High Titration Value?

Gordyp · Post by **Gordyp** » Sat Apr 14, 2007 8:26 am

Hi, folks, I'm new here so please bare with me if I ask or say something stupid. Frankly, this is a whole new experience for me.

I have a lot of questions, but for now I'll try to stick with one subject at a time.

My symptoms were daytime drowsiness such as falling asleep while reading or at the computer. I've never dozed off at the wheel, thank goodness, but I knew the demands of long distance driving had changed a lot for me. I became nervous about driving.

It was a shock the next day, when after my sleep study, the doctor told me that although he had not fully processed the data, I had serious sleep apnea. Something like 45 interruptions/hour and a titration value of 19 cm/H20.

I'm trying the M series with C-flex and using an ultra mirage full face mask. This equiptment is on a one month trial. My humidifier heating setting is on #3.

It's been over a week now and although the 40 min ramp time helps, I generally wake up with serious abdominal bloating. The good news is that I can now read for two hours in the morning without dozing off!

My question is this: Is this titration value unusually high, and if so, should I wait a month or so and have it re-evaluated. Should I ask my doctor for a print out of the full results. Like many physicians or specialists, I get the impression he feels I'm not qualified to understand the data. Actually, I'm a trained chemical research technician, and although it's been some time since I worked in the lab, I'm very computer literate.

Any feedback would be appreciated.

Cheers, Gordyp.

Nitro Dan · Post by **Nitro Dan** » Sat Apr 14, 2007 8:32 am

We are all different. The pressure depends on the severty of the obstruction. My comfort zone is 18 to 20 cm. Been that way for over 20 years now.

SelfSeeker · Post by **SelfSeeker** » Sat Apr 14, 2007 8:58 am

Gordyp,

Welcome to the world of OSA and all that it entails.

You shold always get a copy of your sleep study and the titration study. Whether you can read it or not. Also a copy of your prescription, can be used to buy a machine.

You need to tell the doctor about the abdominal pain. The pain is caused by air you swollow.

Are you using the CFlex option set 1, 2 or 3. Check the top screen of your machine.

Some people with high pressures like yours do better on a Bi-Pap machine becasue they can use a lower exhale pressure.

Catnapper · Post by **Catnapper** » Sat Apr 14, 2007 9:14 am

Hi

Welcome to cpaptalk.

I have only recently acquired my M series auto bipap, so I am no expert about it or much of anything else. However, if I had pressure that high I would want the additional exhale relief of the bipap just in general, and in particular to help with the abdominal bloating. I believe the bloating might qualify you for bipap at that pressure, but your doctor will decide that one. The great thing about the auto bipap is that if you don't need that very high pressure all the time, you will have the pressure you need anyway, and it can be substantially lower. Some people have found that the titration pressure has not been the optimal pressure over time, too.

When it comes time to get the bipap, if you get one, notice that the M series auto and the non-auto are exactly the same price from the manufacturer. Make sure your DME does not give you the one that is not auto because of price. They can be tricky with things like that.

As for the software and understanding it, I don't think it is too hard to get the basics. People here will be glad to help if you need it. The basic information is very helpful, and really contributes to my therapy to know that it is working, even though some of the results are slow to appear for me. At least I know the AHI is great and the leaks are satisfactory, which means that I should see improvement over time.

Good luck to you.

Catnapper

Gordyp · Post by **Gordyp** » Sat Apr 14, 2007 9:39 am

Hi,
Thanks to everyone who has responded to my questions.

The therapist who leased me the CPAP machine set it up for me and didn't give me a manual, so I don't know how to change the C-Flex setting, although I'm sure I can figure it out. What would be a good setting with the Remstar Pro M series to help with my bloating problem?

The Specialist suggested a CPAP machine to try first and probably would let me buy a BiPAP machine, although I have no insurance and would have to pay for it myself. This is a hard call, because once I buy the CPAP machine I'm kinda stuck with it. He most definately won't prescribe an APAP machine. He says he doesn't like them.

I'll get my family doctor to have the Specialist send the results and the prescription. That's probably a good way to proceed.

Thanks again,

Gordyp.

Catnapper · Post by **Catnapper** » Sat Apr 14, 2007 9:51 am

I think that the specialist is not the one who is going to use the machine for several years. The auto can be set to straight cpap, so it is really up to you. Check prices here at cpap.com before you buy from the local DME. The auto can also help you find the best pressure in the more natural sleep setting of your own bed. The lab sleep study is only a snapshot of a few hours, where the auto can check your progress over many nights. I like the idea of more data to make a better informed decision. I wonder why the doctor doesn't like the auto.

