Bipap on the way,now what

[Hornnumb2]

Ok now that I have the 960 on the way, i am trying to get my attack plan together. I am going to start with the pressures in the Phillips titration guide. How many days before I should check the results in SH before making any changes? Any other things I need to worry about at first? Thanks Michael

[LSAT]

The pressure should be set based on what your titration says. Don't be so excited about changing pressures...you might not need it. Be concerned about wearing the mask and using the machine. IF you are comfortable with your mask and are sleeping with the unit, then you can start diagnosing your report and possible make adjustments.

[Hornnumb2]

The only titration that I had was on cpap that failed, so I will be winging it on pressure.

[Sleeprider]

From the titration guide, we know that the EPAP Min needs to be sufficient to stop most obstructive apnea. Pressure support is added for hypopnea and RERA. From what I have seen of your data, OA is not a very prevalent problem, and you can expect to start with EPAP MIN at 6.0 and EPAP Max at 11.0, and allow the auto algorithm to adjust pressure. You could start with EPAP as low as 4.0, but you do have some OA from the studies, so the 6.0 is to keep those from showing up, and leaving plenty of room for the machine to auto-adjust.

Set max pressure to 25 to allow the machine to operate in its full range to address centrals. PS Min at 4.0 should be comfortable and allow PS MAX of 18, which is wide open (EPAP+PSMax =Max Pressure) to deal with the numerous centrals. The machine will only use what is needed to provide control of hypopnea and RERA, but may rapidly increase pressure during centrals to induce a breath.

This is a starting point, and you are going to want to review nightly, but only take corrective action to settings where there is a clear purpose to doing this. For the time being set Breaths Per Minute at Auto. These are fairly wide-open settings and you can expect to see opportunities to narrow things down and address comfort as you gain experience and data. I'll look forward to input from Pugsy and others that have more direct experience with these machines to see if they have some more or different ideas.

Hey, good luck and it's great you took the initiative to take this in hand. I would not hesitate to try to consult with your sleep doc about his recommendations for starting. He has kind of been absent from the process, but you never know he might step up.

Edit to add: what are you going to do for a mask interface? Just curious if you have decided on a direction for that.

[Hornnumb2]

I got a few different ones from grayghost also to try. Pilario Q, Amara View and mirage fx(what I had in the sleep study) I will see how it goes

[Hornnumb2]

I also had a question about bathroom breaks, do I just unhook hose from face piece? Do I need to turn machine off or it just runs until hooked back up. I want to thank the group as you have been very helpful getting me through this without much help from my doctors.

[Sleeprider]

The good news is, if this works, your nocturia, might be a thing of the past. I recommend hitting the control knob to turn off the unit. I didn't mention Ramp, but with these settings you can just turn it off or not exceed 5 minutes. It's much easier to turn the machine off, since the machine will record a disconnect as a large leak and distort your data. The choice is yours whether to remove headset or disconnect at the coupling. I have never left the mask on, but I use nasal pillows.

[ChicagoGranny]

I also had a question about bathroom breaks, do I just unhook hose from face piece?

That's one good way to do it.

What people should not do is take the mask off. You then have to put it back on, and you may have trouble adjusting it. When you do get up, you want to have the least activity possible so you don't become wide awake and have trouble falling back to sleep.

[Hornnumb2]

The good news is, if this works, your nocturia, might be a thing of the past. I recommend hitting the control knob to turn off the unit. I didn't mention Ramp, but with these settings you can just turn it off or not exceed 5 minutes. It's much easier to turn the machine off, since the machine will record a disconnect as a large leak and distort your data. The choice is yours whether to remove headset or disconnect at the coupling. I have never left the mask on, but I use nasal pillows.

Wow didn't know that word, had to look it up. Learn something new every day!

[klv329]

Probably need to become familiar with all of the settings for that machine. System Resistance to match mask type, rise time to your liking, BPM usually set to auto but can be timed, ramp, various pressure settings, etc... May have to experiment some.

Know thyself. keep good daily notes of events, wake ups, external factors affecting sleep, how you feel at wake up and how you feel in the afternoon and evening so you can relate a 'morning feeling' to a quality of therapy (and daytime demeanor). Tough to keep track of external factors because you are asleep. Many people observe the 'no food for 3 hours before cpap time' if you have indigestion. Use software and backup profile data periodically. Data is good!

And ask all these good xpappers on this website to help ya' out 'cause xpappery is a complicated trade!

Edit: And get a back up machine when you can.

[Hornnumb2]

Well it came in the mail today, hopefully I will be on it tonight. Should I check the SH report every day or give it a week? Thanks Michael

[Pugsy]

You are going to want to check the report daily...or at least I know I would so why not?
Besides...you need to at least evaluate leaks

[palerider]

Well it came in the mail today, hopefully I will be on it tonight. Should I check the SH report every day or give it a week? Thanks Michael

personally, I'd check it every day, because I'm curious, but I wouldn't obsess about it, or start fiddling right away, unless things looked really crap.

[Pugsy]

I agree with Palerider...I would check it but not worry so much about the data unless things were really horrible and with the suggestions that were given to you I don't see much that might need a lot of adjustment unless it ends up being the minimum EPAP because of the obstructive events are just way too numerous.

First order of business is simply getting you to sleep decently with the mask and machine...worry about fine tuning once you get some good solid hours of sleep to evaluate.

Good luck tonight.

[Sleeprider]

You're on the right track... good luck. The machines are pretty complex, but seem to do pretty well for most people with complex apnea. There is however a period of time to get used to the new feel. You've come a long way to do this without a lot of help from the sleep clinic.