Pressure Change on Vpap Auto 25

[dlp1195]

I have previous posts with other data with old settings. This is my new settings data where I raised the default low of 4 to my prescription of 10 as suggested by several memebers. I have done it for 2 nights and feel MUCH better. Looks like more improvement can be made and would appreciate any suggestions. I went to my DME on Wed. and his suggestion was another sleep study and a different machine he called a cervo ventelator I think. Any comments would be appreciated.

[jnk]

If raising my Min EPAP for a week lessened the number of apneas I had, and made me feel better after that week, I might be tempted to try raising my Min EPAP another cm or so to see if that got my AI below 1.O the next week. But that is just what I would do for me. The fact that raising pressure seemed to help would tend to indicate to me my apneas were not likely central, but obstructive. However, it sounds to me like your DME believes those apneas may be centrals and that you should be tested for a machine meant to treat that. So that is all something you, your doc, and the RT might need to discuss. Do they think raising your Min EPAP again for another week might be a good idea, or no?

jeff

[dlp1195]

Actuall I raised it myself. The DME seems to think the Auto should take care of it even set at the low of 4 so I raised it myself. My prescription was 10-14 and the Vpap S I started with gave me problems with the transition from EP to IP and they switched to a Auto and it helped that but did not bring down the AHI. It was running in the high 20's with the regular VPAP. This change I made has made a BIG difference in the way I feel after only 2 nights. I will avoid his calls and get this weekend in under my belt before I break the news that I changed it myself. I figure if I have better data it would be harder for him to gripe at me. I was wondering if raising the low setting a little more might do away with some of the Hypopnea's.
My AI was as high as 9.7 and HI was as high as 15.9 on the 4-25 settings and I was a zombie compaired to AI of 1.4 Hi of 11.2 on the 10-25 setting and I felt MUCH better.
You can check some of my earlier posts and see some of my charts from the 4-25 settings.

[jnk]

I do the same, making my own changes, since my diagnosis was strictly OSA. And my opinion is that if a doc is willing to put you on a machine set wide open, that implies to an OSA patient that he doesn't have to worry much about tweaking within the range the doc allowed, within reason. But if you had centrals in your sleep study and your DME mentions the possibility of a machine designed to treat central apnea, that makes me use wording that includes your doc in order for me to feel comfortable saying what I would do, since, again, I was diagnosed strictly OSA (in spite of all my mixed events.) Anyway . . .

I would not worry about HI or AHI just yet. Just worry about AI on that machine. I AM comfortable saying that. I am also saying that the algorithm of that machine may not be the best for you if you are going to run in auto mode, but I have no idea if another brand's algorithm would do any better. There was little variation in your pressures last night, in spite of the high number of apneas. If those were centrals, that was a smart thing for the macihne to do. If those were obstructive, not so much. You may do better finding the one set of pressures that work for you so you can stick with it. You can run that machine in auto mode but in a way that it doesn't do any auto-ing, so that machine will do you fine, once you find the set of pressures that works best for you, IF you have strictly obstructive apnea. If you have other health issues to be addressed that are causing centrals, you may do better on a machine designed for that, like the DME mentioned.

The doc may have wanted you on that machine for it to titrate you. For whatever reason, that machine with its algorithm doesn't seem to have titrated you very well, in view of all those apneas. You titrated yourself by raising your Min EPAP, and from your numbers and how you feel, that seems like it was a smart thing to do. I would say raise the pressure tonight to get AI below one if you have limited time to work with. But the accepted wisdom here is often to make changes over time and to be careful making suggestions to people who may be dealing with central apnea. Thus my irritating weasel wording above.

Does that make sense? If not, feel free to make me clarify so that maybe other posters can comment.

