Titration report received in the mail today

[Stevoreno_55]

I finally received a copy of my June 04, 2014 titration report in the mail today and as I suspected my current CPAP pressure of 18cm increased. Here's what the report says and what does this mean? Recommended pressure of 22/18cm H2O; [ IPAP 22cm H2O, EPAP 18cm H2O ]. Does this mean I'm a candidate for BIPAP? If so what kind of a BIPAP?


Stevoreno_55
MS Gulf Coast
06/21/14

[palerider]

I finally received a copy of my June 04, 2014 titration report in the mail today and as I suspected my current CPAP pressure of 18cm increased. Here's what the report says and what does this mean? Recommended pressure of 22/18cm H2O; [ IPAP 22cm H2O, EPAP 18cm H2O ]. Does this mean I'm a candidate for BIPAP? If so what kind of a BIPAP?

by definition, that's bilevel. cpap of 18 would be like 18/18. cpaps can't go over 3cm, and most don't have a top end higher than 20.

bipap is a trademark of philips respironics, the bilevel that resmed has is the VPAP (for, presumably, variable blah blah blah).

[JDS74]

Sounds like a bi-level to me.
It might be possible to fake it with pressure relief given the small difference though.

[Stevoreno_55]

Sounds like a bi-level to me.
It might be possible to fake it with pressure relief given the small difference though.

Fake it with pressure relief? What does that mean? Are you saying I might have to stay on a CPAP? My DME deals in ResMed machines so can you recommend a ResMed BIPAP model? Thanks.


Stevoreno_55
MS Gulf Coast
06/21/14

[JDS74]

Caution: I'm not an expert on ResMed equipment.

ResMed machines do have a function called EPR that drops pressure on exhale by an amount if not more than 3 cmH20 (ResMed folks need to chime in here on the accuracy of my understanding.)

I think it is adjustable so you may be able to set it to 20 cmH2O with EPR of 2 and get the numbers the study said.

I'm not sure if your DS400 can do something similar.

That all said, I would get a bi-level rather than be right on the edge using EPR.
Remember, a CPAP only goes to 20 cmH20 while bi-levels go up to 25 cmH2O in case you need it later.

[palerider]

Sounds like a bi-level to me.
It might be possible to fake it with pressure relief given the small difference though.

Fake it with pressure relief? What does that mean? Are you saying I might have to stay on a CPAP? My DME deals in ResMed machines so can you recommend a ResMed BIPAP model?

JDS74 is mistaken, you can't "fake" a 22/18 bilevel rx with a cpap, that's a pressure support of 4, one more than a cpap can do, not to mention that the ipap (inspiration, or top number) is 2 cm higher than most cpaps can do.

if you're going to need a regular BILEVEL machine, from respironics, then you'll end up with the VPAP S, though I'd suggest getting the VPAP Auto, the difference between them is much the same as the difference between an elite and an autoset. (ie, plain cpap vs apap).

the vpap auto can be set to cpap mode, or vpap S mode or vauto mode, and if you set it's pressure support to zero, then it behaves like an autoset, so, basically, four machines in one.

source, I use a vpap auto.

ps, you'll really like the S9 vpap auto, it's WAY nicer than your series m... like "is it on?" quieter.

[JDS74]

My mistake. I read the numbers as 20/18 not 22/18.
Bi-level is the only way to get there.

[palerider]

ResMed machines do have a function called EPR that drops pressure on exhale by an amount if not more than 3 cmH20 (ResMed folks need to chime in here on the accuracy of my understanding.)

resmed EPR drops the exhale pressure by 1,2 or 3cm, similar to a basic bilevel, but people that have played around with various resmed machines and are more sensitive to the variances than I (hello Pugsy) often report that they like the bilevel effect of the VPAP machines better than EPR. the behavior of the waveform is also customizable in various ways on the VPAP, including the timing of the effect, and how sensitive the machine is to when you start to inhale and start to exhale, thus making it more customizable to your specific needs.

[robysue]

I finally received a copy of my June 04, 2014 titration report in the mail today and as I suspected my current CPAP pressure of 18cm increased. Here's what the report says and what does this mean? Recommended pressure of 22/18cm H2O; [ IPAP 22cm H2O, EPAP 18cm H2O ]. Does this mean I'm a candidate for BIPAP? If so what kind of a BIPAP?

The script is for a plain bi-level machine (HCPC code E0470) since all it specifies is an IPAP and EPAP pressure. Both bi-level and bi-level auto machines are billed under HCPC E0470, so whether you will be set up with a fixed bi-level machine or an auto bi-level machine depends on whether the DME is willing to sell you an auto bi-level and set it to fixed bi-level mode.

