Bi-Level Titration Accomplished!

[Slinky]

Had a different sleep tech this time. I really enjoyed talking to her. Was delighted to hear she took her training at Baker College (a private business college) until she said it was the one in Flint. Doggone it! Do you think 65 is too old to invest in RPSGT training? It fascinates me. I know Baker isn't cheap!!! My grandson went there for Rad Tech training. Since he was from out of state and didn't know anyone at the time (he lived w/us during his training) I went the first semester and took a Medical Terminology class. That way he had someone he knew on campus but wasn't stuck w/me in the same class just in case it might embarrass him. Besides, Med Term always interested me. Cost me an arm and a leg to do so tho! I don't know if I could swing the full course to get my degree or not financially. *sigh* But, I'm gonna call Baker and at least investigate what's entailed and the costs.

But back to the bi-level titration. Wow! As soon as she turned that bi-level on (way before starting the study) I was AMAZED at how easy it was to breathe! I felt like I could have used a LITTLE 02 but instead she turned the pressure up a bit. It was still comfortable but not that amazing ease of breathing as when it was first turned on. That first pressure, whatever it was, was easier breathing than when I'm up and awake thru out the day!!! Later, we did the "testing": eyes right, eyes left, chew, snore, wiggle legs, etc. I read a short while but as soon as I felt the least tired I suggested we turn the lights out and let me sleep. I had to take a Tylenol as for some reason my back ached. This is the same bed I slept in a couple of weeks ago for the titration and its not an uncomfortable bed. Altho, as I've noticed before, the spread is too heavy and weighs on the toes and feet. I should mention that to the manager and never think to.

We started w/my beloved Simplicity. I'm usually asleep w/in 10-15 minutes. After about 45 -60 minutes I asked if I could take an Ambien. I was asleep shortly after the Ambien. *smile* She came in to add 02. I went right back to sleep. She came in because of a problem w/a lead/leads a couple of times but I don't really remember if it was while I was laying there before taking the Ambien or after I had fallen asleep. Whichever, I didn't have any problems going back to sleep.

I think it was well into the night when she did come in to suggest changing to the Quattro as I was having some high leaks. (First time THAT has ever happened!). I've never in ANY of my titrations had them come in because of a high leak! (Too bad I can't find out how these leaks compared w/previous titrations). So we switched to the Quattro. She needs more experience in mask fitting, but time will cure that, I'm sure. Much too tight on the top straps. I loosened them a couple of times. I think she is gonna make a GREAT tech when she gets the mask fitting down pat!! She couldn't find one of the new Resmed Micros in stock. *sigh*

Then I slept a good straight length of time I'm sure. But woke up w/that Quattro just too darn sore on the snozz. There's definitely a knack to getting that flimsy cushion at the bridge of the nose turned UNDER!!! I'm not impressed w/its being so flimsy. Something just a LITTLE thicker, firmer would be a better idea. In my estimation.

I asked to switch back to my Simplicity because my nose was just too sore to keep that Quattro on much less to sleep w/it and she was agreeable.

I'm not sure if I dozed off for long after changing back to the Simplicity before I KNEW I was awake for the day. I laid there for 10-15 minutes before deciding to call it quits. I was outta there and on the road by 6:30-6:45.

One thing new that I was quite impressed with! They have a print out now that I've not been given before. (I wonder if Eric came up with it?). Thru out the long list of suggestions for adjusting to CPAP it is repeatedly suggested that you call the sleep lab if you have any problems and repeatedly gives the phone number and hours. Even to call at night, if there is a tech on and not busy, the tech will help you! Even some suggestions on flying w/CPAP and NOT checking it as baggage.

Now - if only they still had a doctor who doesn't admonish a patient for asking too many unnecessary questions!!!

No matter. I both told the tech AND wrote on the permission form we have to sign: IF BI-LEVEL NEEDED, DO NOT WRITE ORDER!!!

I did this before when I titrated for the CPAP so I know the lab will honor that - whether this new doctor will or not - who knows. If he won't write the script for the Resmed VPAP Auto I want, I'll ask my family doctor to write it. I also told the tech to tell the office staff to just mail me my dictated and scored reports. I usually stop in and pick them up but w/this new sleep doctor ... why bother? He's pleasant, laid back, soft spoken. But he doesn't listen to the patient at all. This is just such a great sleep lab, I hope this new doctor adopts more of their ways w/time.

