Why is Cpap at 19 ridiculous?

Hambone · Post by **Hambone** » Sat Jul 29, 2006 6:11 am

I too was prescribed a cpap (w/cflex thank god) to be set at 19.

I had two sleep studies one an a cpap and one on a Bipap, My 02 sat was in 60's. The Sleep Doc said I titrated at 10 on the bipap which was equivalent to 19 on a cpap?

They recommended a Cpap w/flex at 19 and my doc prescribed it.

They also said they were trying to get me to reasonable level above 90% without adding supplemental oxygen.?

Does this sound right or should I look into this deeper...

I'll admit I do awaken every night now (didn't at first), but I know what it was like without it so I persist...

Hambone

NightHawkeye · Post by **NightHawkeye** » Sat Jul 29, 2006 6:40 am

Hambone wrote:I had two sleep studies one an a cpap and one on a Bipap, My 02 sat was in 60's. The Sleep Doc said I titrated at 10 on the bipap which was equivalent to 19 on a cpap?

They recommended a Cpap w/flex at 19 and my doc prescribed it.

. . .

Does this sound right or should I look into this deeper...

My recommendation? Look into it deeper. The part that doesn't sound right is BiPAP at 10 and CPAP at 19. My CPAP pressure and BiPAP pressure (IPAP) are the same. Likely the reason your pressures between machines are so different is that your pressure needs fluctuate during the night and while you were on the BiPAP you only needed lower pressure.

Sounds like you're a candidate for the BiPAP-auto to me. Ask your 'doc' if he'd be willing to prescribe BiPAP for you to help you adjust to this therapy. Then get the BiPAP-auto machine. It's priced the same as other BiPAP's, so you shouldn't get any argument from your DME or insurance. (At least I haven't seen anybody report having a problem.)

Where the BiPAP-auto should help you are with pressure relief and accommodating variable pressure needs. BiPAP provides significant pressure relief when exhaling, more so than C-flex. The BiPAP-auto goes even further by providing Bi-flex, which provides additional pressure relief during portions of the exhale cycle. Assuming that the reason you titrated differently on a BiPAP was caused by the fact that you have variable pressure needs, then the BiPAP-auto is the only BiPAP machine which can provide you with varying pressure throughout the night.

If you haven't done so already, then read Rested Gal's new thread raving about the BiPAP-auto. You can also do a search on BiPAP-auto and you'll find rave reviews for this machine from everyone that has used it.

Hope this helps clear things up.

Regards,
Bill

tooly125 · Post by **tooly125** » Sat Jul 29, 2006 10:04 am

Hambone,

My pressure is also 19, it wasn't easy at first but now i'm so used to it that I don't even use the ramp feature anymore.
the biggest drawback of high pressure in my opinion is the masks, they must be worn tight to stay sealed i'm using the hybrid now which is working well for me. I did try a nasal mask once but I couldn't handle all that pressure going straight up my nose.

whatever you end up with i'm glad you seeing some benefits

Linda3032 · Post by **Linda3032** » Sat Jul 29, 2006 10:15 am

Hambone, here is the info that Hawkeye mentioned in his post -- about an Auto Bi-pap.

viewtopic.php?t=9699

Many people love this machine -- especially those with high pressures.

Tooly, I'm glad you are doing so well with your machine. But I can't help but wonder what a Bi-pap could do for you. I would be very interested in your perspective of the differences if you were ever to get a Bi-pap. It just amazes me that you can function at 19 with your current setup. I think your name should be Da-Man. ....

Goofproof · Post by **Goofproof** » Sat Jul 29, 2006 1:57 pm

[quote="Hambone"]I too was prescribed a cpap (w/cflex thank god) to be set at 19.

I had two sleep studies one an a cpap and one on a Bipap, My 02 sat was in 60's. The Sleep Doc said I titrated at 10 on the bipap which was equivalent to 19 on a cpap?

They recommended a Cpap w/flex at 19 and my doc prescribed it.

They also said they were trying to get me to reasonable level above 90% without adding supplemental oxygen.?

Does this sound right or should I look into this deeper...

I'll admit I do awaken every night now (didn't at first), but I know what it was like without it so I persist...

Hambone

wading thru the muck! · Post by **wading thru the muck!** » Sat Jul 29, 2006 8:02 pm

Goofproof wrote: It sounds to me like the Dr. is despensing CRAP instead of CPAP.

LOL!!!!

Sibby · Post by **Sibby** » Sat Jul 29, 2006 8:51 pm

Sounds like the opposite of me. My dr. had mine set on only 6, which seems low to me, especially since I was averaging 50 hypopneas per hour. Perhaps that is why I wake up feeling like I am gasping for breath.