Lots of people who have insurance choose to purchase out of pocket to avoid the issue of dealing with the DME which in some cases can be a nuisance.

kteague · Post by **kteague** » Sat Apr 14, 2007 11:54 am

Hi. Since you are paying for a machine outright, get what you believe will best serve you in the long run. It may be easier to just get the machine of your choice online. If for any reason you choose to stick with who you are working with, ask him to price match since you are private paying, and see if his reduction is significant. When I was going to get some nasal pillows at my local DME, the quoted price was over $60 but the cpap.com price was less than $20. Of course I ordered online. Later I had a conversation with the manager at the DME provider and she said if I had spoken up, they would have given me a lower private pay price (didn't say how much lower). But apparently they would have let me pay the $60+ if willing. Just do your homework.
Kathy

SelfSeeker · Post by **SelfSeeker** » Sat Apr 14, 2007 12:05 pm

For a Bi-level machine you need a bi-level rx.

I copied this from CPAP.com

Someone just posted what the requirements are for his insurance requirements for a Bi-level being Rxed/covered. I can't remember who it was.

BiPAP

Contains one of the following words or phrases "BiPAP", "BiLevel", "VPAP"
Contains your physicians contact information
Contains your physicians signature
Contains your inspiration pressure (Also called IPAP Pressure or Breathing In pressure)

Example: IPAP 13 CM/H20
Example: IPAP 13
Example: IPAP 4 CM/H20
Example: IPAP 4
Contains your expiration pressure (Also called EPAP Pressure or Breathing Out pressure)

Example: EPAP 13 CM/H20
Example: EPAP 13
Example: EPAP 18 CM/H2O
Example: EPAP 18

Back to Question Back to Top Ask A Question

--------------------------------------------------------------------------------

BiPAP Auto

Contains one of the following words or phrases "BiPAP", "BiLevel", "VPAP", "BiPAP Auto"
Contains your physicians contact information
Contains your physicians signature

rested gal · Post by **rested gal** » Sat Apr 14, 2007 1:04 pm

Gordyp wrote:I have no insurance and would have to pay for it myself. This is a hard call, because once I buy the CPAP machine I'm kinda stuck with it. He most definately won't prescribe an APAP machine. He says he doesn't like them.

I'll get my family doctor to have the Specialist send the results and the prescription. That's probably a good way to proceed.

Gordy, I have no insurance either. I'm not a doctor, but if it were me faced with a prescribed pressure of 19 and was having painful aerophagia (bloating) at that pressure, I'd go to my family doctor (not the Specialist who "doesn't like autopaps") and ask my family doctor to write an Rx this way:

BiPAP
IPAP 20
EPAP 10
bi-flex 3
PS 8
Ramp off

I'd send a copy of that Rx to cpap.com and order myself this specific machine -- the Respironics BiPAP Auto with Bi-flex and heated humidifier. Either version of it... M series or non-M series.

That one machine will give you the best of both worlds, imho. Auto-titrating to find the varying pressures you might need throughout the night AND the comfort of a BiPAP machine's pressure drop throughout the entire exhalation.

If the family doc doesn't want to write the Rx and wants to leave all that to the "Specialist", then I'd ask the Specialist for an Rx for a bipap machine with whatever IPAP/EPAP settings the Specialist deems fit...you can always change the settings later yourself.

I'd use the Specialist's bipap Rx to still go straight to cpap.com and order that same machine: Respironics BiPAP Auto with Bi-Flex and heated humidifier.

That machine can be used as just a BiPAP or as a BiPAP with the auto-titrating feature enabled. It can even be used as a straight CPAP, for that matter.

Yes, 19 is a whopping big pressure to have coming at you, especially when you try to exhale. I love C-flex at my usual pressures of 8 - 12 or so, but I've experimentally tried some straight high pressures just to see how much relief C-flex could give me at very high pressure. From 15 on up, C-Flex can't make much of a dent in it for me. That would be different for different people, of course, depending very much on the natural force of each person's exhalation.

My hat's off to Nitro Dan not only for being able to take extremely high pressure with cpap at all, but especially for doing straight cpap like that for the past 20+ years!!! Talk about a pioneer and a dedicated user! Dan, you're amazing. Do you laugh and roll your eyes at us wimpy ones?

Gordy, check your PMs...button at upper right of this page.

Snoredog · Post by **Snoredog** » Sat Apr 14, 2007 1:42 pm

rested gal wrote:
Gordyp wrote:I have no insurance and would have to pay for it myself. This is a hard call, because once I buy the CPAP machine I'm kinda stuck with it. He most definately won't prescribe an APAP machine. He says he doesn't like them.