Oh - and how do I feel this morning? Better than most nights on CPAP and every bit as good as my best nights on CPAP (which were farther apart and fewer than I would have liked). We'll see how the day goes and how I feel this afternoon and evening. I'm just being cautious and trying not to be too enthusiastic just yet.

[Pad A Cheek]

Hey Slinky,
That is great that you had a good titration.

I wish you the very best in getting the machine and settings that will have you waking refreshed and full of vim and vigor every morning.

And 65 is not to old to learn ANYTHING. Great things happen with the extra wisdom you have after 50. I can see it now SLINKY the Sleep Tech,.......

Karen

[Slinky]

Thanks, Pad! But is it worth the FINANCIAL INVESTMENT? Would anyone HIRE me at 67-68 years of age? I mean, if the RPSGT training were free or cheap, even reasonably priced, I'd take the course in a heartbeat and not have to worry about whether I could get hired full time. But that's an awful lot of money (based on my Med Term tuition) to take out of our savings this late in our life! Baker College has EXCELLENT courses and training. Flint is an hour drive in GOOD weather.

You know, this is the FIRST time in my life that I've EVER wished that I was younger!!!!

[Slinky]

Ooops! Sorry, Pad. Thank you too for the good wishes on the titration.

[gasp]

Glad your titration went well!

Regarding the heavy covers - I am a 'keep my pinkies free' person and always pull the covers out from being tucked under the bed. Then I make a fold which serves as a tent out of the sheet and blanket across the bottom of the bed. I tuck in the excess sheet/bed cover at the bottom of the bed to keep the 'tent' in place. The fold makes room for my feet while sleeping. If the bed cover is too heavy I take it off and ask for an extra blanket if needed.

Usually sleep centers are so warm I don't need the extra blanket.

: )

[rested gal]

Great report, Slinky!

Glad to hear your titration night went well, other than the Quattro bit, which you got changed back to your comfier usual mask.

I wouldn't be too quick to demand the Malibu. And I'm not saying this because of my distaste for resmed's long-standing attack on internet "cpap" sales.

What matters, especially with additional health problems beyond OSA, is to get the right machine for the most effective treatment as well as comfort. You've already experienced the extreme comfort of breathing with a bilevel right there at the titration.

With COPD, I don't think auto-titration is recommended at all. So probably what you'll need to use is "just" bilevel.

That said, I'd still do what you want to do... get an auto-titrating bilevel machine. Just don't turn on auto-titration. Use it only in bilevel mode.

Having a machine that could be used in autotitrating bilevel mode, even if you never use it in anything but pure bilevel mode, is a good investment, imho. Much more desirable machine for selling later, if you ever want to sell it.

The reason I said forget the Malibu (resmed's VPAP Auto) is because I think with COPD, you need every bit of comfort and easy breathing out that you can get. Getting each exhalation started as easily as possible is the key to comfort with a bilevel, imho.

The Bi-Flex feature in the Respironics BiPAP (and BiPAP Auto) gives that bit of extra drop in pressure at the beginning of each exhalation, then smoothly brings back in the already lower EPAP pressure for the remainder of the exhalation. Bi-flex's easy start to each exhalation could make all the comfort difference in the world to someone with COPD. Might even make a treatment difference where COPD is an underlying breathing issue.

Already having the software for one particular brand and liking the machine display is understandable. Not a small consideration.

However, looking at the single most important consideration -- effective treatment -- while also considering the COPDer's need for the easiest, most comfortable exhaling possible, I'd recommend bilevel with bi-flex. Either the BiPAP with Bi-Flex, or the BiPAP Auto with Bi-flex, used in bilevel mode with bi-flex turned on. If it turns out that setting a "rise time" is preferable to turning on bi-flex, the Respironics machine has adjustable rise times -- how fast the full IPAP is delivered when a person starts to inhale.

I've used both of the major brands' bilevel machines. Bi-flex does make an amazing difference in getting an exhalation started. While I don't need that, I do enjoy the comfortable feel of using bi-flex. I like the feeling it gives of such natural breathing. Comfort issues, whether it be mask or ease in getting an exhalation started, can sure matter when it comes to getting restful sleep along with effective treatment.

