the possibility of errors in the process. Are you using the most current version of #SleepyHead? As suggested above, it might be worth downloading ResScan and comparing the results (though ResScan is not a very user-friendly program). Given the discrepancy in results, I would be reluctant to recommend any changes, but if the SleepyHead results are correct then lowering the PS should have a beneficial effect on the central apneas. Increasing EPAP minimum should reduce snoring and obstructive events.

For your SleepyHead charts, you should turn on the pressure graph, and turn off AHI, Time at Pressure, Resp Rate and Tidal Volume - that will make things easier to read.

[Walla Walla]

I agree with ajack on dropping your Pressure Support (PS) to 3cm. I think the reason you may have different data readings is you need to set the ResMed Aircurve. Go to clinic settings and scroll down to reports than set to one day. To access the Clinic menu the round button on the front at the same time you push the home button which has the house painted on it. Hold it for 3 or more seconds and the clinic menu should pop up. Also from the Clinic menu you can set the PS setting under therapy.

[ajack]

I would check with the doctor, but I think it's reasoned. It is different for me to suggest lowering, It seems lately all I'm saying is increase it