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+--- Thread: Tweaking Bilevel (/Thread-Tweaking-Bilevel)
RE: Tweaking Bilevel - Crimson Nape - 07-30-2024
ahuman - It appears that information was probably in some training manual. Feel free to disregard.
- Red
RE: Tweaking Bilevel - ahuman - 07-31-2024
It might be worth trying a small increase in PS, but I did try PS 6 and couldn't sleep with that. Whether I could adjust eventually is unclear, but a PS 6 setting is not common here and seems it would result additional centrals in many users. Where is this information coming from? Just because a machine can do that does not mean that many patients need that. Many are trying to treat UARS or increase comfort by using BiPAP.
I'm open to other suggestions. Possibly it could help to limit the adjustments the machine makes in case that is causing arousals by setting IPAP to EPAP+PS. I'd probably have to compromise then by increasing PS some and trying to set EPAP to an optimized level. What's the best way to approach titrating that? Even if I can get to that, I will occasionally have a lower IPAP than if the machine was allowed to adjust up. Perhaps that doesn't matter?
RE: Tweaking Bilevel - Crimson Nape - 07-31-2024
First, please attach your images here and not use Google. Every link I tried produces a 403 error.
- Red
RE: Tweaking Bilevel - ahuman - 07-31-2024
It must be some setting on your browser. Links work for me (without login) and others have commented on them so links must be working for them.
RE: Tweaking Bilevel - PeaceLoveAndPizza - 07-31-2024
I get a 403 error on the images as well. If I log out of Google I can access it, but I’m always using Google for something, so it will not work having to do so.
For the moment, please do not go changing the PS or other settings without someone here reviewing it. We can help but need to see the data first. Just post them here to avoid the issues.
Here is what I get when trying to access the images…
Error 403 (Forbidden)!!1
[url=safari-reader://www.google.com/][/url]
403. That’s an error.
Your client does not have permission to get URL
Code:
/drive-viewer/AKGpihayOPXqqF6I6F5zgjkJT1ePbXV2XOyrf3RCrAr65BnLm3zviE2fq_TKC994f16msrArfdTEjXK4wQVayrEmriWon-vn3hpyUtY=s1600-rw-v1from this server. (Client IP address: 45.26.12.37)
Forbidden That’s all we know.[/size]
RE: Tweaking Bilevel - ahuman - 07-31-2024
Think this should work...
![[Image: AKGpihaG02c8UHNRvGolDlNXyN-vpaNbOtRdxBXq...1600-rw-v1]](https://lh3.googleusercontent.com/drive-viewer/AKGpihaG02c8UHNRvGolDlNXyN-vpaNbOtRdxBXqnUOF6_T0P9YNvxNrBPxQGNK0dsm5LIlCqD-qbzmTWfIdwwyriWnlRo1yvLmffw=s1600-rw-v1)
RE: Tweaking Bilevel - PeaceLoveAndPizza - 07-31-2024
I logged out of Google and can now access your charts, but it is best to just post them here.
What I notice is that your AHI is excellent, but there are still some arousals. Even as flow limitations occur, your pressure never rises more than 1-2 cmH2O, which tells us things are being handled well by the pressure support.
Another observation is with your TiMax set to 3.5s but your IPAP time never exceeds 1.8s, so there is no reason to increase TiMax beyond 2s. I would set it back to 2s.
If you want to try something for a few days, see if the following helps:
Mode VPAPauto
IPAPmin 9
EPAPmax 14
PS 4
No ramp
Trigger high
TiMax 2.0
That will tell us whether continuing to increase pressure is going to help with the arousals. If not, we will have to consider other things to change.
RE: Tweaking Bilevel - ahuman - 07-31-2024
Sometimes my inspiratory time can be longer which is how I settled on Ti Max 3.5s as somewhere there's a discussion that letting it run longer can help, IIRC, when falling asleep. I can change it back and see.
Did you make a typo with IPAPmin 9 and EPAPmax 14 as the machine has IPAPmax and EPAPmin? Now and then pressure auto-adjusts beyond 14, but I'll give this all a try.
RE: Tweaking Bilevel - PeaceLoveAndPizza - 07-31-2024
Bloody heck. You are correct, I bungled the names. Too little sleep last night watching the Olympics. Mea culpa!
Mode VPAPauto
EPAPmin 9
IPAPmax 14
PS 4
No ramp
Trigger high
TiMax 2.0
RE: Tweaking Bilevel - ahuman - 08-26-2024
Tried those settings and it seems to need more tweaking. Below is an example night. It seems like I've had more trouble falling asleep - could that be from the reduced TiMax?
![[Image: AKGpihYXnlO0IHisk4mCehnv6md1q8mbtBGuNrk8...1600-rw-v1]](https://lh3.googleusercontent.com/drive-viewer/AKGpihYXnlO0IHisk4mCehnv6md1q8mbtBGuNrk8wGNuldXgzDJJP7e5eeoFqa9SEoCgcguhE6ZNnsgXWdmTlCUrMuvpr3aiKNm42kM=s1600-rw-v1)