Need Help Understanding BiPAP Clinical Settings

[Jake B]

Hi all, I just recently started BiPAP after failing at CPAP (see previously threads if necessary.) Long story short: CPAP made me feel twice as worse even though all my numbers were good... switching to BiPAP doesn't necessarily make me feel as bad, but I haven't had much relief yet however I feel I'm on the right track. My main issue now is central apneas - I had AHI of 10 last night which is very high for me compared to in the past. Since starting BiPAP I've been anywhere from 2-10.

My question is about the clinical settings on my machine and what might help correct this. My resp. therapist wasn't much help, I won't see my physician for a while (but I doubt they'd help much either), and the clinical manual isn't clear to understand.

So what can anyone tell me about the below settings and what might be best?

-My pressure is at 14/10
-Easy Breathe - default at On
-Ti Max -  default at 2.0
-Ti Min - default at 0.3
-Trigger - default Med
-Cycle - default Med
-Any other settings that might be useful?

Edit: hopefully this makes sense... Let me know if I need to provide any more info. I had to quickly write this out due to trying to multitask while working.

[Crimson Nape]

Without viewing a Daily screenshot in OSCAR, it is next to impossible to speculate on your settings.  Please install OSCAR on your computer and provide us with a screenshot.  Look at my signature for added help along these lines. The download link is at the top of the screen and I've provided it here, https://www.sleepfiles.com/OSCAR/. Please do not download it from any other source.

[Sleeprider]

It appears you are using your Aircurve 10 Vauto in fixed pressure mode (S). If you switch to Vauto mode, you can enjoy lower and variable pressure. I'd rather look at a typical OSCAR chart before making a recommendation, but in Vauto mode you will set a minimum EPAP pressure, PS of 4.0 and a maximum pressure. This will define the auto range.

[Jake B]

Without viewing a Daily screenshot in OSCAR, it is next to impossible to speculate on your settings.  Please install OSCAR on your computer and provide us with a screenshot.  Look at my signature for added help along these lines.  The download link is at the top of the screen and I've provided it here, https://www.sleepfiles.com/OSCAR/.   Please do not download it from any other source.

Added screenshot.

It appears you are using your Aircurve 10 Vauto in fixed pressure mode (S). If you switch to Vauto mode, you can enjoy lower and variable pressure.  I'd rather look at a typical OSCAR chart before making a recommendation, but in Vauto mode you will set a minimum EPAP pressure, PS of 4.0 and a maximum pressure.  This will define the auto range.

The fixed pressure is what the doctor prescribed after titration so that's what I have gone with.

[SarcasticDave94]

Was there any sleep study data posted? You have almost all CA on the BPAP S Mode. I say we need to see the sleep study, as I'm suspecting we may see CA on that test. More info if/when we see that test data.

[Jake B]

Was there any sleep study data posted? You have almost all CA on the BPAP S Mode. I say we need to see the sleep study, as I'm suspecting we may see CA on that test. More info if/when we see that test data.

I do have the study, I will have to go through it to pull out the pertinent info and scan it to my computer.

[SarcasticDave94]

OK that'd be very helpful to see this. Please redact your personal info.

[Sleeprider]

Jake, trust me. You have central apnea from too much pressure support. If you don't want to use the advice, don't ask for it. Just sayin' a titration is not going to necessarily pick up on the problem you are having because central apnea is consistently inconsistent and may or may not occur during the titration period. You need different settings, and I'm trying to tell you your EPAP and pressure support are both too high. We can make you more comfortable and significantly lower your AHI, but not if you're going to stick with what your doctor told you.

When you're ready, so are we.

[Jake B]

Jake, trust me. You have central apnea from too much pressure support.  If you don't want to use the advice, don't ask for it.  Just sayin' a titration is not going to necessarily pick up on the problem you are having because central apnea is consistently inconsistent and may or may not occur during the titration period.  You need different settings, and I'm trying to tell you your EPAP and pressure support are both too high.  We can make you more comfortable and significantly lower your AHI, but not if you're going to stick with what your doctor told you.

When you're ready, so are we.

So which settings are going to be most beneficial? I just know my doctor is going to wonder why I've been changing around all the settings, but I'd like to try anything that will help me feel better.

[Sleeprider]

Your are at 15/10 (PS 5) pressure. We want to go to Vauto mode and see how you respond to lower pressure. A conservative start is:
Mode: Vauto
EPAP min 8.0
PS 4.0
IPAP max 15.0
Trigger Sensitivity: High

This brackets your current prescribed pressure but drops the pressure support. It will reduce your AHI. The trigger sensitivity is a setting your doctor and clinic know nothing about. It causes your machine to trigger IPAP sooner, and often reduces CA events by stimulating a breath.

It's always easier to explain why you made a change when it results in a positive therapeutic response and solves a problem. That is what you will do.