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Bart
Unread post  Post subject: Dreamstation BiPAP autoSV Therapy settings  |  Posted: Wed Jun 05, 2019 10:43 am

Joined: Wed Jun 05, 2019 10:35 am
Posts: 20
Location: Pacific NW - dry climate - Elevation 5100'
PAP Mask: Philips Respironics DreamWear
PAP Machine: Philips Dreamstation BiPAP autoSV
Humidifier: Philips Heated Humidifier

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I suffer a significant amount of aerophagia and am wondering if you can help me figure out better settings on my BiPAP. Current settings under Therapy on the actual unit are: OptiStart ON, Pres 17.0, EPAP up 12.0, EPAP down 8.0, PS up 7.0, PS down 0.0, BPM 14, Ti 1.0. I have attached a screenshot of last night's SleepyHead results. Any insights you can offer would be greatly appreciated. Thanks, Bart


Attachments:
Last Night BiPAP.pdf [328.09 KiB]
Downloaded 49 times
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diamaunt
Unread post  Post subject: Re: Dreamstation BiPAP autoSV Therapy settings  |  Posted: Wed Jun 05, 2019 10:14 pm
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Joined: Wed Mar 02, 2016 2:26 am
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Location: Dallas(ish)
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Do screenshots like this:

http://www.cpaptalk.com/wiki/index.php/ ... d:Organize

_________________
Sleepyhead Info
How to format your charts


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Bart
Unread post  Post subject: Re: Dreamstation BiPAP autoSV Therapy settings  |  Posted: Thu Jun 06, 2019 6:38 am

Joined: Wed Jun 05, 2019 10:35 am
Posts: 20
Location: Pacific NW - dry climate - Elevation 5100'
PAP Mask: Philips Respironics DreamWear
PAP Machine: Philips Dreamstation BiPAP autoSV
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I have added an updated screenshot


Attachments:
screenshot-20190606-073400.png
screenshot-20190606-073400.png [ 138.66 KiB | Viewed 3486 times ]
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Pugsy
Unread post  Post subject: Re: Dreamstation BiPAP autoSV Therapy settings  |  Posted: Thu Jun 06, 2019 8:02 am
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PAP Mask: Bleep/DreamPort nasal mask
PAP Machine: ResMed AirSense 10 AutoSet for Her
Humidifier: ResMed AirSense 10
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Hmmm...Settings reported don't quite match up. Obviously the minimum EPAP is 6 and not 4.

Turn off OptiStart for one thing.

You need more pressure...either in the form of EPAP or IPAP but more pressure is likely going to feed that aerophagia monster.

If it was me I would probably just add more minimum PS and see if consistent higher IPAP (epap plus PS) helped reduce those hyponeas (assuming that they are obstructive in nature and not central).

General rule of thumb...more EPAP for OAs and more IPAP for hyponeas.

I would change PS minimum of 0.0 to 4.0....the machine seems to want to do that anyway...and see what happens.

Did you actually have an in lab sleep study done using the ASV machine to get an idea what to use or did they just pull some numbers out of the hat?


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Bart
Unread post  Post subject: Re: Dreamstation BiPAP autoSV Therapy settings  |  Posted: Thu Jun 06, 2019 10:21 am

Joined: Wed Jun 05, 2019 10:35 am
Posts: 20
Location: Pacific NW - dry climate - Elevation 5100'
PAP Mask: Philips Respironics DreamWear
PAP Machine: Philips Dreamstation BiPAP autoSV
Humidifier: Philips Heated Humidifier

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The "Machine Readings" in SleepyHead do not match the "Therapy" settings in my BiPAP. I'm not sure why that is.

Last night I adjusted the settings, as follows, and experienced very little aerophagia.
ON OptiStart
20.0 Pres
10.0 EPAP up
6.0 EPAP down
6.0 PS up
0.0 PS down
14 BPM
1.0 Ti

I really appreciate your response and insights. I am now adjusting the settings based on your advice. I also learned from your advice that IPAP = EPAP + PS. I didn't know how IPAP was determined before your comment.

