Bi-Level Data Question ???

[Snoredog]

Thanks, Advans. This is an accredited sleep lab and the sleep pulmo is an accredited sleep doctor and I did have an in-lab bi-level titration and I even used my own mask. They didn't even ask for any of my data when I went in for my 3 month follow up after starting bi-level but I brought a printout anyway.

How are you doing?
Yes, bi-level is helping.
Good. I'd like to see you again in six months.
Well, because of the high leaks which I KNOW are caused by the lip flutters I'm thinking of changing 8 EPAP to 7 and leaving IPAP at 13 or should I drop it to 12?
Well, there shouldn't be any harm in doing so.
I'm also thinking that if I'm doing good there's no sense in coming back in at 6 months for a well-visit. I'm not bashful about calling for help if I'm not doing good as you have found out so what do you say we leave it at I'll see you in one year UNLESS I run into problems and if I do "I" will call "you.
Okay, that's fine. Just be sure to call if you need help.
You can keep that data prinout if you would like.
What? Oh yes, thank you I'll keep it in your file.

So tell me, Advans, if the data from the autoPAPs are unreliable and an in-lab titration didn't quite hit the mark, how many more in-lab titrations at what intervals until we do get it right?

We have yet to find a full face mask small enough to fit comfortably and leak free. A chin strap is useless for the lip flutters.

My most comfortable, effective mask is the old Respironics Simplicity Petite simple nasal cushion mask followed by the new Resmed Mirage Micro Small nasal cushion.

How much difference in size is there with a Pediatric full face mask from the various small adult full face masks?

LOL didn't you hear a thing AdvansCPAP.com had to say Slinky??

Stop messing around and go see your doctor!! cause you have no idea what you are doing and well Auto anything just don't work for anyone period. They are making those Autos by the millions to be only used as door stops (especially the one you got)

Now why someone would ignore the advice from their local yocal DME and doctors and come here for advice is well beyond me.

Now didn't you know this website exists solely for the purpose of slime ball spammers and DME's who come here to take advantage of their competitors good will only to peddle their own competitive website? Yep it is a free for all and well the only advice you can get from here is "go see your doctor or DME".

Sorry AdvansCPAP.com as you can tell no welcome from me, it is obvious to me why you are here, I think you are a low life slime ball only showing up here to take advantage of your competitor's good will in order to advance your own financial interests.

Stooping that low says alot about your business to me, I live in California and travel down to Anaheim area regularly, I'll make sure I never step foot in your B&M office.

You must have been drawn to this site from your ears burning as we get a lot of complaints about lying slime ball DME's.

But if you think patients come here only to hear the same thing they hear from behind your counter in Garden Grove you are totally mistaken. And no we don't NEED you to tell every poster to ignore suggestions here and see their doctor and DME because that is not what they come here for.

[Slinky]

... I think you once said that you were thinking of going to S mode, regular bilevel, using your VPAP Auto. I think if I were in your shoes, I might seriously consider doing just that, for several reasons. ...

Yup, haven't put that idea outta my mind, jnk. However, keep in mind that I was started on straight CPAP at 6 cms, gave it 30 days and insisted on seeing doctor, raised to 7 cms, let it go 30 days, insisted on autoPAP or overnight oximetry, spent 3 weeks on an auto (won't go into how the sheister DME did their best to screw THAT up), pressure raised to 8 cms, gave it 30 days, insisted on overnight oximetry, 2L of 02 supplementation added. Gave up wasting time w/sleep doctors for awhile. Experimented w/self-purchased autoPAP and various EPR settings. New sleep doctor also accredited. Contacted doctor, brought in for new evaluation w/and w/o 02, brought in for bi-level titration, IPAP 13, EPAP 8. I think 7-8 cms for EPAP is in the ballpark. There's no reason to suspect 13 IPAP is too high given the titration. But the Pressure Support, Trigger and Cycle Sensitivity, etc. I'm willing to bet are all default settings that COULD make a difference IF the doctors would butt out and let the RPSGTs venture some opinions.

