Did Dr. give corect pressure?

[flounder]

I just got a copy of my sleep study report and can not figure
out how my Dr. came up with a bipap setting of 23\18. I will attempt to list
the pertinent data from the titration study.

Note: due to mask leaks etc. the tech was only able to titrate me up
to 20 before we ran out of time.



press obsapp cenapp rdi

6 - 0 - 5 - 13

7 - 0 - 6 - 32
8 - 0 - 0 - 0
9 - 0 - 0 - 0
10 - 0 - 0 - 0
11 - 0 - 0 - 0
12 - 0 - 1 - 32
13 - 1 - 1 - 30
14 - 1 - 3 - 22
15 - 1 - 3 - 33
17 - 5 - 0 - 9
18 - 7 - 0 - 61
19 - 1 - 0 - 18
20 - 2 - 0 - 31

The Dr. said he arrived at a setting of 23 because at 20 I was still
having apnea events and the bipap only goes up to 25 so he settled on 23.

I did not have a copy of this report when I talked to Dr.--At the setting of 23 I have an AHI of 5.

Question 1-- Is it normal to have this many central apneas?

Question 2--- It looks to my uneducated eye that a setting of 8,9,10 or 11 would yield much better results. Am I missing something?

Thanks to all for your help.

Don

[littlemo]

when the pressure gets too high, it can stimulate centrals, also some pt's have what we refer to as sleep onset centrals, which are irrelevant unless they are associated with Sp02 desat's, then you titrate from a desat point. Hope this is helpful.

Mo

[flounder]

Mo
Thanks for the info on centrals.

don

[rested gal]

flounder, I'm not a doctor or anything in the health care field, but I'd want to see what sleep stage and sleep position I was in for each of those titration pressures.

Regardless of whether I ever got to see the stages and positions info, I'd be asking to be put on the Respironics BiPAP Auto with Bi-Flex for the benefit of two things going at the same time: auto-titrating (in case I didn't really need such high pressures all night) and bipap exhalation relief. I'd ask (or do it myself) that the BiPAP Auto be set to operate in auto-titrating bi-level mode, with min EPAP set at 9 or 10 and max IPAP set at 20, PS (max pressure support) set at 8, bi-flex set at 3.

I'd want the software so I could see for myself how things were going. Or, without the software, I'd want the DME or doctor to do a download once a week and print out the "full details" report for me.

Yeah, I want a lot when it comes to my own treatment. A lot more than being handed a bipap at that kind of stratospheric pressure, and likely no one checking what's going on for weeks or months to come.

[LDuyer]

I agree with Rested Gal about the use of the auto bipap.
Those numbers do look suspicious, but you said there were mask leak and other issues. What type of mask were you using during the sleep study? Any significant mask leakage or mouth breathing without a full face mask could make false readings. They should be watchful for those things, but you never know for sure. So because they couldn't titrate you properly, then either a new titration study is necessary or the auto bipap would be logical.


Linda

[jules]

I think there is also an issue of how much (or really how little) time was spent doing this titration. When you start looking at say the pressure of 18 with an AHI of 61 and 7 events - hmm - 7 events in under 7 minutes. For pressure of 12 and 13 they are an event every 2 minutes so a whooping 4 min at 13 and just under 2 at 12.

I think the issue of why 8 - 11 have 0 AHI needs to be determined - how long at each? Why was the pressure raised higher?

An Auto Bipap is a nice machine however, a lower starting pressure might be in order once there is sufficient detective work on what is going on at 8, 9, 10 and 11.

A new titration is in order whether it be in the lab or via AutoBipap at home with frequent downloads and analysis. I just kind of wonder what kind of rush job this was.

[rested gal]

flounder, your profile listing your machine, mask, etc., shows an M series BiPAP Auto as your machine. Is that the machine you are using?

EPAP 18, IPAP 23 sounds like it's been set to operate just in bi-level mode; not in auto-titrating bi-level mode.

If you do have the BiPAP Auto, do you know how to get into the clinical menu so you can see what all the settings are?

Please check your Private Messages -- button at upper right of this page.