OFF OptiStart
20.0 Pres
10.0 EPAP up
6.0 EPAP down
6.0 PS up
4.0 PS down
14 BPM
1.0 Ti


Yes, I had an overnight "in lab" sleep study. I then met with the MD sleep specialist once and a technician set the original settings of the BiPAP based on her recommendations:
23 Pres
13 EPAP up
13 EPAP down
10 PS up
4 PS down
1.0 Ti

I could not even use the BiPAP with her original settings. I would be in severe gut pain after a mere hour of putting the mask on and was unable to fall asleep. There were no appointments available with the sleep specialist for another 6 months out and I had to prove compliance within 2 months so I discovered I could leave the BiPAP on and the mask shoved under a pillow and somehow this worked for proving compliance. Every night I would try to acclimate to the original settings, but always ended up taking the mask off and shoving it under a pillow so I could go to sleep. 2 months later I took my card into the sleep specialist's office and had a technician read the card to prove compliance.

I exchanged multiple secure written communications with the sleep specialist's office, but they were unable to offer any advice or allow settings to be changed before having another appointment with the MD sleep specialist. I basically gave up and started changing the Therapy settings myself in an effort to get to a point where I could tolerate the BiPAP. By month 4 I was able to sleep up to 6 hours with the mask on. I started having dreams and more restful sleep. Month 6 I finally had an appointment with the MD sleep specialist, but she canceled and I was left meeting with a nurse and 2 technicians in a group appointment instead. They were pissed that I changed the settings and attempted to humiliate me in front of the other patients. I shut them down politely and firmly by stating that my care is my responsibility and that they are there for me and not the other way around. I then asked them what a patient is supposed to do when they cannot use the machine and cannot get an appointment for 6 months. They calmed down when they found all the other patients looking at them with irritation on their faces. They then gave me new settings that I have used for the past year. Only now am I finally realizing I should go further and try to optimize my settings for best results and optimal comfort.


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Pugsy
Unread post  Post subject: Re: Dreamstation BiPAP autoSV Therapy settings  |  Posted: Thu Jun 06, 2019 12:03 pm
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Joined: Wed Aug 02, 2017 8:01 pm
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PAP Mask: Bleep/DreamPort nasal mask
PAP Machine: ResMed AirSense 10 AutoSet for Her
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Pressure Setting: Depends on the machine as I actually have more than one

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SleepyHead has a known bug in reporting of the machines settings in some situations. It used to tell me that my humidifier was disconnected and it most certainly was connected and in use. Just a software bug.
Ignore it.
I don't know if they got that bug fixed in OSCAR or not (it is based off SleepyHead 1.1).
You can try it if you wish
https://www.sleepfiles.com/OSCAR/

Since you did have an in lab titration those original suggested settings probably did do a good job. Unfortunately they also invited the aerophagia monster to come and set up residence and he is a nasty house guest to have to deal with.
It would have been nice if your medical care team had acknowledged the problem and taken steps to try to reduce the problem that aerophagia brings...but they dropped the ball.

Sometimes we have to make compromises.....maybe use a little less pressure (and let maybe a few apnea events slide) so that a person can actually get some sleep and decent enough therapy without all the belly issues. You are having more hyponeas than I would want to let slide if it were me....at least without trying a minor change to see if we get lucky and maybe easy and simple works. Sometimes miracles do happen.

When you make any changes....make only one change at a time.
That way you know what the results are tied to.
Remember Science 101 ...keep your variables to a minimum so you know which change caused what result.

Minimum PS of 4 is a common enough setting for these machines.
That's why I say try easy first. Sometimes it works. If it doesn't we regroup and see what else we can try.


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Pugsy
Unread post  Post subject: Re: Dreamstation BiPAP autoSV Therapy settings  |  Posted: Thu Jun 06, 2019 12:06 pm
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Joined: Wed Aug 02, 2017 8:01 pm
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PAP Mask: Bleep/DreamPort nasal mask
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When you get a chance you might take a look at this document.
http://www.isetonline.org/yahoo_site_ad ... 190318.pdf
if you haven't seen it already

It's sort of the guideline that the techs use when doing the in lab titrations.
The monkey in the wrench is that they can't factor in the aerophagia monster coming for a visit. They are only going for the apnea related prevention stuff.
It may help you understand the "whys" behind some of this stuff.