The most common bi-levels seen on the forum are:

Fixed pressure bi-level machines

• Resmed VPAP S
  PR Series 60 System One BiPAP Pro

Auto adjusting pressure bi-level machines

• Resmed VPAP Auto
  PR Series 60 System One BiPAP Auto

All four listed machines record full efficacy data, so you don't have to worry about being given a brick. All four machines work with SleepyHead. The Resmed VPAPs use the same humidifier as the S9 APAP. The PR BiPAPs use the same humidifier as the System One Auto CPAP.

An additional note: It looks like your EPAP will be the same as your old CPAP pressure setting. And the IPAP is 4cm above the old CPAP setting. That's not uncommon when people are being switched to bilevel.

[Stevoreno_55]

Sounds like a bi-level to me.
It might be possible to fake it with pressure relief given the small difference though.

Fake it with pressure relief? What does that mean? Are you saying I might have to stay on a CPAP? My DME deals in ResMed machines so can you recommend a ResMed BIPAP model?

JDS74 is mistaken, you can't "fake" a 22/18 bilevel rx with a cpap, that's a pressure support of 4, one more than a cpap can do, not to mention that the ipap (inspiration, or top number) is 2 cm higher than most cpaps can do.

if you're going to need a regular BILEVEL machine, from respironics, then you'll end up with the VPAP S, though I'd suggest getting the VPAP Auto, the difference between them is much the same as the difference between an elite and an autoset. (ie, plain cpap vs apap).

the vpap auto can be set to cpap mode, or vpap S mode or vauto mode, and if you set it's pressure support to zero, then it behaves like an autoset, so, basically, four machines in one.

source, I use a vpap auto.

ps, you'll really like the S9 vpap auto, it's WAY nicer than your series m... like "is it on?" quieter.

So the ResMed VPAP Auto is the machine you recommend in the ResMed line? The doctor will write a script saying what? BIPAP Auto; pressure 18cm/22cm or something like that? I remember reading comments by another member discussing a BIPAP auto; the member said the auto feature or the pressure changing feature disrupted his sleep. I've slept for almost 7 years on 18cm straight CPAP; no ramp; just put my mask and headgear on and hit go; will there be some time in me adjusting to a BIPAP or BILEVEL or whatever kind of a machine at 18cm/22cm? Will there be times when I might experience pressures of 22cm during the night; waking up to a turbo hair dryer effect blowing up my nose or if I go to a FF mask that volume of air blowing into my mouth as well? I'm not looking forward to 22cm on a FF mask if my mouth opens up because I've been there at 18cm and waking up in the morning hasn't been that pleasant; waking up to a very dry mouth.


Stevoreno_55
MS Gulf Coast
06/21/14

[Stevoreno_55]

I finally received a copy of my June 04, 2014 titration report in the mail today and as I suspected my current CPAP pressure of 18cm increased. Here's what the report says and what does this mean? Recommended pressure of 22/18cm H2O; [ IPAP 22cm H2O, EPAP 18cm H2O ]. Does this mean I'm a candidate for BIPAP? If so what kind of a BIPAP?

The script is for a plain bi-level machine (HCPC code E0470) since all it specifies is an IPAP and EPAP pressure. Both bi-level and bi-level auto machines are billed under HCPC E0470, so whether you will be set up with a fixed bi-level machine or an auto bi-level machine depends on whether the DME is willing to sell you an auto bi-level and set it to fixed bi-level mode.

The most common bi-levels seen on the forum are:

Fixed pressure bi-level machines

• Resmed VPAP S
  PR Series 60 System One BiPAP Pro

Auto adjusting pressure bi-level machines

• Resmed VPAP Auto
  PR Series 60 System One BiPAP Auto

All four listed machines record full efficacy data, so you don't have to worry about being given a brick. All four machines work with SleepyHead. The Resmed VPAPs use the same humidifier as the S9 APAP. The PR BiPAPs use the same humidifier as the System One Auto CPAP.

An additional note: It looks like your EPAP will be the same as your old CPAP pressure setting. And the IPAP is 4cm above the old CPAP setting. That's not uncommon when people are being switched to bilevel.

So making the transition from a straight CPAP at 18cm to a soon to be BIPAP or BILEVEL at 18cm/22cm which machine will be a smoother transition for me coming from my old CPAP pressure of 18cm? A fixed BIPAP or an auto BIPAP? Is an auto BIPAP the one that detects you need more pressure during the night and does it automatically?