About the job market for mature people embarking on a new career.... heheh. Well, since I'm in my sixties, too, and just as fascinated by "sleep" as you are, Slinky... maybe we should go back to school together! We might have to start our own sleep lab, though, when we find no place would hire newly graduated sixty-something'ers:

"Senior Sleep Lab"

I'll put cots in the unoccupied kennel runs.

[Slinky]

Yer on, RG!!! Seniors Sleep Lab. Sounds good to me. And it would be FUN to have a friend as a classmate!

The Resmed VPAP Auto is new. Its not the Malibu. This new VPAP Auto is in the S8 body and uses the Humidaire 3i (the Malibu uses the Humidaire 2i and I "think" may be in the S7 body).

http://www.resmed.com/en-us/assets/docu ... sa-eng.pdf

The one I did want before learning about the new Resmed VPAP Auto was the Respironics pre-M Series Bi-PAP w/Bi-Flex but I wasn't sure my DME supplier could still get it.

Actually, I'd be satisfied w/either one. No way I can afford to buy either or the other via self-pay so have to stick w/my local DME supplier and fortunately, they are a good one (can't say the same for the orignal local I had!!!!). I just don't want the M Series.

Hey! It turns out MartiniLover and I had the same sleep doc! My ORIGINAL sleep doc, not this new guy. And ML likes my original sleep doc too!!

[ozij]

Hey, Slinky,
I just tried to congratulate you in the live chat room - and it said you were away!

O.

[mindy]

Hi Slinky,

So happy to hear your titration went well!

Although we're a little ahead of the boomers, once that big group hits retiremenet, some employers will probably be fighting over us currently "sixty-somethings" I think you and RG would make great sleep techs ... RG would send them all home with panty hose tights!

Mindy

[Banned]

I know this is going to sound very rude and disrespectful, but at 68 years old, haven't you earned the right to slip into something more comfortable like a ResMed VPAP Adapt SV? It may even help diminish those O2 cravings.

Cheers

[StillAnotherGuest]

I know this is going to sound very rude and disrespectful, but at 68 years old, haven't you earned the right to slip into something more comfortable like a ResMed VPAP Adapt SV? It may even help diminish those O2 cravings.

This is poor advice.

Slinky is actually an "Overlap Syndromer", and a clear contraindication for ASV.

SAG

[StillAnotherGuest]

BTW, Slinkster, have you heard the VPAP Auto run? The flow generator is encased in an air cushion, the noise level is unbelievably low.

SAG

[dsm]

Slinky,

Good news! - also very interesting feedback.
Please do tell us more when you have one at home (like what does you Reslink report ?)

Cheers

DSM

[Slinky]

Wow! Thanks, everyone!! I'm sorry I missed you in chat, Ozij!

Gasp! What a wonderful idea about the "tent" for the tooties and toes!! Duh. I never thought of that. This sleep lab was definitely NOT too warm for this old pansy. I even asked for and got an extra blanket every time I've slept there. I'm always cold. Especially my feet. I can't sleep w/o sox on, even when I was a little kid. Cold feet, no sleep.

Thanks, Banned, but this is NOT the Resmed Adapt SV. This is a new Resmed VPAP Auto. It is NOT the Malibu either. (The one I'm talking about that I'd like to have.)

SAG! THANK YOU! I'm flattered, thank you for taking the time to comment. No, I haven't heard it run. Thanks for that info. I've just read about it at

http://www.resmed.com/en-us/assets/docu ... sa-eng.pdf

That was the first that I had heard of it. And I can thank DSM for that. I even contacted Resmed to be sure it WAS available in the USA.

Of course, I will keep you informed, DSM. We'se ResLink owners who haven't tried the ResLink yet, aren't we?

Giggle! Thanks, Mindy. Yer probably right about RG and the pantyhose tights. And of course, I'd be telling them you MAKE the doctor order the access to your data on the LED screen!!! DON'T you let that DME give you anything less than a fully data CPAP!! Ah, the local DMEs would hate us.

Oh, and, yeah, RG. I even use my Vantage in just straight CPAP mode. Well, yeah, I did play around w/7 cms to 10 cms and 8 cms to 11 cms on 2 separate occasions (based on the data from that RemStar Auto loaner my doc had scripted way back when), but that's all.

[ColinP]

Glad it went well Slinky. Or should that be Dr Slinky?

Colin