I've been prescribed what I consider an unreasonably high expiratory pressure for my Bipap machine- for one who is a hypoventilator, has a high blood gas level (PCO2), and was determined to be an extremely light breather after my pulmonary function test. I believe I'm not able to overcome the high expiratory pressure and my exhaled carbon dioxide is being blown back into my lungs due to the high pressure.

My prescribed settings after my most recent sleep study are 13/11. My understanding is that the minimum difference on Bipap is 4cm, and the maximum difference is 10cm. My Bipap machine is the Respironics Auto M. Working with a tech at my DME, I've taken it out of auto mode to work with the settings. I can see the AHI on the display for the last seven or thirty days, but don't believe the machine senses my carbon dioxide levels. It also has a smart card, but the software is unavailable to the public, as far as I know.

I just don't see the advantage to having a high expiratory pressure at all. I don't want much pressure when exhaling. How can I collect data at different expiratory pressures to determine what works best? I know I've felt clearer since dropping the pressure, but can't determine what is the current best expiratory pressure for me.

The local medical community seems to believe that as long as I've been "titrated" that the job is done. I think I've been poisoning myself with my own carbon dioxide for a long time now.

So are you experiencing difficulty exhaling?  Also, when did you start your bipap and have you had a followup visit with your doctor?
If you're having any difficulty with exhale, call your doctor.    It may be that's what worked during your titration but you need greater exhalation relief at other times.  You might even want to discuss an auto bipap with your doctor.

You can always have your local DME print out the results of your smart card.  You may have to call and schedule it.


Linda

I see you do have an auto BiPAP..I have the same machine.  Often one has apneas that are also happen on the exhalation..could be the reason for the higher EPAP.  Usually the EPAP is a 3cm or 4 cm below IPAP.

 The best way to gauge things is your AHI reading and leak rates.  You can ask your DR to have the EPAP lowered..but I also believe you have the BiFlex feature too which I have on mine.  That dropps the end of the inhalation down about 3cm per setting..not exactly but around there.

NO, AN Xpap will not give you O2 or your CO2 levels...

What makes you believe you are rebreathing?  What is happening?


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BiPAP Auto M 13/8 Mirage Nasal Swift. 20 years+ undx'd. RLS/PLMD, Hypersomnia & more.

What makes me think I'm rebreathing is that it is difficult to exhale against the 11cm prescribed in the sleep study, and the pulmonologist didn't want to lower it despite my initial request. I also feel much improved with a lower exhalation pressure. I've been dropping it a .5cm per nite and am now down to 4.5cm. and holding there. I wasn't aware that apneas can occur on exhalation too.

So much of this is subjective and eludes hard data. Someone said that "Without data, I'm just another person with an opinion" I can watch my seven day average, which would begin to move in either direction. If I had access to the software to read the Respironics Auto Bipap M, it would be clear on a nightly basis, but I can go to the DME periodically to have them read the card - although the knowledge level varies a great deal depending on what technician I get. I had tried to have a tech explain the different settings, and this is the first explanation I've heard concering Biflex dropping the pressure down 3cm or so at the end of the inhalation. All the manual says is that Biflex "increases comfort".

I did take the machine out of Auto mode as it  just wants to push the exhalation pressure higher. I know there is a great debate on whether a patient should have control of their own machine, but I've had little but trouble (like many others)trying to get to a solution through the usual channels.

I did check the leak rate for the Ultra Mirage full face I use, and it was within the parameters given.

Thank you for the information provided. I'm still trying to elude the knife and the UPPP.

The smart card reader and Encore Viewer software is available to the public.  (Encore *Pro* is not.)  I believe the Encore Viewer software will read your machine's data, but I'm not certain.  Plaease verify that before purchasing, as these items aren't cheap.

Blessings,
--pseudonym

It is not exactly 1cm per setting on the BiFlex..but that is about the best rule of thumb.  What is it giving you for AHI readings?


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CLICK HERE FOR MORE INFO~ http://tinyurl.com/69q52a

BiPAP Auto M 13/8 Mirage Nasal Swift. 20 years+ undx'd. RLS/PLMD, Hypersomnia & more.

After lowering my expiratory pressure considerably to 4.5cm, my 7 day AHI has increased from 10 events per hour to 16 events. Apparently I've dropped it too far, and had no awareness that pressure may be necessary to hold the throat open to exhale also. I'll begin to take it back up and see what happens to the 7 day average. I've begun charting it to see where the lowest number of apneas is.

 I hope that lower AHI figures are consistent with a sense of improved restfulness. I've been reminded there's a difference between clinical sleep and restful sleep. Mornings are the worst and if I can get going, the rest of the day begins to ramp up. Before Bipap, things were the same all day long.

 I will look further into the software, but understand there is a large difference between owning the software and being able to use it effectively. Like others, I will be so happy to get to a non-invasive solution to the SA issue.

Duplicate post

This is why we do not advocate people treating themselves and instead suggest that if you feel your physician is incompetent or unresponsive you find someone who you can work with.  If you find a good doc., then they really are the experts and you will get better care.

Maybe your doc. had a good reason for using APAP mode, maybe not, but did you ask about her/his rational for that choice?  Personally, I do better in CPAP mode too and my doc. hates APAPs.

You would only be rebreathing if your BiPAP was off, your mouth was closed and the anti-asphyxiation ports were blocked.  You have a constant flow of air that is blowing off the CO2.  That is why pressures which are set too high for someone cause central apneas.  One signal to breath is increased levels of CO2, if the pressure is too high, the CO2 is blown off and the brain doesn’t get another signal to breathe until the CO2 goes back up or the O2 drops.

Vicki


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That which does not kill you makes you stronger-Friedrich Nietzsche
Friedrich must of had apnea.

I see this happening all the time on here..questioning the Dr settings.  I think that since those of us who need to know how everythng works.. to fully understand something, are not being satisfied with our Dr's 'non' explanation...or lack of detail..it would probably be very hard for them to go through a long explanation especially when it may confuse matters more for many people..(which I have also seen on here)..or open a can of worms.  I have had similar situations in business when  I learned from those cans of worms..to K.I.S.S. it.  Unfortunatley there were many that would have benefited from the knowledge..I found waitng to see if there were any questions then, I would talk only on the level of the questions that were presented to me.

  I have a very hard time when someone says..don't ask questions..just do it.  I also have found that over my time of being on xPAP, I can see how I was unable to 'intelligently' communicate with my Dr due to not knowing enough about SA..I thought I knew all about it..but still continue to learn and usually read something new every week or so..that I didn't know before....or, the information allows 2 and 2 to be added correctly for me...and things from the past now make sense.


_________________

CLICK HERE FOR MORE INFO~ http://tinyurl.com/69q52a

BiPAP Auto M 13/8 Mirage Nasal Swift. 20 years+ undx'd. RLS/PLMD, Hypersomnia & more.