At-home study

[OnTheCouch]

I am in desperate need of having my BiPAP therapy re-titrated. As a confirmed DIYer, I'd prefer to do it myself, but am reluctant to go messing with the settings, even if I were able to figure out how to get into them. (I didn't mind self-adjusting my machine when I was on standard CPAP therapy, but BiPAP seems a little more complex.)

Unfortunately, I've got a 4K deductible on my current health insurance policy, so I'm going to be bearing the entire cost of a study on my own, which is tough. Since at-home studies are so much more affordable, does anyone know if they are a good option for titration of BiPAP therapy? I've tried to wrap my mind around how it would work, but I just can't see it.

Thanks in advance for opinions and input!

[Pugsy]

Home sleep studies are only for diagnostic purposes....the prove the need for the machine.

To find optimal pressures using a sleep study one has to be in the lab and have humans doing the tweaking.

Now you can self titrate at home using your own machine but you need to educate yourself on what to look for as well as how to make changes and be comfortable doing so.

[Miss Emerita]

Self-titrating, with help from experts here, would be easiest if you had a machine with an SD card and compatibility with the Oscar software. Any chance you might change machines? I would highly recommend the ResMed VAuto Aircurve bilevel machine. Forum member LSAT sometimes has some lightly used machines for sale; actually that's how I got the one I have. You might send him a PM if you're interested.

[OnTheCouch]

Thank you, I will look into that. I would love to change machines and that's definitely in the plans, but even if I were to get a new one, I'd still need a new study, unfortunately, since the last one was over 4 years ago and, clearly (to me) my needs have changed.

[ChicagoGranny]

I'd still need a new study, unfortunately, since the last one was over 4 years ago and, clearly (to me) my needs have changed.

Here is a common experience on the forum. The lab gets one night to get the machine settings right. In the lab, you are sleeping in a strange environment with a lot of devices attached to your body. We sleep differently night to night and throughout any one night. We most certainly sleep differently at home in our own beds than under sleep lab conditions. Often, the patient comes away from the lab with a script for machine settings that is not optimal. Sometimes, it is far from optimal.

With an auto machine and free OSCAR software, someone with a little savvy and the help of forum members can take several nights at home to optimize their settings. Here is a thread showing how one member is trying to optimize the settings he was prescribed - viewtopic/t179510/Recently-chanced-upon ... r-AHI.html

If you decide to get a better machine, please use this thread to inquire about the best one for your condition.

[Norma45]

Just a FYI, I have been self titrating since during Covid my sleep lab are not doing appointments. And some labs are doing only the non machine portion (one other person reported) so no tritration.
I was diagnosed with an at-home study.
Yes, a bi-pap is more complicated and it was a bit of a learning curve, and a bunch of trail and error, but with the help of the group things are getting better (still have one issue to figure out and then some smoothing to do).
Post your charts (see the post that says what people like to see) and let people see how your doing.

My experience - summary form:
First thing I looked at is what I was hitting limits of.
An interesting thing was that my respiration rate was high (20+) and I was hitting my TiMax (max time to take a breath in) a lot - this came set as 2 seconds.
I was also hitting my max IPAP (max inspiration pressure).

So my first change was to increase my TIMax to 3, and upped my IPAP max about 5.
This made a big difference in how rested I felt in the morning - it even how much better starting the first minute I used the bi-pap that night.

I was still hitting close to the max with TIMax, so I upped it to 4 and I now I float between 1.5-2 each night with some chunks pushing up to 3 or just above 3.
My respiration rate floats between 14 & 14.5 with occasional short high periods.

TiMin I left as it came (less than 1 second).

My adjustments of max IPAP (max pressure inspiration) were not helping, I just kept hitting the new max though I did try 25 one night just to confirm this.

Next I adjusted:
EPAP (minimum pressure that will keep your airway open always so that it doesn't close which makes the next in-breath difficult even if IPAP is high) - Thanks to Pugsy for that great explanation in reply to someone else's issues).

That made a big difference. I went from AHI of 14 to about AHI 6 and actually hit below AHI 3 last night.