Don't misunderstand. I am NOT trying to eliminate my high leak rate w/bi-level pressure settins. What I AM trying to do is get my leak rate as much under control as I can w/finding the best pressure settings UNTIL or IF I can EVER find a full face mask that is small enough.

And, yes, I know, I know, I "should" tape my lips. Well, I won't tape but HAVE used the PoliGrip Denture Gel very successfully. But, again, I'm too d*mn lazy. My bedtime routine is prolonged enough beyond my control. I would much prefer to just fall into bed when I'm tired and ready to sleep and just don my mask and bi-level and go to sleep. I'm doing well enough I'm not willing to add yet another "something" to my bedtime routine. I'm just a bull-headed ole broad about some things. And extending my bedtime routine is one of those things.

... Maybe that would be a silly approach. Maybe some techs could comment on how silly that would be, I don't know. But it would be an approach that would work in my mind for me personally, if I were in what I understand to be your shoes. That's just my looopy opinion. ...

Oh, I don't know that approach is any sillier than what I'm doing now. And its one I'm saving and will give more thought too. Just as I do many or most of the suggestions in the forum that might apply to my situation. I think them over and try the ones that make sense to me or that I'm willing to give a go. Its just so darn slow slugging thru one week at a time but I need that much data to have anything reliable to go on.

[Slinky]

SnoreDog, you ole fart! I was wondering when you were going to show up! What took you so long? Yer slipping, guy! Must be old age creaping up on you, you think? Is that the best advice you can come up with? As you can see I tried that. Its only taken me 23 months to get this far.

[Slinky]

By the way, I've got the S8 ResLink, the Embla XPod oximeter and Embla finger sensor. I just have NOT had the time to sit down, read thru the manuals and get the ResLink attached to the VPAP Auto.

First it was a week getting the horses, kids, tack and outfits and costumes ready, then it was a week at the fair. Oh, there was almost a week of not feeling so hot so some blood draws, etc.

I had thought tomorrow since hubby is going fishing and I would have the day to myself, but nope, granddaughter and friend are spending the night tonight to get her horse, tack, etc. together and ready tomorrow as she is going to some big time barrel racing event for kids.

[AdvansCPAP.com]

[quote="Slinky"] They didn't even ask for any of my data when I went in for my 3 month follow up after starting bi-level but I brought a printout anyway. - They focus on the raw detailed data coming from the sleep study. They will not consider yours as more valid than theirs. Ask them why if you wish.

So tell me, Advans, if the data from the autoPAPs are unreliable and an in-lab titration didn't quite hit the mark, how many more in-lab titrations at what intervals until we do get it right? - I couldn't tell you. If the tech running the test is good, they will try all sorts of things to see what helps with your lip leaks. They can raise the head of your bed to decrease the severity of your apnea, thus allowing them to lower the pressure which helps with lip leaks. They can have you sleep more on your side, use a heated humidifier, use all sorts of different types of chinstraps and the list goes on and on. Like I said, it all depends on what the tech is willing to try on you and hopefully finds something that works in one night.

We have yet to find a full face mask small enough to fit comfortably and leak free. - Full face masks are very difficult to seal well for most people. Some will say they do great on them, which is fine with me. As long as they're happy.

A chin strap is useless for the lip flutters. - It all depends on which one you try. Some work better than others. Respironics makes a deluxe CS that seems to work for most.

How much difference in size is there with a Pediatric full face mask from the various small adult full face masks? - Peds masks are super small compared to adult masks.

If abosolutely nothing works for you, the only choice is to lose enough weight so you dont ever have to use BiPAP again. That is if you only have OSA, not CSA/ MSA.

[Slinky]

Thank you, Advans, but there is no way in h*ll a chin strap can in any way control the lip flutters. I "was" pleased to learn just the other day that the Quattro full face comes in an XSmall. My supplier didn't even know that. I've asked for one when I'm due in November for a new mask.