Stevoreno_55
MS Gulf Coast
06/21/14

[Pugsy]

You need to remember that Bipap is Respironics trademark name for a bilevel machine...we use it sort of generically but actually when you say Bipap...that's a Respironics machine.

VPAP is the Resmed trademark name for a bilevel pressure machine.

A fixed bilevel pressure machine (either brand) has 2 modes of operation...cpap mode and fixed bilevel pressure mode.
An auto adjusting bilevel pressure machine has 3 modes of operation...cpap mode, fixed bilevel mode and auto adjusting pressure mode.
If at all possible get the auto adjusting model of whichever brand you and your DME decide you are going to get.
If the auto adjusting pressures bother you too much you can always use the machine in fixed bilevel mode.
Not everyone has problems with auto adjusting pressures and sometimes they actually are an advantage.

And yes....22 and 18 is going to be a much easier transition than 18/18 that you have been using.

[ChicagoGranny]

A fixed BIPAP or an auto BIPAP?

Get the Auto BIPAP. If you end up preferring a fixed pressure, the Auto machine can be set to fixed. But if you get the straight (fixed) BIPAP and ever decide you want to try Auto, you will need an Auto machine.

ChicagoGramps

[Stevoreno_55]

You need to remember that Bipap is Respironics trademark name for a bilevel machine...we use it sort of generically but actually when you say Bipap...that's a Respironics machine.

VPAP is the Resmed trademark name for a bilevel pressure machine.

A fixed bilevel pressure machine (either brand) has 2 modes of operation...cpap mode and fixed bilevel pressure mode.
An auto adjusting bilevel pressure machine has 3 modes of operation...cpap mode, fixed bilevel mode and auto adjusting pressure mode.
If at all possible get the auto adjusting model of whichever brand you and your DME decide you are going to get.
If the auto adjusting pressures bother you too much you can always use the machine in fixed bilevel mode.
Not everyone has problems with auto adjusting pressures and sometimes they actually are an advantage.

And yes....22 and 18 is going to be a much easier transition than 18/18 that you have been using.

The RT working for my DME has told me they deal primarily in ResMed machines; she didn't know if they could order me a Philips Respironics machine but they would try to do it when the time comes which is much closer today than it was yesterday. I've been using a gently used ResMed S9 Elite CPAP machine with heated humidifier from my DME for 2 months now since my P.R. DS400S finally died 2 months ago. The loaner from my DME is set to 18cm straight CPAP. So I need to try and get an auto adjusting machine and not a fixed machine. The fixed machine wouldn't be set for 22cm straight pressure I hope. It would have a range from 18cm to 22cm?


Stevoreno_55
MS Gulf Coast
06/21/14

[robysue]

The RT working for my DME has told me they deal primarily in ResMed machines; she didn't know if they could order me a Philips Respironics machine but they would try to do it when the time comes which is much closer today than it was yesterday. I've been using a gently used ResMed S9 Elite CPAP machine with heated humidifier from my DME for 2 months now since my P.R. DS400S finally died 2 months ago. The loaner from my DME is set to 18cm straight CPAP. So I need to try and get an auto adjusting machine and not a fixed machine. The fixed machine wouldn't be set for 22cm straight pressure I hope. It would have a range from 18cm to 22cm?

No. There's no real point in trying to get an S9 AutoSet or a PR System One APAP set to 18-22cm at this point.

First: APAPs can't go up to 22 cm. So you need a bi-level machine anyway. The suggestion is to try to get an auto adjusting bi-level so that you have the option of running in either fixed bi-level mode or auto adjusting bi-level mode.

Second: Once you have a bi-level, the first thing to try is fixed bi-level mode with IPAP = 22cm and EPAP = 18cm. The pressures won't auto adjust (so there's one less thing to get used to), but the pressure WILL switch from IPAP to EPAP at the start of every exhalation and it will switch from EPAP to IPAP at the start of every inhalation. The switch between IPAP and EPAP should follow your respiration---in other words, the switch to IPAP should occur right as you start to inhale and the switch to EPAP should occure right as you start to exhale.

For a few people, the changes between IPAP and EPAP don't seem to quite "sync" with the natural respiratory pattern. On the Resmed S9 VPAP there are additional settings (Ti max, Ti min, Trigger and Cycle) that can be used to fine tune the transitions between IPAP and EPAP. On the PR System One, the rounding in Bi-Flex provides a bit of flexibility in helping the machine match your breathing; if Bi-Flex is uncomfortable, then the Rise setting may help.