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Bart
Unread post  Post subject: Re: Dreamstation BiPAP autoSV Therapy settings  |  Posted: Thu Jun 06, 2019 2:41 pm

Joined: Wed Jun 05, 2019 10:35 am
Posts: 20
Location: Pacific NW - dry climate - Elevation 5100'
PAP Mask: Philips Respironics DreamWear
PAP Machine: Philips Dreamstation BiPAP autoSV
Humidifier: Philips Heated Humidifier

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I installed OSCAR and am reading through the PDF you recommended. I've wondered if my hypopneas have increased due to nasal congestion. At one point I had an AHI averaging below 6. My favorite mask is the nasal cushion, but it is less effective when congested.

Thank you for your insights. I look forward to making progress and hopefully moving my AHI downwards.


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Bart
Unread post  Post subject: Re: Dreamstation BiPAP autoSV Therapy settings  |  Posted: Sat Jun 08, 2019 9:15 am

Joined: Wed Jun 05, 2019 10:35 am
Posts: 20
Location: Pacific NW - dry climate - Elevation 5100'
PAP Mask: Philips Respironics DreamWear
PAP Machine: Philips Dreamstation BiPAP autoSV
Humidifier: Philips Heated Humidifier

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I've used the new setting for a couple of nights and experienced no aerophagia. I read through the article your provided and am finally feeling like I can get more serious about this. My goal is to get my hypopneas down now. What would you recommend changing next? From what little I've learned, my best guess is I should raise the PS up a little bit at a time until I start having aerophagia problems or I reach 10.0 (I'm assuming there is no point to >10.0 unless I raise the 20.0 Pres).

On a separate note, I'm not having much luck with Oscar or SleepyHead in the past few days. Neither seems to import any data from the past 3 days since the first time I used either of them successfully. I did a "rebuild CPAP data" this morning and it still shows the last time I used my machine was 3 days ago when I have used it every night including the past 3 days.

OFF OptiStart
20.0 Pres
10.0 EPAP up
6.0 EPAP down
6.0 PS up
4.0 PS down
14 BPM
1.0 Ti


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Pugsy
Unread post  Post subject: Re: Dreamstation BiPAP autoSV Therapy settings  |  Posted: Sat Jun 08, 2019 4:42 pm
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PAP Mask: Bleep/DreamPort nasal mask
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Humidifier: ResMed AirSense 10
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Wish I could see the most recent reports. Need to see what kind of events are still happening.
Try creating a new user profile and importing and see the the data is there.


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Bart
Unread post  Post subject: Re: Dreamstation BiPAP autoSV Therapy settings  |  Posted: Sat Jun 08, 2019 5:38 pm

Joined: Wed Jun 05, 2019 10:35 am
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Location: Pacific NW - dry climate - Elevation 5100'
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Creating another profile worked. The screenshot is attached.


Attachments:
screenshot-20190608-183624.png
screenshot-20190608-183624.png [ 149.42 KiB | Viewed 3430 times ]
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Pugsy
Unread post  Post subject: Re: Dreamstation BiPAP autoSV Therapy settings  |  Posted: Sat Jun 08, 2019 7:21 pm
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Try 1 cm more EPAP minimum and 1 cm more PS minimum and see how thing go with OA and hyponea reduction and hopefully the aerophagia monster stays away.


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Bart
Unread post  Post subject: Getting AHI Down  |  Posted: Sun Jun 09, 2019 6:59 am

Joined: Wed Jun 05, 2019 10:35 am
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Location: Pacific NW - dry climate - Elevation 5100'
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Changed the settings for last night and here are the results

OFF OptiStart
20.0 Pres
10.0 EPAP up
7.0 EPAP down
6.0 PS up
5.0 PS down
14 BPM
1.0 Ti


Attachments:
screenshot-20190609-075644.png
screenshot-20190609-075644.png [ 143 KiB | Viewed 3404 times ]
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Bart
Unread post  Post subject: Getting AHI Down  |  Posted: Sun Jun 09, 2019 7:36 am

Joined: Wed Jun 05, 2019 10:35 am
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Location: Pacific NW - dry climate - Elevation 5100'
PAP Mask: Philips Respironics DreamWear
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Forgot to mention no aerophagia last night.

I do wake up congested each morning. Where I live the air is dry and I'm at an elevation of 5,100'. I'm going to include other settings in case it matters.


