How to get prescribed Bipap?

palerider wrote: ↑

Mon Mar 19, 2018 10:07 pm

USMCVet wrote: ↑

Mon Mar 19, 2018 9:39 pm

I'm confused. Are you saying my current tidal volume is not low? I haven't been able to find something that specifically tells me what it should be during sleep . I have seen the ventilation guides which may not reflect what I should actually have.

I have been peeking at others tidal volume on here and most seem to be higher then mine.

What I'm saying is that you don't know what you're doing, and you're liable to end up causing yourself problems because you're going about things wrong.

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

Thank you that helped a lot. I would be remissed however if I did not point out the incorrect information in the video lol. Around 5 minutes and 45 seconds he says that ipap of 8 and epap of 6 = pressure support of 3. Think his math is off on that one!

On serious note though..... Ok I may or may not need a Bipap for tidal volume if it's confirmed I have restrictive issues and to help tidal volume. However thinking I could use it to increase oxygenation by lowering epap to reduce leaks is not accurate. So most likely I'll have to find a new mask of I can't make my current one work. Going to talk with RT tomorrow about trying a strap to see if that helps.

Thanks again for the informative video I appreciate the learning experience.

I don't 'need' a BiPAP but I got one anyway. The advantage for me was that I could have more control of my exhalation pressure and be more comfortable when exhaling. It has worked very well and brought my AHI down even further.

USMCVet wrote: ↑

Mon Mar 19, 2018 10:31 pm

Ok I may or may not need a Bipap for tidal volume if it's confirmed I have restrictive issues and to help tidal volume.

*IF* it's confirmed that you have restrictive issues, then you may benefit from a *RESMED* (not respironics) aircurve 10 vauto machine, because they have breath shaping settings that can be adjusted to give you more time to inhale, thus getting the air into your lungs.

From the titration manual:

Patients with restrictive lung disease have a difficult time maintaining the inhalation phase long enough to ensure adequate tidal volume and gas exchange. This can be caused by a physical restriction of the lungs or by neuromuscular weakness.
The recommended settings use a low cycle sensitivity and a longer Ti Min time to provide a longer inhalation time to help increase tidal volume and gas exchange.

Depending on the nature of my lung diagnosis, I might even push for iVAPs (ResMed) or AVAPS (the other guys).

https://www.resmed.com/us/en/healthcare ... tions.html
https://philipsproductcontent.blob.core ... 48a27d.pdf

Sometimes our asking for the machine just beyond what we hope to get now will allow the docs/payers room to negotiate a fall-back option that will still meet our present needs but that will get a discussion going about future testing. That may allow info to be put into our files involving mention of something specific about what machine we may need at some point in the future, just in case. It's a system, so it sometimes has to be worked.

I can't comment on the complexity of your wanting to help with tidal volume. Others with more experience would need to help with that.

I can only give my reason for upgrading to BiPap. For me I was on a ResMed APAP doing fairly well but I noticed that I was spending most of my time in the high teens if not hitting the machine's upper limit of 20. My AHI was averaging in the upper 3's to as high as 8 or 9 on bad nights.

I went to my doctor with the request of getting a BiPAP to raise that ceiling of 20 a little higher since BiPAP's can go to 25 pressure. I'm now averaging in "pressure" high teens and almost never hitting 25 but only going as far as 23.5 some nights. My AHI averages are now under 1 with 2's and 3's for bad nights which are fewer then before.

I had to jump through a bunch of hoops and I had already done my home work as to why I wanted BiPAP and what I expected to get from changing to that type of machine. Doctor was hesitant at first wanting to tell me that I was doing fine with my current machine but I wanted to see if I could do even better.


If you feel you need to change your type of machine make sure your using your current machine to it's fullest as far as it's options. If your using it now as a fixed machine you'll want to set it to Auto and give your self a small window of variability to see if that improves your situation before you try and jump to a BiPAP.

BiPAP also gives you the option to adjust the amount of time you get to inhale before it drops pressure. I think 2 seconds is default for most machines... I found that to be a bit too quick and the sudden drop in pressure while I was still breathing in was disturbing and was driving me nuts. Adjusting that setting helped with that issue. Only tweak it a little bit till it feels comfortable. Baby steps.

