2007 Sleep Study

Guest · Post by **Guest** » Sat May 12, 2007 3:49 pm

Thanks, SAG. I was only interested in the Hoffstein Calculation because LittleMo said they used it as a STARTING pressure if it would save time and I was interested in what the HC might come up with.

I just got a Resmed S8 Vantage and am not impressed w/the 4 cms to 20 cms suggested by my sleep pulmo. Turns out my Vantage is subject to Recall so "we've" been discussing what range of pressure to try when my replacement comes in. My current straight CPAP pressure is 8 cms. I had been thinking 7 cms to 11 cms. Of course, I'll give my sleep pulmo the final say but that doesn't mean I can't nose around and have some suggestions or questions of my own.

Guest · Post by **Guest** » Sat May 12, 2007 3:55 pm

LittleMo, if you were able to lower a patient's pressure by 4 cms just by changing them from full face mask to a nasal mask, do you think it was just due to the full face mask leaks or do you think they might have been a bit mis-titrated as well? Its rather surprising that mask leaks could make THAT much difference in pressure needs. Makes one wonder what the devil kind of leak rate were they coming up w/each morning!!!

StillAnotherGuest · Post by **StillAnotherGuest** » Sat May 12, 2007 4:31 pm

Slinky - Guested wrote:I just got a Resmed S8 Vantage and am not impressed w/the 4 cms to 20 cms suggested by my sleep pulmo.

Yeah, I wish he'd wipe that 20 cmH2O idea out of his mind, too. Even tho the chances of high-pressure CPAP-induced pneumothorax are very remote, that considers all comers. If somebody walks in and says, "Yeah, I had one of those", but still ends up with an unnecessarily wide-open high limit, I mean, what's the point? Why risk it, theoretical or not?
SAG

rested gal · Post by **rested gal** » Sat May 12, 2007 5:15 pm

pemoha wrote:Are those the numbers you're talking about?

Yes, thanks.

On page 1 ... where I have the first arrow drawn to the words "Auto Bi-Level with Bi-Flex", what words does yours say there?

Also on page 1, where my next arrow is drawn to point at the number "20" and I labeled it "Max IPAP", what number is shown there on yours. And what number is shown on yours for the "8" on mine (labeled "Min EPAP")? Those red arrows and red labels I drew on mine won't be on yours, of course.

pemoha · Post by **pemoha** » Sat May 12, 2007 5:49 pm

It says
Avg flex setting: 3, last setting: 3
Auto-Bi-Level with Bi-Flex

Max Ipap 20

Max Epap 4

Guest · Post by **Guest** » Sat May 12, 2007 6:02 pm

hi slinky,

It could be a combo of different reason's but one of the common things I come across is that pt's seem to need a higher pressure to combat snoring with the full face, thus could lead to over titration when the initial is done in a lab
I think we have to consider the reservoir on a full face. I've spoken to ResMed reps about this and they tend to agree with me, maybe thats cause i'm scarier in real life than on a website!!!!

the lab i work in, we much prefer to get a pt's on a nasal mask, most people with untreated OSA will mouth breath, it's part of the symptom, but once they start treatmnet most ( not all ) do well on a nasal and there's no need to go to a full face.

Slinky · Post by **Slinky** » Sat May 12, 2007 7:17 pm

LIttleMo, do you ever suggest to your nasal mask mouth breathing patients that they tape or PoliGrip their lips shut? Or do you leave it at suggesting a chin strap? The tape and PoliGrip suggestions seem to be more effective than the chin straps.

Do you have patients who improve considerably on CPAP who use nasal masks or nasal pillows who reach a plateau w/therapy due to not being able to get their mask leak rates lower than the 60s-80s range? How do you get THEIR AHI down to 5 or less?

And thank you, SAG. I did have one pneumothorax treated in the early 80s and have every reason to believe I had had two prior to that. None since. But I do have blebs and bullae on my lungs. That has been my biggest objection to and question about the 4 cms-20 cms range.

2007 Sleep Study

Lose the 20 cmH2O

Re: 2007 Sleep Study

2007 Sleep Study