3rd titration

Well, howdy everyone.

I haven't posted in a long time. I've been waiting and waiting to get my right machine.

My saga began when I went to the doctor's office on 7/29/21 and said, "I stop breathing when I'm asleep." The first sleep study showed a very solid baseline full of centrals and the occasional snore. But, they only got the machine up to a level 11 before it was time to kick me out. Dr. Novak recommended going back for a full night sleep.

So, I go back for sleep study #2, but only hit REM for 1.5 minutes. Horrible night, but the sleep tech turned on the "backup rate" once I was on level 18, and with that backup rate, I completely normalized. 0 centrals and 98% O2. I think I might have normalized at a lower pressure, but who knows?

Whoever read that sleep study said that I normalized at 18/14 with 11 backup rate (BUR). So, of course, they wanted to send me home on straight CPAP level 10. Yeah, at level 10 my Nadr was 88%. So, I called me doctor, and argued with him. Why take away the backup rate when my baseline (no mask) showed a lot of centrals. Well, he saw it my way, and agreed to talk to the sleep guy who made that recommendation. I don't know what happened, but I was referred to the sleep disorder specialists.

And that's when I met Kassandra, who after about 15 minutes agreed that I need the better machine. And she set up a 3rd sleep study (with Lunesta). Her orders were "Since he has a primary CSA at baseline and not just treatment emergent CSA, a full night Bilevel S/T titration starting with Bilevel S/T 11/6 cmH2O and BUR of 11 bpm. with Transcutaneous CO2 monitoring was ordered."

Enter sleep tech Melvin. I showed up for my third sleep study, got hooked up and went to sleep. In the morning, I asked Melvin, "How'd we do?" He said, "Great, we never even got above 12 cmH2O." That seemed odd since we were supposed to start at 11. "And," he added, "I never even had to turn on the bipap." I said, "But that's what I came."

Melvin left me at 5 for 45 minutes, 7 for 40 minutes, 9 for an hour, 10 for 35 minutes, and 12 for 2 full hours. Yep, he treated me like a new patient.

When I went in to "discuss the results" of my study, I said, "Alright, first I'd like to know why Melvin did what he did." She had no answer of course, but after some conversation, agreed that I needed to have a Resmed auto bipap with humidification set at IPAP max 20 and EPAP min 8 cmH2O, and pressure support of 4.

Can somebody tell me if that prescription has that BUR of 11 backup rate? Is that part of "auto"?

Thanks!

ShallowBreather wrote: ↑

Sun Mar 06, 2022 2:12 pm

needed to have a Resmed auto bipap with humidification set at IPAP max 20 and EPAP min 8 cmH2O, and pressure support of 4.

Can somebody tell me if that prescription has that BUR of 11 backup rate? Is that part of "auto"?

No....the "auto" part of the ResMed Auto Bilevel/bipap machine just refers to the auto adjusting pressures that are needed to deal the the obstructive events as they vary during the night.

These settings reflect a bilevel machine in auto mode...and there is no mention of a back up rate at all.
Not all bilevel machines have a back up rate.
Not all bilevel machines with a back up rate have auto adjusting pressure capabilities.

The ResMed AirCurve 10 Vauto...is a bilevel machine that your minimum EPAP of 8 and PS of 4 with Max IPAP of 20...will satisfy those parameters but it does NOT have any back up rate capabilities at all.
It normally isn't used for people who have central sleep apnea and need a back up rate...back up rate just means the machine will breathe for you or force a breath when you don't breathe on your own.
It sounds like this is the machine they are going to prescribe but it doesn't have a good track record of dealing with central apneas very well since it can't force you to breathe when you don't breathe from a central apnea.

If you have both obstructive sleep apnea and central sleep apnea without any cpap...you probably would do better with the ResMed AirCurve 10 ASV machine....it will treat both the central apneas (using the back up rate it will calculate) and obstructive apneas by auto adjusting the pressures as needed.

You might want to read up on just which ResMed BiLevels models do what.

https://www.resmed.com/en-us/sleep-apne ... 0-bilevel/