I'll get my family doctor to have the Specialist send the results and the prescription. That's probably a good way to proceed.
Gordy, I have no insurance either. I'm not a doctor, but if it were me faced with a prescribed pressure of 19 and was having painful aerophagia (bloating) at that pressure, I'd go to my family doctor (not the Specialist who "doesn't like autopaps") and ask my family doctor to write an Rx this way:

BiPAP
IPAP 20
EPAP 10
bi-flex 3
PS 8
Ramp off

I'd send a copy of that Rx to cpap.com and order myself this specific machine -- the Respironics BiPAP Auto with Bi-flex and heated humidifier. Either version of it... M series or non-M series.

That one machine will give you the best of both worlds, imho. Auto-titrating to find the varying pressures you might need throughout the night AND the comfort of a BiPAP machine's pressure drop throughout the entire exhalation.

If the family doc doesn't want to write the Rx and wants to leave all that to the "Specialist", then I'd ask the Specialist for an Rx for a bipap machine with whatever IPAP/EPAP settings the Specialist deems fit...you can always change the settings later yourself.

I'd use the Specialist's bipap Rx to still go straight to cpap.com and order that same machine: Respironics BiPAP Auto with Bi-Flex and heated humidifier.

That machine can be used as just a BiPAP or as a BiPAP with the auto-titrating feature enabled. It can even be used as a straight CPAP, for that matter.

Yes, 19 is a whopping big pressure to have coming at you, especially when you try to exhale. I love C-flex at my usual pressures of 8 - 12 or so, but I've experimentally tried some straight high pressures just to see how much relief C-flex could give me at very high pressure. From 15 on up, C-Flex can't make much of a dent in it for me. That would be different for different people, of course, depending very much on the natural force of each person's exhalation.

My hat's off to Nitro Dan not only for being able to take extremely high pressure with cpap at all, but especially for doing straight cpap like that for the past 20+ years!!! Talk about a pioneer and a dedicated user! Dan, you're amazing. Do you laugh and roll your eyes at us wimpy ones?

Gordy, check your PMs...button at upper right of this page.

I agree, the GP can use his PSG findings for making the DX and RX that is what my GP did.

20yrs on the hose? No insurance? Get a Bipap Auto, buy the thing any way you can but get the Auto version, you can run it in any mode you want and worst case you set it wide open and let it take care of things on its own.

Go here and print out the Bipap Auto information, read it you will probably know more than your doctor.

http://bipapautomseries.respironics.com/

and if they balk at that just say "look you little whipper snapper, I've been on the machine longer than you have been a sleep doctor..." That gets them every time and the chances of that being true are like 98:1

Gordyp · Post by **Gordyp** » Sat Apr 14, 2007 8:03 pm

Hey, everyone,

Thanks a bunch!. My family doctor is really great, so I think I'll let him sort this out. The information here is very good so I'm sure we'll do what is necessary and right..

It looks like I may need a BiPAP Auto with Bi-flex and heated humidifier. When it's averaged out per week it's not too bad a price to pay.

Thanks, Gordyp.

Moogy · Post by **Moogy** » Sat Apr 14, 2007 8:53 pm

My advice is to absolutely avoid ANY machine that has a top pressure of 20. If you are at 19 now, you may need 20+ in a year or two. This happened to my sister--she is stuck with a machine that only goes to 20, even tho she suspects she may need a higher pressure now.

Most straight cpaps top out at 20. The Respironics Auto Bipap tops at 25, and I believe there may be some machines that go to 30.

I also vote for an auto bipap. If you adjust well to the auto feature, you can spend much of the night at a lower, more comfortable pressure. If for some reason you do better with straight cpap mode, that is also available on the auto bipap.

Moogy

Linda3032 · Post by **Linda3032** » Sat Apr 14, 2007 9:18 pm

This is the bundle (machine, humidifier, software pkg) that you should get. Your DME can't match this price, and can't/won't sell you the software. Also, cpap.com provides you with all the manuals.

https://www.cpap.com/productpage-bundle.php?BundleID=46

Gordyp · Post by **Gordyp** » Sun Apr 15, 2007 9:03 am

Hi,

Thanks to everyone for your advice. This is a great site and I'm glad I found it.

I think this thread has some good information to offer so I'm now going to follow up on the links. It seems clear what needs to be done now and I'll let you all know how it goes.

All the Best, Gordy.

High Titration Value?

High Titration Value?

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