Good luck getting to the solution that works for you.

tooly125 · Post by **tooly125** » Sat Jul 29, 2006 8:58 pm

Linda3032 wrote: But I can't help but wonder what a Bi-pap could do for you.

Unfortunately I have spent a small fortune on masks (4 masks in 6 months)So buying a new machine right now is out of the question.
I'm one of those people who wish they found this site before getting my equipment.
I figure as long as I don't start feeling air leaking out my ears or have my eyes pop out my body is handling the pressure.

Linda3032 · Post by **Linda3032** » Sat Jul 29, 2006 9:04 pm

I know Tooly. But if you ever go missing, we will know you either popped or blew away.

Goofproof · Post by **Goofproof** » Sat Jul 29, 2006 9:09 pm

Sibby wrote:Sounds like the opposite of me. My dr. had mine set on only 6, which seems low to me, especially since I was averaging 50 hypopneas per hour. Perhaps that is why I wake up feeling like I am gasping for breath.

Good luck getting to the solution that works for you.

Your Dr. could have been serving you out of the same basket. The pressure required to keep your airway open, Is NOT tied to how severe your Sleep Apnea is. The pressure needed is just the pressure needed to keep the airway open. Everyones pipes and muscles, are different. Jim

Sibby · Post by **Sibby** » Sat Jul 29, 2006 9:34 pm

Goofproof wrote:
Sibby wrote:Sounds like the opposite of me. My dr. had mine set on only 6, which seems low to me, especially since I was averaging 50 hypopneas per hour. Perhaps that is why I wake up feeling like I am gasping for breath.

Good luck getting to the solution that works for you.
Your Dr. could have been serving you out of the same basket. The pressure required to keep your airway open, Is NOT tied to how severe your Sleep Apnea is. The pressure needed is just the pressure needed to keep the airway open. Everyones pipes and muscles, are different. Jim

I am learning that! Thanks

Hambone · Post by **Hambone** » Sun Jul 30, 2006 4:34 am

So I need a new prescription as mine says cpap w/Flex?

Is it possible that I need such a high pressure continously to keep things open that I was prescribed cpap?

Can an Auto Bipap self titrate to a higher pressure for longer if it was needed? or is it too slow?

What I mean is would it reach 19cm after 45 minutes (my current ramp time) if it saw I needed it?

You folks are all very helpful, Wish I would have found this months ago!Thank you

May you all count one sheep tonight and fall fast asleep

Hambone[/quote]

NightHawkeye · Post by **NightHawkeye** » Sun Jul 30, 2006 5:58 am

Hambone wrote:So I need a new prescription as mine says cpap w/Flex?

To get a BiPAP, yes. A new prescription shouldn't really be a big deal though. Most physicians I've dealt with are reasonable. Just state your concerns like you have done here, and then tell him/her that you have researched machines a little and think that a BiPAP might be a better machine in the long run for you. If your physician objects, then press for answers about why, and again go through your concerns about 20 cm pressure being the limit for standard CPAP, your difficulty exhaling against the pressure, etc.

Hambone wrote:Is it possible that I need such a high pressure continously to keep things open that I was prescribed cpap?

Interesting thought. I'm skeptical that it would be true, but it's certainly fair to ask your physician about it.

Hambone wrote:Can an Auto Bipap self titrate to a higher pressure for longer if it was needed? or is it too slow?

Absolutely, it can titrate higher, all the way to its limit of 25 cm.

Hambone wrote:What I mean is would it reach 19cm after 45 minutes (my current ramp time) if it saw I needed it?

This is the ramp function you are asking about, and the answer is yes, although the higher pressure would occur at the end of the ramp. After the machine completed the ramp in your prescribed 45 minutes, then the auto-titration would take the pressure higher if you needed that. What's most likely to happen though is that at the end of the ramp the auto function will actually take the pressure lower, because your titrated pressure is only needed for a short 10% or so of time. For the other 90% of the time, your pressure needs are less, sometimes considerably less. In my own case, I can sleep about two-thirds of the night at the machine's lowest pressure because my apnea only occurs during REM sleep, and not even always during REM. I have many charts showing this pattern, which is not an uncommon pattern for apnea.

Hambone wrote:You folks are all very helpful, Wish I would have found this months ago!Thank you

Be sure to thank yourself too, Hambone, for taking the time to dig into this deeper and wanting to understand a little about your therapy. Many folks want to just believe that a doc's prescription is all that's required. Sometimes that works, but it's almost never the best treatment, and about 50% of the time is so poor that it results in no treatment at all because the patient eventually gives up.

It's good to hear that you are finding the info useful. Continued good luck with your therapy.

Regards,
Bill

Why is Cpap at 19 ridiculous?

Why is Cpap at 19 ridiculous?

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