Attachments:
5.jpg
5.jpg [ 306.02 KiB | Viewed 3404 times ]
4.jpg
4.jpg [ 445.14 KiB | Viewed 3404 times ]
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Pugsy
Unread post  Post subject: Re: Dreamstation BiPAP autoSV Therapy settings  |  Posted: Sun Jun 09, 2019 7:55 am
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Joined: Wed Aug 02, 2017 8:01 pm
Posts: 1298
PAP Mask: Bleep/DreamPort nasal mask
PAP Machine: ResMed AirSense 10 AutoSet for Her
Humidifier: ResMed AirSense 10
Pressure Setting: Depends on the machine as I actually have more than one

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What humidity setting are you using?

For tonight try adding another 1 cm to minimum EPAP.
Leave PS alone for tonight.
Adding to minimum EPAP forces IPAP up by default.
Trying to go slow and not cause the aerophagia monster to show up.


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Bart
Unread post  Post subject: Getting AHI Down  |  Posted: Sun Jun 09, 2019 9:19 am

Joined: Wed Jun 05, 2019 10:35 am
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Location: Pacific NW - dry climate - Elevation 5100'
PAP Mask: Philips Respironics DreamWear
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Humidifier: Philips Heated Humidifier

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3 FLEX
Adaptive HUMIDIFICATION
off MASK TYPE
15 TUBE TYPE


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Pugsy
Unread post  Post subject: Re: Dreamstation BiPAP autoSV Therapy settings  |  Posted: Sun Jun 09, 2019 12:44 pm
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Joined: Wed Aug 02, 2017 8:01 pm
Posts: 1298
PAP Mask: Bleep/DreamPort nasal mask
PAP Machine: ResMed AirSense 10 AutoSet for Her
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Pressure Setting: Depends on the machine as I actually have more than one

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If you are waking up with more nasal congestion than you go to bed with it may be that you need to adjust your humidity settings.
I don't know how much "adaptive" is in terms of relative percent but you might try a little more humidity or a little less by taking it out of auto/adaptive mode and changing it to manual selection.

Sometimes too much or too little humidity will actually make nasal congestion worse. Since people are individuals and not everyone will want more or less ...this is something each individual as to sort out for themselves.


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Bart
Unread post  Post subject: Re: Dreamstation BiPAP autoSV Therapy settings  |  Posted: Mon Jun 10, 2019 5:53 am

Joined: Wed Jun 05, 2019 10:35 am
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Location: Pacific NW - dry climate - Elevation 5100'
PAP Mask: Philips Respironics DreamWear
PAP Machine: Philips Dreamstation BiPAP autoSV
Humidifier: Philips Heated Humidifier

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Things are improving. I sure like the downward trend in hypopneas. Congestion was a bit less with taking adaptive humidification off and setting it to a level of 3.

20.0 Pres
10.0 EPAP up
8.0 EPAP down
6.0 PS up
5.0 PS down
3 Humidification

OFF OptiStart
14 BPM
1.0 Ti
OFF Mask Type
3 FLEX
15 Tube Type


Attachments:
screenshot-20190610-065035.png
screenshot-20190610-065035.png [ 132.76 KiB | Viewed 3372 times ]
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Pugsy
Unread post  Post subject: Re: Dreamstation BiPAP autoSV Therapy settings  |  Posted: Mon Jun 10, 2019 8:17 pm
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PAP Mask: Bleep/DreamPort nasal mask
PAP Machine: ResMed AirSense 10 AutoSet for Her
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Try 1 cm more minimum EPAP.
See what happens.


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Bart
Unread post  Post subject: Re: Dreamstation BiPAP autoSV Therapy settings  |  Posted: Tue Jun 11, 2019 6:46 am

Joined: Wed Jun 05, 2019 10:35 am
Posts: 20
Location: Pacific NW - dry climate - Elevation 5100'
PAP Mask: Philips Respironics DreamWear
PAP Machine: Philips Dreamstation BiPAP autoSV
Humidifier: Philips Heated Humidifier

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I experienced aerophagia last night and woke up in pain around 3a. I tried to power through it, but ended up taking the mask off around 5a I think.

20 Pres
10 EPAP up
9 EPAP down
6 PS up
5 PS down
3 Humidification

OFF OptiStart
14 BPM
1 Ti
OFF Mask Type
3 FLEX
15 Tube Type


Attachments:
screenshot-20190611-074338.png
screenshot-20190611-074338.png [ 139.96 KiB | Viewed 3330 times ]
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