Change Machines

[Phil587]

Hi, guys -- new guy here.

I posed a question in another apnea forum and got some good responses. I thought I would post the same question here to get a larger/different sampling of opinion. Here goes by way of copy and paste:

Anywho -- diagnosed 6/11 during sleep study. Was provided a 60 Series Respironics CPAP set at 6 CM3 H2O so I could "get used to the idea". Back for second night sleepover titration nad was provided a BiPAP 60 Series set at 19/15. First rank was 27.4 AHI. CPAP set at 6 lowered that to 20-24 AHI. In other words, not much. With new BiPAP last night's AHI was 2.0 with 7 day average running around 3.7 -- had a few "issues" at first. Now, at 19/15.....

Have you ever seen one of those things on the side of the road designed to get you attention? You know -- the ones with air blowing through them and the flop all over the place? That's kinda how I feel at this high pressure.

I am considering purchasing on my own an *Auto* BiPAP 60 Series to help with the pressure. If I have done my just due properly, I can set the auto machine to only go that high if it needs to do so. According to the Sleepyhead software, that would only be a short period of time during any given night and I could have a morfe comfortable setting the balance of the night.

Sound logical or have I lost my mind? What say the more experienced around here?

Thanks for any help offered!

Phil

[englandsf]

Have you tried an apap with exhale pressure relief and a wider range of pressures. My titration was faulty but I got a new S9 set at 10-20 (with -3 EPR) and now I have the right mask (P10) I am down to 2-3 AHI from high thirties. Pressure used is 10-12 so no blow ups. Are you on a full face mask or what?

[Phil587]

Have you tried an apap with exhale pressure relief and a wider range of pressures. My titration was faulty but I got a new S9 set at 10-20 (with -3 EPR) and now I have the right mask (P10) I am down to 2-3 AHI from high thirties. Pressure used is 10-12 so no blow ups. Are you on a full face mask or what?

Thanks for your response, englandsf. No, I have not ried an apap with a wide range capability. After my first night sleepover test, my doc wrote a scrip for a CPAP machine with a single approved setting between 6 and 10 cm3H20. My chosen DME provided a Philps Series 60 set at 6 to use until I had my second sleepover titration 2 weeks later. The 6 cm3H20 essentially did nothing to aleviate my apnea. The nurse/Tech during my second sleepover 2 weeks ago gradually incrfeased the pressure during the night until my apneas ceased at a high number. They then changed my scrip to a BiPAP unit set at 15 and 19 cm3H20 and the DME provided the machine. It is not, however, an "automatic" machine. I'm thinking an "auto" machine would allow me to operate at a lower pressure for most of the night only going to a higher number when required. I'm hoping that the case because 19/15 blowing in your face all night is STOUT.

If so, my very next question will be Philips or ResMED?

Thanks,
Phil

[Phil587]

Have you tried an apap with exhale pressure relief and a wider range of pressures. My titration was faulty but I got a new S9 set at 10-20 (with -3 EPR) and now I have the right mask (P10) I am down to 2-3 AHI from high thirties. Pressure used is 10-12 so no blow ups. Are you on a full face mask or what?

Forgot one of your questions -- sorry!

The mask I am using is the Mirage Quattro full face mask. So far, I have adapted to it quite well. My AHI last night was reported at .4 by the BiPAP machine.

Phil

[JDS74]

If you are having good results with the Respironics BiPap machine, you should continue with an Auto BiPap as well.
You could try a couple of things with the auto.

1. Turn on Ramp with a minimum pressure of 10 cm H2O and a time of 20 minutes. That should get you to sleep before the main pressure increase.

2. Try setting the auto to 13/19 for a while and see how the data is after a week or so.

3. Get either SleepyHead or Encore so you can track your own data.

The feeling of being in a tornado will go away and there will come a time that at your pressures you will have to check to see if the machine is on 'cause you won't feel the pressure.

Stick with Respironics since your local folks deal with them, the titration was done with one, and you actually seem to be able to use one.

BTW, the ramp function will work with the current BiPap machine. Just understand that some apneas will occur during the ramp time. After that you will be asleep and not notice the pressure.

[Phil587]

If you are having good results with the Respironics BiPap machine, you should continue with an Auto BiPap as well.
You could try a couple of things with the auto.

The feeling of being in a tornado will go away and there will come a time that at your pressures you will have to check to see if the machine is on 'cause you won't feel the pressure.

Stick with Respironics since your local folks deal with them, the titration was done with one, and you actually seem to be able to use one.

Thanks for the detailed response, JDS74. You provided some excellent info for me to consider.

It's funny you mention checking to see if the machine is on because I already do that in the mornings. It's really strange after the night before when first turning on the machine I feel I need to hold on to something to keep from being blown away.