That's my opinion anyway. Try also using the exhalation relief on your current machine as well and see how that effects your numbers.

Wish you well.

Take care, Gryphon

palerider wrote: ↑

Tue Mar 20, 2018 7:47 am

USMCVet wrote: ↑

Mon Mar 19, 2018 10:31 pm

Ok I may or may not need a Bipap for tidal volume if it's confirmed I have restrictive issues and to help tidal volume.

*IF* it's confirmed that you have restrictive issues, then you may benefit from a *RESMED* (not respironics) aircurve 10 vauto machine, because they have breath shaping settings that can be adjusted to give you more time to inhale, thus getting the air into your lungs.

From the titration manual:

Patients with restrictive lung disease have a difficult time maintaining the inhalation phase long enough to ensure adequate tidal volume and gas exchange. This can be caused by a physical restriction of the lungs or by neuromuscular weakness.
The recommended settings use a low cycle sensitivity and a longer Ti Min time to provide a longer inhalation time to help increase tidal volume and gas exchange.

I already know that won't be given to me IF I even needed it. My VA is only resperonics.

I do know my gas exchange efficiency was something like 94% which is good.

I guess I'll find out soon enough and should stop thinking about it until then.

Gryphon wrote: ↑

Tue Mar 20, 2018 8:12 am

If you feel you need to change your type of machine make sure your using your current machine to it's fullest as far as it's options. If your using it now as a fixed machine you'll want to set it to Auto and give your self a small window of variability to see if that improves your situation before you try and jump to a BiPAP.

I was on auto with great numbers but not so great oxygenation so that's why the put me to CPAP after titration study.

I definitely want to be as informed as possible though and I do appreciate all the information being shared.

USMCVet wrote: ↑

Tue Mar 20, 2018 8:13 am

I guess I'll find out soon enough and should stop thinking about it until then.

Having a hard time with this part?

To fix a problem you first have to identify the problem and your problem has yet to be identified.

Pugsy wrote: ↑

Tue Mar 20, 2018 8:32 am

USMCVet wrote: ↑

Tue Mar 20, 2018 8:13 am

I guess I'll find out soon enough and should stop thinking about it until then.

Having a hard time with this part?

To fix a problem you first have to identify the problem and your problem has yet to be identified.

I'm very motivated lol so it's hard for me to wait on things lol. I'm trying to work on it though LMAO. First step is admitting I have a problem lol

USMCVet wrote: ↑

Tue Mar 20, 2018 8:36 am

First step is admitting I have a problem

I could easily spend hours trying to figure out whether I'm overthinking things or not.

An AHI under one is considered very good. If it's 0.5 or less, it's excellent. If your blood oxygen is too low at night, you might want to look for a cause other than SDB.

Since your machine is an automatic, you could try setting a min of 8 and a max of 12. However, your readings are so good, that there's little room for improvement.

Ok back from RT appointment.
He said my mouth breathing could be from dry nasal passage since it's winter. Suggested I change settings . Currently tube heat set at 0 and humidity at 5. Suggested bumping heated tube to 2 and see if that helps.

He said my leaks aren't bad with average leak rate of 35 but admitted sleep centers probably like it better under 25 but my numbers look good so leak doesn't matter.

I saw that he had my results from latest testing so I went to release of information and grabbed copy.

Impression is mild restrictive lung disease. So honestly no idea what that means but think I am probably a bit young for that. Looks like maybe I'm just in the mild category??

I don't know what this stuff means.

No significant change. A good thing. Especially with anything mild.

I am glad there wasn't a big change.... They were two weeks apart.

Here are the things that I guess worry me most.
RV/TLC was 37% of predicted
RV was 28% of predicted
FRC was 54% of predicted

USMCVet wrote: ↑

Tue Mar 20, 2018 8:13 am

I already know that won't be given to me IF I even needed it. My VA is only resperonics.

Respironics won't work, their bilevel machines don't have the settings you need to accommodate restrictive lung disease.