Bi-Level Titration Success and How I got there!

Folks:

Thanks to the folks here on CPAP.com along with numerous calls to Resmed, Puritan Bennet, and numerous Internet Searches....I can proudly anounce that I am finally getting proper BiLevel Therapy.

I had a sleep study in late Dec, went home with a new Resmed Activa Mask and My DME sent me a brand new Puritan Bennet GK 425 at my request (A very small compact machine that can be run several nights on 12 Volt DC battery! Great for the outdoor enthusiast hosehead!). I was determined to be a mouth breather, so I needed a chinstrap. I slept great! That is...until the chinstraps started failing, After four differnt chin straps, I decided to get a full face mask.

At that point everything fell apart! I had brain fog, I was tired again, I zoned out at work, I had poor short term memory. I was in dire straights! I have one of those high stress jobs that require you to multi task. You need your brain to fire on all 8 cyllinders or your toast! Work piled up, I worked longer, I got more fatigued each day and my boss was less than pleased.
My boss is one of those that believe that OSA is self inflicted..."just loose some weight an it will probably go away!" Guess what ...I had OSA when I was an athlete, and could never figure out why my workouts sucked the life out of me...overtraining I guess!

At the verge of loosing my job I took matters into my own hands, My DME said I needed another sleep study, and My doctor wanted to give me provigil. I wasn't satisfied with that.....I was doing fine on a nasal interface, but what changed, why did a full face mask change my therapy.

A RT at Puritan Bennet asked...Did an RT from your DME come to your house and synchronize the machine for me? I said.."NO they just mailed it to me in a big box". The RT said, "Go Back to your DME and ask them to synchronize the machine, You need to adjust the IPAP, EPAP sensitivities and RT(Rise Time) to give you full natural breaths. You have symptoms of shallow breathing...you are experienceing Hypopneas!

Sure enough, When I got home I tied both interfaces side by side and realized, The activa Nasal mask gave me nice full chestfulls of air; The full face mask, I got 1/2 way through the inhalation and the EPAP pressure would kick in. I was spending the majority of the night at the low pressure setting!!! I couldn't go back to a nasal interface because I was a mouth breather! Yet my full face mask, wasn't interfacing well with my machine at the default sensitivities!

I called my DME, and told them I need to adjust these settings to which they replied..."Those sensitivity setting numbers mean nothing it's all about the pressure!"

I was at wits end! My job was in jeopardy, I was a zombie and neither my DME nor my doctor was doing anything to help(He just wanted to give me pills!). I was Desparate!

So that's when I took matters in my own hands. I learned how to adjust the darn machine myself! I spent two weeks changing sensitivities and keeping careful data. It turns out that the turbulence inside a full face mask was tricking the machine into thinking I was exhaling before I finished a breath! I needed to lower the sensitivity!

Today....I am at the following settings with a Resmed Ultra Mirage Full Face Mask

IPAP-16 CM
EPAP-12 CM
IPAP sensitivity-7 (on scale of 1-10 where 1 is the most sensitive)
EPAP sensitivity-7
RT(Rise Time)-3 (Is the time it takes to go from EPAP to IPAP pressure. This setting is in Milliseconds, 3=300 milliseconds).

Perfect titration on a Bi-Level machine is not a Gimme....It takes a really good RT to set you up right! Most DME's don't hire the sharpest tools in the shed! I had to be my own RT to get it right!!! I know I got the right settings...My OSA sympoms are gone and now I leave about 1/8" of water in the Heated humidifier tank because I am taking full deep, complete breaths. Before proper titration I left about 1 1/2" water in the tank due to shallow incomplete breathing.

If any of you are experiencing difficulties in BIPAP therapy.....insist on having a good RT look at your equiptment...

Is it synchronized?
Is it delivering the proper pressure?
Is your mask leaking?
Do you have the correct interface for you?
Are you a mouth breather?
How does your mouth breathing and or sleep mechanics comprimising the effectiveness of your treatment?

Keep a sleep log, Go to AWAKE meetings, ask questions, scour the internet....but don't give up! This stuff works when properly used, change up until you get relief....don't give in to drugs right off the bat...doctors just love to give you a pill so you'll go away! Take an active roll in your treatment! Don't be intimidated by arrogant physicians or dopey RT's that work for DME's.

IN the OSA game it's "PATIENT HEAL THYSELF!!!"

Cheers
Joe A

Good for you, Joe A! We do often have to be our own therapists when the DME and/or doctor can't or won't do it. There is sooooo much about this kind of treatment and the more sophisticated machines that they simply do not know - and don't seem to want to take the time to understand. Glad you got your treatment straightened out.

Hey Joe !! That was a fantastic story. Way to go my friend !!

Congratulations Joe. It's stories like these that give me some hope.