desensitization!

Friday afternoon I setup a Patient with an ASV unit made by Res Med: Setting were EEP of 10 with a min PS of 5 and a max PS of 10. So in essence the BIPAP starting pressure was going to be 15/10 with no ramp. There is no way anyone can tolerate this type of pressure to start with. So I called the Dr. office and asked if we could implement a DESENSITIZATION protocol on this patient and was granted the green flag. If you are struggling with pressure ask your DR. or DME about this process.

15 at start! Well, actually, that was me, too. I started at a very high level.

But I am by no means a "typical" patient. I was quite determined to make this work, and I just forced myself to deal with the mask. Now I had the usual assortment of leak problems, bruises (from too tight a mask), etc, but pressure wasn't an issue in my case. I did try Ramp at the start, but within 3 days I disabled ramp because I found it hard to exhale when the pressure was low.

I think I was fairly severe at start (I wasn't educated at the time and never got my report).

But I think you did a great job ... for most people going from 0 to 15 is going to be a severe sleep disruption!

Wow, I would have loved to have that opportunity for desensitization.

I started out at bipap of 21/15 along with a bad case of claustrophia from the full face mask.

It's really easy to lay in bed and become fixated on every leak or sound from the mask and machine.

Dave

CPAP101 wrote:Friday afternoon I setup a Patient with an ASV unit made by Res Med: Setting were EEP of 10 with a min PS of 5 and a max PS of 10. So in essence the BIPAP starting pressure was going to be 15/10 with no ramp. There is no way anyone can tolerate this type of pressure to start with. So I called the Dr. office and asked if we could implement a DESENSITIZATION protocol on this patient and was granted the green flag. If you are struggling with pressure ask your DR. or DME about this process.

We have been talking about better education and care for those starting with CPAP. This should have been, should be SOP. Why on earth not? Why do you have to ask? Why not just do?

From a college - From: http://www.smbs.buffalo.edu/pccm/sleep/CPAPacclim.htm

CPAP DESENSITIZATION STEPS

1) Wear the mask at home while awake for one hour each day.

2) Attach the mask to the CPAP device, and switch the unit "on". Practice breathing through the mask for one hour while watching television. reading or performing some other sedentary activity.

3) Use the CPAP during scheduled one hour naps at home.

4) Use CPAP during initial 3-4 hours of nocturnal sleep.

5) Use CPAP through an entire night of sleep.

Advance by one step after each five days, once the step can be carried out without anxiety.

Therapeutic guidance should be provided during outpatient visits to the prescribing clinician.

The pace of treatment is guided by the patient's scheduling preference and by the reported rate of progress.

A couple of more thoughts:

This should be called "xPAP Breathing Reflex Training"
Some of the time should be in bed learing specifically to breath quietly and methods to quiet breathing.
Some of the time in bed should be spent moving to all the likely differant sleeping positions to check hose management and mask fit.
Time should be spent on detecting and preventing hypocapnia and hypercapnia.
Every single patient should be taught all of this every time.

The current 20% able to use CPAP for more than four hours a night at the one year mark can be easily improved indeed!

Todzo wrote:

CPAP101 wrote:Friday afternoon I setup a Patient with an ASV unit made by Res Med: Setting were EEP of 10 with a min PS of 5 and a max PS of 10. So in essence the BIPAP starting pressure was going to be 15/10 with no ramp. There is no way anyone can tolerate this type of pressure to start with. So I called the Dr. office and asked if we could implement a DESENSITIZATION protocol on this patient and was granted the green flag. If you are struggling with pressure ask your DR. or DME about this process.

We have been talking about better education and care for those starting with CPAP. This should have been, should be SOP. Why on earth not? Why do you have to ask? Why not just do?

From a college - From: http://www.smbs.buffalo.edu/pccm/sleep/CPAPacclim.htm

CPAP DESENSITIZATION STEPS

1) Wear the mask at home while awake for one hour each day.

2) Attach the mask to the CPAP device, and switch the unit "on". Practice breathing through the mask for one hour while watching television. reading or performing some other sedentary activity.

3) Use the CPAP during scheduled one hour naps at home.

4) Use CPAP during initial 3-4 hours of nocturnal sleep.

5) Use CPAP through an entire night of sleep.

Advance by one step after each five days, once the step can be carried out without anxiety.

Therapeutic guidance should be provided during outpatient visits to the prescribing clinician.

The pace of treatment is guided by the patient's scheduling preference and by the reported rate of progress.

This could save the insurance companies a ton of money.
Should we be letting this get out?

The hospital clinic where I got treated had everyone on a cpap at 7 for several weeks before titration, just to get them used to wearing it before they did an overnight with it. The DME was useless.

Todzo wrote:A couple of more thoughts:

This should be called "xPAP Breathing Reflex Training"
Some of the time should be in bed learing specifically to breath quietly and methods to quiet breathing.
Some of the time in bed should be spent moving to all the likely differant sleeping positions to check hose management and mask fit.
Time should be spent on detecting and preventing hypocapnia and hypercapnia.
Every single patient should be taught all of this every time.

