BiPap: Possible to Have Too Much Air?

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Katalin

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My 87 year old mother just got her BiPap machine four days ago. Therapist set it up for her, and the rental unit relays info by wifi to the therapist's office, and he can control it remotely. She felt like it was blowing air too harshly into her lungs over the weekend, and I asked him to dial it down for her today. She seemed to tolerate it better...the three or four times she's used it, it seems to induce deep relaxation, and today, after the pressure was lowered, she fell quickly into a good sleep, for about 50 minutes. She looked, while she was sleeping, like she was breathing sort of normally. When she woke up, she felt very disoriented and "out of it", and said it was too much. She only had about 10 minutes on the previous few days. Any thoughts? Is it too much BiPap too fast?

Thanks...

Kathy
 

lgelb

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Yes, indeed, Kathy, in helping PALS here I have found that often initial settings are too high, or some other variable is off, like a too-high backup rate that triggers when it's not needed; trigger/cycle settings that make breathing too fast, slow, long, short...well, you get the idea.

Of course, it's also possible that her settings are fine and she hasn't really gotten used to the machine yet.

I will send you a PM so you can send me info about her settings if you want to fine-tune them, either in discussion w/ the RT or DIY. That will also entail unlocking detail view so you can see what is happening with her breathing while using the machine.

Everyone should know how to control the machine, anyway, not only for coughing/choking, but to adapt to progression. Remote monitoring is treating numbers, not people, and is especially questionable in ALS.

Best,
Laurie
 

Katalin

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Thanks Laurie, I can send you info by PM on email after I talk to my mother, and get down to her machine to provide more info. It does seem like she's maybe breathing a bit faster than she normally does. And I agree, it does seem kooky to adjust this from remote. I was curious myself to see what it felt like. I place the mask over my nose/mouth, exhaled, then was shocked at the blast that came through on the initial setting. Will write tomorrow morning. I feel like one of those plate spinners on the Ed Sullivan show!

https://www.youtube.com/watch?v=Zhoos1oY404
 

WeirdTim

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In my personal experiences, a BiPAP is the same pressure each and every breath weather you need it or not. The new pulmonologist I hired last year got me an AVAP machine because my levels were to good for Medicare or supplemental insurance to cover a Trilogy.

The AVAP has the feature of being able to set highs and lows but then it automatically adjusts pressures based on individual needs.

Was a game changer for me as the BiPAP was causing me to hyperventilate in certain situations. That means putting your body under stress which is never good regardless if it is physical or mental stress. The AVAP has been great for almost a year now. Along with it and my medication, my breathing has not progressed since being on AVAP!
 

azgirl

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I much prefer avapp that I use at night to trilogy I use during day for portability. Laurie was extremely helpful in getting my settings comfortable!
 

lgelb

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Tim, BiPAPs come in various flavors, some including volume support (VAPS). As Kathy and I determined, her mom has an ST type that does not have a VAPS option, and I did recommend that she press for that. So it is not that BiPAP is inadequate, it just depends on the type.

Apart from possible use with a trach, the Trilogy is essentially a portable AVAPS BiPAP. It has no special features beyond that applicable to most PALS, and arguably, as azgirl points out, a less smooth algorithm than less powerful machines. It is just a lot more expensive, because of the internal battery and form factor, so reimbursement is more strict.
 
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Katalin

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Hi all, just a quick update: my mother did wind up having a new machine delivered with IVAP, which responded to her respiration, without having a fully fixed rate and volume. She was able to tolerate it better, but she only had it for a day before she passed away. I think it would have been a great thing for her.

<Memorial thread here>
 
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