There are other things to play with:
SP - but Pugsy (and others likely) warn this one can make things worse so play carefully (and I would suggest as newbies we take suggestions from the experienced people on the forum).
Trigger sensitivity.
Cycle sensitivity.
I have not done much playing with the settings above yet.

I use somnopose (and an oximeter) to help diagnose info. The oximeter showed much better results as I did the settings above. I can tell with somnopose (phone ap that shows position) that I still get high AHIs at times on my back. But it is sometimes not always (not last night with my low AHI, the night before about 1/2 of my back sleep was good, the other half was high AHIs).
So I am now trying a phone strapped to my chest and one to my forehead so I can figure out if my head position is different

If you post your charts (I would include the standard ones they ask for plus your respiration rate, inspiration time, and expiration time) and let the knowledgeable people give you things to try.

PS You can get a clinical manual from apneaboard.com, give them a day or so to get it to you.

[OnTheCouch]

Thank you so much, Norma, for your reply and your advice, and do everybody else, as well. Unfortunately, I have found the same thing: local sleep labs are not doing in-office studies right now. So my next question: If I were to get an APAP, would I even necessarily need a study? Would the machine just kind of figure out the right setting for me? If so, would a ResMed AirSense™ 10 For Her be a good choice? I've found one that I can actually afford, even with my absurd deductible.

And, if the ResMed AirSense™ 10 For Her is a good machine, would I want the Slimline tubing, or the Climateline tubing? What are the pros and cons of each type?

[Pugsy]

would I want the Slimline tubing, or the Climateline tubing? What are the pros and cons of each type?

The Climateline hose is really for air temp comfort as well as condensation prevention or control. I usually advise people to get the heated hose. You can always turn the hose air temp way down if you don't need it to prevent condensation and that's what is more comfortable for you. That's what I do...low in the summer and higher in the winter to help prevent condensation as well as ice cube nose discomfort from the cold air. A lot will depend on the general bedroom temperatures. If you keep it on the cool side there is a greater chance for condensation. Now if you are like my mom and keep the house at 78 degrees....you won't ever need it.
So it really depends on ambient temps and humidity levels used just how much you need or might want it.

Now there are things that can be done with the non heated regular slimline hose to prevent condensation and air temp discomfort even without heat...we did those things for years before we had heated hoses integrated with the machines. So it's not like you can't manage those annoyances without the heated hose but the heated hose does make it quick and easy to manage those annoyances.

If I were to get an APAP, would I even necessarily need a study? Would the machine just kind of figure out the right setting for me? If so, would a ResMed AirSense™ 10 For Her be a good choice?

Yes, for the most part using auto adjusting mode will figure out the pressure needs up to a point. The only caveat to that is sometimes the minimum pressure needs to give the machine a better head start to get to where it might need to go to give you the best therapy.
It doesn't change the pressure in a blink of an eye. It takes a period of time over several minutes to get to where it needs to be if it senses the airway trying to close up and if it starts too low then the airway can collapse during the trek upwards that the machine might try to do. It doesn't/can't just "blow" the airway open when it closes off...doesn't work that way and in fact during an actual apnea event the machine doesn't do anything at all until the apnea is resolved. We want to use a baseline pressure minimum that does a good job holding the airway open in the first place and then can adjust upwards quickly enough to take care of the times when we might have special needs in terms of pressure.

Yes, the AirSense 10 AutoSet for Her would be an excellent choice. Easy to use....is a full efficacy data machine with free and easy to use software so that optimal therapy management is easy to obtain when going down the DIY road.

[Dog Slobber]

If I were to get an APAP, would I even necessarily need a study? Would the machine just kind of figure out the right setting for me? If so, would a ResMed AirSense™ 10 For Her be a good choice? I've found one that I can actually afford, even with my absurd deductible.

And, if the ResMed AirSense™ 10 For Her is a good machine, would I want the Slimline tubing, or the Climateline tubing? What are the pros and cons of each type?

Many people here self-manage and haven't had sleep studies.

The ResMed AS 10 AS for Her is one of the preferred machines and is a terrific choice.