[flounder]

Rested gal, Linda, Jules
Thanks a lot for the feedback. The highest I got was stage 3 sleep. Since my Doc did not ask for my card in my -2weeks on the machine- visit, Just told me to come back in a year: I will take RG's advice on settings. Will do it tonight if I can get it programmed or tomorrow at latest. Having provider manual is great- thanks Laura.
Don

[SWK]

hey just wanted to drop you a line saying that most of the time, apneas get worse as the night goes on, so when a tech is titrating you , it could last all night. The 0's at 6 7 and 8 were probably because the tech skipped those numbers because u were that bad, or maybe you weren't sleeping in your worst position(on your back) and you proabably had not hit REM yet (where apneas are usually worse. )

Your dr. randomly picking 23 is a little odd to me .. but if you are uncomfortable with that, go back to your dr. and ask specifically to have another sleep study where they they can start you higher and get you properly titrated. You wont be putting the dr. out at all.

[flounder]

Just an update on first night using auto feature.
Bipap settled on 12/9 vs. 23/18 prescribed by Doc.

AHI 1.4 --this is my lowest ever, down from avg 5.4

Variable breathing 27.5 vs. 17 avg --Not sure exactly what that means, but I think it indicates deeper sleep.

Did have one flow limitation vs none before but this was at very beginning of sleep.

No gas problem whatsoeverjavascript:emoticon(':D')
Very Happy-- Did take two Phazyme as usual but may not need it in future. ( A pressure of 23 is like like having a wind tunnel hooked up to your digestive tract).javascript:emoticon(':twisted:')
Twisted Evil

Some snores recorded but I think this is because machine can pick them up better with less wind noise.

Much greater mask comfort at lower pressure.

I am now a very happy hose head.

My sincere thanks to all of you who helped.

If only we all could find Doctors who are as knowledgeable, responsive and caring as this crew.

Best regards to all of you.

Don

[Wulfman]

Just an update on first night using auto feature.
Bipap settled on 12/9 vs. 23/18 prescribed by Doc.

AHI 1.4 --this is my lowest ever, down from avg 5.4

Variable breathing 27.5 vs. 17 avg --Not sure exactly what that means, but I think it indicates deeper sleep.

Did have one flow limitation vs none before but this was at very beginning of sleep.

No gas problem whatsoeverjavascript:emoticon(':D')
Very Happy-- Did take two Phazyme as usual but may not need it in future. ( A pressure of 23 is like like having a wind tunnel hooked up to your digestive tract).javascript:emoticon(':twisted:')
Twisted Evil

Some snores recorded but I think this is because machine can pick them up better with less wind noise.

Much greater mask comfort at lower pressure.

I am now a very happy hose head.

My sincere thanks to all of you who helped.

If only we all could find Doctors who are as knowledgeable, responsive and caring as this crew.

Best regards to all of you.

Don

Great news, Don!

Did YOU set up the machine or did your doctor help with the settings?.....I wasn't quite clear from your post.
I can obviously see what your doctor prescribed, but since you're using the Auto Bi-PAP, I was wondering about who set it up.

Den

[flounder]

Wolfman,

Thanks for your good words.

Doc set bipap pressure at 23/18 despite titration showing no apnea events between 8 and 11. With advise here I set machine to auto and got the low AHI.

Don

[Wulfman]

Wolfman,

Thanks for your good words.

Doc set bipap pressure at 23/18 despite titration showing no apnea events between 8 and 11. With advise here I set machine to auto and got the low AHI.

Don

I got it now!
I can also relate...... My sleep doctor prescribed CPAP pressure of 18 (even though my titration stopped at 16) so I re-set my machine to 10 and got very low AHI numbers. He also thought that I might need even MORE pressure than 18. Even with the Encore Pro printouts, he didn't want to believe I could do that well on almost half the pressure he prescribed.
It's experiences like yours and mine (and quite a few others) that have created suspicions in my mind about the true qualifications of these so-called "sleep doctors".

Good luck with your therapy and best wishes,

Den

[cpapernewbie]

this is a very good case study - it show how reckelss if you depend fully on doctors prescription and have no data to track yr progress


Now with a pressure of 9/12 you do not even need a BIPAP!

what you need is the usual auto CPAP

[Linda3032]

Another sad story about "doctors" is one I just discovered. My sister who has serious health problems has been on cpap for two years. On medicare, they put her on one of the "cheapie" machines and never follow up with her.

During her recent visit, I put her on my machine at her pressure of 10, so I could download her data. Good grief, at 10 - her prescribed pressure, she still had an AHI of over 20 using a full face mask with very low leakage.

I told her to get her butt back to her doctor and get another sleep study. They never did a real sleep study -- just one on an auto in her house.

No wonder she feels like crap.