I will not be dealing with my "local people" for my new machine. I am going to purchase it outright and one or the other (probably the one I have now) will be regulated to backup and travel unit status. I intend to get a copy of my scrip that will allow me to purchase the machine I feel I need instead of an arbitray selection by some gomer/gomerette at my DME. They have already made enough mistakes to let me know I need to be in charge of my own therapy -- doctor monitored, of course.

Thank you very much for your suggestions.

Phil

[bwexler]

If you want an auto BiPap machine why not discuss it it with your doctor and have him write them prescription for what YOU want and have the DME provide it and your insurance pay for it. You will need the prescription anyway.
I am assuming your insurance is picking up the tab for all or most of this.

[Phil587]

If you want an auto BiPap machine why not discuss it it with your doctor and have him write them prescription for what YOU want and have the DME provide it and your insurance pay for it. You will need the prescription anyway.
I am assuming your insurance is picking up the tab for all or most of this.

Thanks for you post, bwexler.

Gwetting my doc to write a new scrip is precisely what I am doing. There are two very good reasons for not going through a DME. First, my insurance will cover a purchased machine. Second, the reason they will cover it is I have proven to them *they* will save a ton of money doing so PLUS, even though insurance would cover 80% through the DME, *I* personally will save $250 doing the outright purchase. Insurance companies and people are awful.

Phil

[englandsf]

Phil. I went ResMed based on my circle of friend's recommendation. Full face mask was huge error for me to start with extreme claustrophobia. Turns out my pressure is about 12, so amy machine is Autoset at 10-20 and EPR of 3 feels very low pressure all the time and works well with pillows (which struggle with higher pressures I think... Watching everything on Sleepyhead (Mac user so no other choice)is very cool.

[archangle]

Auto is convenient. Since auto machines almost always work as manual pressure machines, there's little reason not to buy an auto.

However, with enough tinkering by your doctor or on your own, you can probably find the "right" pressure even with a manual bilevel machine like you have already. If it costs a lot of money to upgrade, you may be able to get by with the manual.

You'll probably adjust to the pressure pretty quickly. I use 16 cmH2O pressure and have to put my hand near the vent sometimes to convince myself the machine is running.

Whacky Waving Inflatable Arm Flailing Tube Man doesn't tend to hang around for very long.

[Phil587]

Phil. I went ResMed based on my circle of friend's recommendation. Full face mask was huge error for me to start with extreme claustrophobia. Turns out my pressure is about 12, so amy machine is Autoset at 10-20 and EPR of 3 feels very low pressure all the time and works well with pillows (which struggle with higher pressures I think... Watching everything on Sleepyhead (Mac user so no other choice)is very cool.

Thanks for your follow-up, englandsf. The individuals on this message board seem to have a preference for ResMED equipment for some reason and had me initially leaning that way. However, the DMEs and sleep docs locally seem to prefer Philips equipment and I am now trending that way simply because of local experience. I'm thinking I can't go wrong whichever I choose. Now masks, on the other hand, are a different matter. My DME provided the "Wisp" nasal mask at first and I had no problems with it. The sleep tech at my titration sleepover suggested a Quattro full face due to the pressures I apparently need. I'm thinking 19 cmH2O would blow that Wisp across the room! I also have a bit of claustrophobia but, so far, have been able to "talk myself off the ledge" so to speak. It does take a little convincing, though.

Again, thanks for your post.
Phil

[Phil587]

Auto is convenient. Since auto machines almost always work as manual pressure machines, there's little reason not to buy an auto.

However, with enough tinkering by your doctor or on your own, you can probably find the "right" pressure even with a manual bilevel machine like you have already. If it costs a lot of money to upgrade, you may be able to get by with the manual.

You'll probably adjust to the pressure pretty quickly. I use 16 cmH2O pressure and have to put my hand near the vent sometimes to convince myself the machine is running.

Whacky Waving Inflatable Arm Flailing Tube Man doesn't tend to hang around for very long.

Yep -- that's the guy! Just what I feel like at 19 cmH2O.

Thank you for the info and support provided -- just what I needed to hear.

I am almost possitive I need to purchase an auto machine precisely for the reasons you stated. Sleephead is telling me my "events" come in clusters lasting around 30 minutes or so and I simply see NO reason to have that gale force wind in my face all night long. I may end up that way bvut I think an auto would better help me make that determination. The 15 cmH2O on exhale seems not too bad but that 19 on inhale seems to cross some invisible line. It feels MUCH stronger than just the 4 additional cmH2O would suggest.

Thanks you,
Phil

[Julie]

A pressure of 10 is very average, and certainly should not dislodge a Wisp if the mask is at all fitted properly.

[Phil587]

A pressure of 10 is very average, and certainly should not dislodge a Wisp if the mask is at all fitted properly.

Thanks for your post, Julie, but my prerssure in NOT 10 (not sure where you got that). My inhale pressure is 19 and I can almost guarantee that will dislodge a Wisp. I tried it. As long as I adjusted it *perfectly* it was fine -- until I made the slightest movement.

Phil

[palerider]

nothing to see here.