[dlp1195]

jnk, Everything you said makes sense to me and I appreciate the imput. I had 9 centrals durning my sleep study. I have no problem doing another study if that is what the doc wants but from what I have read here the default settings of 4-25 has been a problem for lots of people and I gave it a try for 12 days and felt terrible. I have a very nice DME it seems they have switched machines with me with no problem but I am not convinced they have done everything to solve the problem. When I suggested setting my low to the prescription he thought the machine would make that adjustment with no problems. My thinking was if that is what my prescription was why not try it and see. The cheapest I have seen the machine he might put me on is 3999.00 and I have insurance with a 20% co-pay so I want to make sure every avenue has been tried before going to that step. The only thing I am not sure I understand about your imput is the algorithm thing.... Thanks for your imput.

[jnk]

jnk, Everything you said makes sense to me and I appreciate the imput. I had 9 centrals durning my sleep study. I have no problem doing another study if that is what the doc wants but from what I have read here the default settings of 4-25 has been a problem for lots of people and I gave it a try for 12 days and felt terrible. I have a very nice DME it seems they have switched machines with me with no problem but I am not convinced they have done everything to solve the problem. When I suggested setting my low to the prescription he thought the machine would make that adjustment with no problems. My thinking was if that is what my prescription was why not try it and see. The cheapest I have seen the machine he might put me on is 3999.00 and I have insurance with a 20% co-pay so I want to make sure every avenue has been tried before going to that step. The only thing I am not sure I understand about your imput is the algorithm thing.... Thanks for your imput.

I think the doc may have wanted you on an auto to see if it would find the right pressure to treat you. It did not. The DME believes the sales literature that tells him the machines are designed to run 4-25. That didn't work for you for titrating OR for treatment. So putting the minimum close to your prescribed pressure turned out to be the right thing for you, as it has for me and many others here.

My personal opinion is that 9 centrals is nothing to worry about. But I'm no doc, and I could be wrong, depending on your medical history and other health matters. Your DME may have been speaking based on knowledge that you might benefit from an ASV machine, or maybe he was just hoping to sell a more expensive machine and to drum up a little more business for the lab. Hard to tell. The cynic in me leans toward the latter possibility, though.

The algorithm thing was just my way of saying you may not be a candidate for using that particular auto in auto mode with a big range like 4-25, although some others may do fine. You may find running the machine with one fairly steady set of pressures works better for you for treatment in the long run, based on the lousy job that machine did at preventing your apneas when set wide open. My guess is that you find Easy-Breathe very comfortable, so running the machine in auto mode is best, even if you limit the range so much that the pressure never varies in order to keep the machine at the right pressures for successfully treating you.

I tend to be overly cautious and to worry about what I don't know in any situation involving medical decisions. I've only been on therapy for about 15 months, myself. But it looks to me like your story is headed in the direction of a major success story as an example of an informed patient being active in your own therapy and it paying off for you big time.

If you decide to raise your pressure higher to see if that gets your AI below one, it will be interesting to hear how you feel then and what your doc and DME do about it. If your AI gets below one and you feel great, that will say a lot right there.

jeff

[dlp1195]

I tend to think selling a higher dollar machine might weigh in the situation also. The RT at the DME said 9 centrals in that study was no big deal also. I think I will keep the 10 one more night and then raise it a little and see if that helps. Would you raise it to 11 or say 10.5 or so. I realize everyone wanting to be cautious with advice but I am not going to go far from my prescription. I figure if I was titrated at 10-14 I should not be doing much harm to raise the bottom number close to the 14 as that would be like straight cpap pressure I would think. I just got a call from the doctor saying they was scheduling me a different type sleep study and the lab would call me. That will probably take a week so I should have some numbers to show them before and maybe I won't need it, but if he thinks I need it still I will jump through the hoops.

[jnk]

I tend to think selling a higher dollar machine might weigh in the situation also. The RT at the DME said 9 centrals in that study was no big deal also. I think I will keep the 10 one more night and then raise it a little and see if that helps. Would you raise it to 11 or say 10.5 or so. I realize everyone wanting to be cautious with advice but I am not going to go far from my prescription. I figure if I was titrated at 10-14 I should not be doing much harm to raise the bottom number close to the 14 as that would be like straight cpap pressure I would think. I just got a call from the doctor saying they was scheduling me a different type sleep study and the lab would call me. That will probably take a week so I should have some numbers to show them before and maybe I won't need it, but if he thinks I need it still I will jump through the hoops.

