CPAP to BiPAP transition and pressure settings

[ttodd]

HI - I was having some "Clear Airway" events as well as some general tolerance issues with my CPAP after about 8 months of use with the CPAP.  Doctor suggested that I try the BIPAP saying that both these issues might be addressed by the BIPAP.

With the CPAP - My pressure settings were previously set for 6-12 with an EPR Level of 3.  Most of the night the pressure would stay somewhere between 6 and 8, rarely did it creep up much above 8 or 9.  I let the doc know that these higher pressure settings were very difficult to tolerate for me and she thought too that the higher settings could be contributing to the CA events.

Now that the BIPAP, I see that the setting starts at 6, but I guess with the nature of BIPAP vs CPAP, there is a higher setting for the inhale vs exhale.  So the 6 is corresponding to my exhale setting and it goes up to 10 for my inhale.  

So before where I used to be at a steady pressure setting, now I'm bouncing back and forth between a 6 and 10.   I think that this is making things worse.   

My question is (and I'm still waiting to hear back from doc and or respiratory therapist on this), should that old pressure level of 6 be matched up with the inhale setting on the BiIPAP rather than the exhale setting?  So in other words rather than currently having 6 for exhale and 10 for inhale, should I be 2 for exhale and 6 for inhale?

I was originally told that the BIPAP would make it easier to exhale.  So still having this setting of 6 for my exhale doesnt seem an improvement.   And now having the additional pressure up to 10 is causing mask leaks.

Thanks

[PeaceLoveAndPizza]

Please post some charts from your machine past and present. It is best to make recommendations based on actual data, and there are nuances in the OSCAR charts that are best seen.

I am not quite sure without seeing data how a bilevel would be more tolerable for you with the same settings as a CPAP. Rather than guess, lets review your current data and see what makes sense.

[ttodd]

Hi - Thanks for getting back so quickly.   I'll try to gather this data, but in the meantime - just to clarify, I wasn't so much looking for feedback on whether or not the BiPap vs CPAP was needed.   I was just looking for general recommendations on the pressure level and whether or not these corresponding pressure levels make sense.

When discussing the possibility of transitioning to BiPap - the way the doctor explained it was with the CPAP you have a constant pressure of 6 (inhale and exhale).  With the BiPap - it lowers the pressure on your exhale making it easier to exhale.  Well this kinda makes sense to me - so far so good.

The supplier gives me the machine and once I turn it on and observe the pressure settings I see that I am at 6 for exhale and 10 on inhale.  Yes there is a difference the exhale is indeed lower than the inhale.  However the level of 6 is exactly where I was at before.  To me, it would make sense that this exhale number should be LOWER than the 6.   Is my thinking correct here?

[SarcasticDave94]

Regardless of whether the question is "do I need BPAP or CPAP" or if it's "what pressures are correct", the response still is we'll be better equipped to help when we see OSCAR charts. We could just guess, but it's far faster and much more accurate with data to base answers and directed pressure edits.

Most cases BPAP (bilevel) is a better therapy, unless the diagnosis was Central based. If my interpretation of your settings is accurate, exhale EPAP is 6, while inhale IPAP is 10, this makes PS 4. That may be too much differential and increasing CA. But right now we're still at the guessing game.

You may want to include the detailed diagnostic report. It should tell about your Apnea, which shapes what your settings and correct machine ought to be. And yes you need this report, even if it's never shared and sits in your sock drawer for 20 years collecting dust. This report proves need of therapy, and things happen to reports. So you need your report as a data backup. In the US, HIPAA permits your request, so pull that card if doc refuses to supply it.

And 6-10 isn't a very high pressure spread. Mine was 7-25.

[PeaceLoveAndPizza]

There are many differences between the Autoset and Vauto. EPR and PS are only one of them in that EPR is a drop in pressure for EPAP and PS is an increase in pressure for IPAP. Simply put, with EPR if your IPAP is 9 with an EPR of 3, then your EPAP is 6 (9-3=6). On a Vauto if your EPAP is 6 and PS is 3, then your IPAP is 9 (6+3=9).

It sounds like your bilevel came set up for an EPAP min of 6 and PS of 4, which means IPAP is 10 to start. Without any data to support this starting point, it seems a reasonable place to begin.