[AdvansCPAP.com]

Stop messing around and go see your doctor!! cause you have no idea what you are doing and well Auto anything just don't work for anyone period. They are making those Autos by the millions to be only used as door stops (especially the one you got) - Never did I say the pt had no idea what they were doing. Nor did I say they will not work for "anyone period". Please do not accuse me of these things Mr Snoredoggie. Autos are okay, but will not catch everything. And just because they make millions of them does it mean they work for everyone? If they do what's the point of still making regular CPAP's or Bilevels? Do tell.

Now didn't you know this website exists solely for the purpose of slime ball spammers and DME's who come here to take advantage of their competitors good will only to peddle their own competitive website? Yep it is a free for all and well the only advice you can get from here is "go see your doctor or DME". - If you read my few posts, I just gave my thoughts from professional experience with helping out thousands of pts over the past 10+ years. I not only work on the DME side, but I used to run sleep studies and am an RPSGT, FYI. No where in any of my posts did I say come buy anything did I?

Sorry AdvansCPAP.com as you can tell no welcome from me, it is obvious to me why you are here, I think you are a low life slime ball only showing up here to take advantage of your competitor's good will in order to advance your own financial interests. - Your insulting does not make you look very good. Did I make any personal attacks on you? Did I put you down? Did I say anything about your posts? No, I didn't. And that's okay you do not welcome me as I did not ask for your approval did I? My posts are to Slinky, not YOU. Apparently you feel the need to put me down. How does it help anyone reading this? How about you help the original poster rather than wasting your time insulting me? Or did you have nothing better to do than rack up 5000+ posts . You must be so proud.

Stooping that low says alot about your business to me, I live in California and travel down to Anaheim area regularly, I'll make sure I never step foot in your B&M office. - B&M Office? Please clarify. You say I stoop low, you call me names and insult me. What does that tell everyone about you? Also, swing by if you get a chance and act like a customer. Ask away and I'll be happy to help. I know once you actually speak to me in person face to face you wouldn't be saying what your saying now. Believe it or not, there are decent people out there in this world and work at DME's god forbid. It's rather pathetic you group people together and insult them after a bad experience. What a shame. Go get some good sleep and hopefully you will stop your whining for everyones sake

You must have been drawn to this site from your ears burning as we get a lot of complaints about lying slime ball DME's. - Actually, no. If you had any idea about the level of customer service we provide it is very rare if at all our patients are not happy. If they're not happy, it's usually from a misunderstanding. Have you read any complaints about our services? I don't think so.

But if you think patients come here only to hear the same thing they hear from behind your counter in Garden Grove you are totally mistaken.
And no we don't NEED you to tell every poster to ignore suggestions here - I never once said to ignore other peoples suggestions here.. It's rather amazing how you come up with these things.

and see their doctor and DME because that is not what they come here for. - For your information Slinky asked for my thoughts. I know exactly why people come here and it's definitely not to read about your bitterness and insults to people who have been trying to give input to their issues. I merely give suggestions. If you want to listen then listen. If not, no biggie. Just don't go calling people you don't know names left and right. Simply amazing..

[AdvansCPAP.com]

Thank you, Advans, but there is no way in h*ll a chin strap can in any way control the lip flutters. I "was" pleased to learn just the other day that the Quattro full face comes in an XSmall. My supplier didn't even know that. I've asked for one when I'm due in November for a new mask.

No problem Slinky. If the chinstrap doesn't work out then you just have to try the FFM and hopefully it works. Good luck. My apologies about getting side tracked with the other poster as I have no tolerance for people who has nothing better to do than cause trouble.

[Slinky]

'S okay, Advans. But I missed something else I really can't afford to lose weight. I'm 5'4", 110 lbs, 13" neck, 66 years old, female and have Crohn's disease.

I FINALLY got around to using the S8 ResLink and Embla XPod oximeter and sensor last night. Just trying to be patient and give the VPAP Auto and Reslink time to get their data together so I can check it out w/ResScan this morning. Curiostiy killed the cat!