You mention deductible, that suggests insurance. Typically for insurance you will need a sleep study. And no, APAP's don't just figure out the proper setting. To self-titrate one sets a fairly low minimum, and then analyses the pressure graphs, and narrow the minimum pressure until you find the sweet spot.

One of the benefits of CPAPTalk is to post graphs and others will help you optimize your pressures to get you going on self-management.

IMHO one should get a heated hose. It's better to have one and not need it, than to need one and not have it. They are a little more expensive but if you use high humidity, depending on your environment you might need it to prevent excess water condensing in hose.

[ChicagoGranny]

Ooops. I thought I was posting this in a thread used by a member who has been PMing me. Sorry, I'm editing this out.

(I generally don't like to give advice by PM. It's better to be out in the open. The group knows more than any single member.)

[OnTheCouch]

Thank you all so much for your willingness to help me figure this out. I can't figure out the quote function, so I can't reply inline as I'd prefer, but here are some of the things I have to say.

1. Unfortunately, I need a BiPAP, so I'm told I'm not a candidate for a home study.
2. My insurance will cover for the in-office study, but I've got a 3K deductible and just don't have that kind of money lying around. Another significant issue, I'm learning, is that local sleep centers are not doing in-office studies right now, due to COVID. You're correct, it won't cover the equipment without the study, but given the 3K deductible - that I'm not going to meet this year - I'll be paying out of pocket, anyhow.
3. I, too, keep the temp in my house at 78 degrees. Further, I live in a part of Texas where it rarely gets below freezing AND I almost never use the humidifier with my machine, anyhow. So it looks like I'll be fine with the slimline tubing.
4. I was able to figure out, through Youtube videos, how to get into the settings of my current machine. If I were to put those same settings in the ResMed, then that would be a good starting place, correct, and let the machine work its magic (with a bit of coaching) afterwards?

Honestly, I'm feeling much less defeated now. I truly appreciate it.

[Pugsy]

What are your current bilevel machine settings?

The AirSense 10 AutoSet for Her does have a feature that will give you some limited bilevel capabilities. We might get close enough depending on what your current pressure needs are. I don't remember if I saw your settings above.

Given where you live and your preferred ambient house temp....I see no need for a climateline hose in your situation.
You can always add one later if needed. Amazon or EBay are good options for a cheap heated hose.

And yes....you have a bunch of good coaches here to help you with whatever you decided to do.

[khauser]

Just the quote function bit. There's a button with a " sign in it, its at the upper-right of each message, including while you are writing a reply (look below). If you click it, it will insert the entirety of that message in to your reply.

A more advanced use is to break it in to pieces, that requires you to do some of the work manually.

When you use the button, you create a quote that references the original poster, like:

Thank you all so much for your willingness to help me figure this out. I can't figure out the quote function, so I can't reply inline as I'd prefer, but here are some of the things I have to say.

You can also create anonymous quotes by surrounding your code with

Code: Select all

[quote]

and

Code: Select all

[/quote]

There's a button for that too, same look, but its above the text editing, next to the Bold, Italic and Underline buttons.
Interested in more? https://en.scratch-wiki.info/wiki/BBCod ... d%20links.

[OnTheCouch]

What are your current bilevel machine settings?

Not sure, but I will check when I get home and let you know.

And thanks, Kevin! Figured out the quoting!

[OnTheCouch]

OK, after a lot of craigslist stalking and 350 mile road trip, I'm the proud new owner of a Resmed Aircurve 10V Auto with just under 500 hours on board!

I was unable to figure out which of the settings on the old machine corresponded to which on the new, so I just crossed my fingers and made a wish while letting her work her magic. I've used her for three nights now, and I see definite improvement, but not nearly as much as I had hoped for.

To my (extremely untrained) eye, the numbers look pretty decent, but I am awake and aware way too frequently during the night (although less frequently than with the old machine, so there's that, at least) and I've got that "I didn't get enough sleep" headache that I'm sure you're all way too familiar with.

At this point, I've got two main questions:

1. Do you see any reason for the frequent wakefulness here, or should I look at other possible causes for that particular issue?

and

2. Are there any settings that you recommend I change?

Thank you, everyone, for helping guide me through this journey!