I've heard one of our sleep pros, JohnBFisher, in a discussion about ResMed's ASV machines. He said (paraphrase) it's virtually mandatory for those ASV patients to learn to control their breathing rate because the machine's 'auto' algorithm logs back several minutes to establish a base respiration rate. Once established, the algorithm compels you to breathe (the V in ASV means ventilation) at that time interval. It obviously adapts to the new appropriate rate when you fall asleep. BTW, I think it's a good idea to focus on your breathing while falling asleep... I consider it almost a yoga type exercise which forces one to clear the mind. Maybe if you're focusing on your breathing those unpaid bills won't get worried over

Sir NoddinOff wrote:

Todzo wrote:A couple of more thoughts:

This should be called "xPAP Breathing Reflex Training"
Some of the time should be in bed learing specifically to breath quietly and methods to quiet breathing.
Some of the time in bed should be spent moving to all the likely differant sleeping positions to check hose management and mask fit.
Time should be spent on detecting and preventing hypocapnia and hypercapnia.
Every single patient should be taught all of this every time.

I've heard one of our sleep pros, JohnBFisher, in a discussion about ResMed's ASV machines. He said (paraphrase) it's virtually mandatory for those ASV patients to learn to control their breathing rate because the machine's 'auto' algorithm logs back several minutes to establish a base respiration rate. Once established, the algorithm compels you to breathe (the V in ASV means ventilation) at that time interval. It obviously adapts to the new appropriate rate when you fall asleep. BTW, I think it's a good idea to focus on your breathing while falling asleep... I consider it almost a yoga type exercise which forces one to clear the mind. Maybe if you're focusing on your breathing those unpaid bills won't get worried over

"Yoga for xPAP Therapy" - I would buy that book!!!

That's a great trick to teach patient's on, YOGA 1,2,3 in 1,2,3, out, pure genius. This is why I love this forum. In this trade its the feed back of the consumer that makes us better technicians. I called my buddy this afternoon, my 72hr follow up call and he expressed to me more comfort now that we were able to lower the pressure opposed to having him start so high. He was a big guy about 375 and an AHI index of 127. With the Res Med unit he is able to press his I button to view his last night report in which he stated has gone to 13. Now its not where I want it to be but it sure beats 127 obstructions an hour. He also stated he had more energy. Its that type of improvement that makes my job worth wile. I love the fact I get to help people for a living. I have scheduled him to come in for a week DL where we will increase pressure by 1cm. My goal is to get him where the Dr. ordered his pressure to be within a month.

CPAP101 wrote:That's a great trick to teach patient's on, YOGA 1,2,3 in 1,2,3, out, pure genius. This is why I love this forum. In this trade its the feed back of the consumer that makes us better technicians. I called my buddy this afternoon, my 72hr follow up call and he expressed to me more comfort now that we were able to lower the pressure opposed to having him start so high. He was a big guy about 375 and an AHI index of 127. With the Res Med unit he is able to press his I button to view his last night report in which he stated has gone to 13. Now its not where I want it to be but it sure beats 127 obstructions an hour. He also stated he had more energy. Its that type of improvement that makes my job worth wile. I love the fact I get to help people for a living. I have scheduled him to come in for a week DL where we will increase pressure by 1cm. My goal is to get him where the Dr. ordered his pressure to be within a month.

What I would love to see is an understanding of breathing stability as affected by xPAP therapy enter the sleep medical community. I think it is why most attempts at using xPAP therapy eventually fail (less than 50% at a year).

15/10? They started me out at 19/13, but that's not on ASV. I also had a ramp, which I don't use any more.
I don't want to focus on my breathing. Last night I couldn't fall asleep because of pain, couldn't think of anything except how much I hurt, so I laid there thinking "Breathe IN... Breathe OUT..." for 20 minutes and I could feel the frustration and panic starting to go critical so off with the mask and sat up reading until I settled down. Still hurt, but I was able to fall into some semblance of sleep for 3 hours...

I like these "desensitizing" steps. I need to go back and do them some more. Say, while I'm thinking about it, I'm most ill at-ease when it's dark. Something about it being night and this thing on my face that sets me on edge. Anybody else feel like that?

John from Brookston wrote: I'm most ill at-ease when it's dark. Something about it being night and this thing on my face that sets me on edge. Anybody else feel like that?

I was ill at ease in the dark when I was a child (I just knew the monster from Forbidden Planet was under my bed). My practical and loving parents bought me a nightlight. No nagging, no psychiatrists, no ADHD drugs or kiddy-downers... problem solved. Sometimes the old ways are the best ways. And for those that are curioius: No I don't still use a nightlight. WTF tho, use one if it helps.

With the modern CPAPs with cell modems, it should be really easy to start at a lower pressure and then ramp up slowly night by night for those who have pressure problems. Unfortunately, "one size fits all" seems to be the standard practice.

Heck, it should be built into the machine itself to allow a doctor to prescribe something like 7 cmH2O, increasing 0.2 cmH2O per night until it reaches 14.

Sir NoddinOff wrote:

John from Brookston wrote: I'm most ill at-ease when it's dark. Something about it being night and this thing on my face that sets me on edge. Anybody else feel like that?

I was ill at ease in the dark when I was a child (I just knew the monster from Forbidden Planet was under my bed). My practical and loving parents bought me a nightlight. No nagging, no psychiatrists, no ADHD drugs or kiddy-downers... problem solved. Sometimes the old ways are the best ways. And for those that are curioius: No I don't still use a nightlight. WTF tho, use one if it helps.

Your parents should have told you the monster wasn't under your bed, it is controlled by your subconscious mind, your ID! For me it was War of the Worlds 1, both are classic sf. Jim