Until I got AI down to below 1.0, I would raise pressure in 1 cm increments. I would go to 11 if it was me. And probably tonight.

When you think about it, if they don't know you have the ability to self-titrate like you are doing, and they don't know you are finding some success with that machine, their thinking about another study and another machine makes sense from that angle as being in your best interests. And if you weren't a patient who was so capable of using your data to self-titrate, a sleep study might be the only way to go. But once you are sure you are finding success self-titrating with that machine, you might want to let them know that. After that, all of you might be in a better position to figure out whether another sleep study is the right thing to do or not.

[Slinky]

Am I misunderstanding something here??? You were titrated on a bi-level in-lab w/IPAP 14, EPAP 10 and the doctor ordered a bi-level auto set at IPAP 14, EPAP 10 BUT the local DME supplier opted to take it upon themselves to set the pressures wide open at 4 - 25???

Maybe the sleep doctor is SMARTER and MORE KNOWLEDGEABLE about the VPAP Auto 25 then the local DME supplier and is aware how SMOOTH the EasyBreathe technology makes breathing set in Auto mode w/Pressure Support set to the difference between IPAP and EPAP settings. But the DME supplier figures Auto mode means wide open to auto titrate?? Or am I just not remembering the entire story from you previous posts?

jnk is smarter than me about these things. And has a better memory.

[dlp1195]

I had the sleep study then was given a ResMed Vpap S set at 14-10 and was having problem with the transition from Ip to EP and the doctor changed the prescription for a 10 day trial of a ResMed Auto 25 and they set it at 25-4. I saw the prescription for it and it only had Auto Vpap and no settings on it. The DME guy said the auto takes care of the settings which for me did not work out. The Dr. wants to do another study see if I am having more centrals now. SInce changing the settings I feel better and have less episodes as the data shows. Any more ? and I will try and answer.

[Slinky]

Nope. Thanks. As soon as you mentioned the VPAP S I remembered more of your details and your explanation brought me up to date. I think you're on the right track and have the right plan. I'd do the same as you are planning to do. Beware tho of "first night effect". I've often found when changing therapy settings that the second and subsequent nights don't always correlate well w/the first night w/the changes. But that could be just me.

[dlp1195]

Sure glad you mentioned that about the first night. I had a few more events than the night before and was thinking it was the higher setting but now I will give it another night. My AI was 2.4 and HI was 11.9 for a 9.1 hour time sleeping. What I can't figure is the pressure line was a flat line straight across 14 and no change for an episode which seemed to be in clusters of 3. Kind of leads me to think they might be centrals but I don't know enough to judge that. I will post the results if anyone wants to take a look. Thanks for your imput.

[Slinky]

So how did you do last night?? As I understand it the Pressure line in the Detailed graphs shows the midpoint of pressure so your EPAP was running at 12 and your IPAP at 16 all night if you had a straight line. We need jnk to verify this tho.

I've forgotten what your current pressure settings are and I don't think you've changed your Pressure Support from 4. Am I correct on this because I am assuming your PS is still set at 4 in reference to the above.

[twokatmew]

So how did you do last night?? As I understand it the Pressure line in the Detailed graphs shows the midpoint of pressure so your EPAP was running at 12 and your IPAP at 16 all night if you had a straight line. We need jnk to verify this tho.

It does on the VPAP Auto, but not on the VPAP Auto 25, which shows IPAP. Or at least this is what jnk posted last I knew. All I know for sure is that my VPAP Auto 25 shows IPAP (for pressure) in ResScan 3.7. (I'm running in auto mode, too.) Confusing, isn't it?!

[Slinky]

Yes, it is. I don't care if IPAP and EPAP can ONLY travel in sync at the PS setting, Resmed SHOULD give us an IPAP line and an EPAP line, heck, one red line, one blue line, same color line, who gives a rat's rear as long as they give us one line for each. Ah well. C'est le vie. Remember, the sleep pros say we aren't supposed to be able to understand this stuff anyway.