Do I really need a new titration study??

palerider wrote:

HST wrote:

palerider wrote:then when you mouth the 'weight loss help apnea' old mindset, you should be sure and add the caveats, that it can *CHANGE* needs, might make apnea better, MIGHT MAKE IT WORSE, might not change it at all.

I was warned that being a tech I would need some thick skin and expect to get slammed. I'm not trying to push MyAir, I simply noted that it is a free feature included with the machine. As for the weight loss and surgery, It is a fact that significant weight loss can reduce and sometimes cause apnea to go away. Deviated nasal septums, enlarged uvulas, enlarged adenoids and enlarged tonsils can cause obstruction in the airway and sometimes when removed or corrected can cure sleep apnea.
When I get a patient that doesn't want to do a sleep study and states that they would rather have a surgery, I tell them that most of the time surgery doesn't work and CPAP is the most effective method of treatment.
Tips for betting? Don't lol, save your money.
There ya go

I think you pasted in the wrong answer there, hoss.

Did you not see the bold text? Maybe I did it wrong

HST wrote:

palerider wrote:

HST wrote:[As for the weight loss and surgery, It is a fact that significant weight loss can reduce and sometimes cause apnea to go away.

I think you pasted in the wrong answer there, hoss.

Did you not see the bold text? Maybe I did it wrong

burying your snarky response in the middle of something you pasted to someone else, leading off with a comment about myair isn't great communication.

however, your statement is like saying "Jumping off a cliff CAN be fun and exhilarating!" it can also leads to death and serious injury. present balanced, not biased information.

there are plenty good reasons to lose weight, trying to fix your sleep apnea is not one of them.

Hi, I was just diagnosed with sleep apnea last month and I am a small older lady. Sometimes I wish I was overweight so I could just simply go on a diet to lose 15 or 20 lbs or more to get some refreshing sleep without having to use pills or c-pap, etc.

I have read sleep apnea postings on other sites, people said they lost weight and it helped lessen the severity of sleep apnea and they slept better without aids. My husband lost weight
recently, about 20 lbs because he has to be on a special diet. I notice he doesn't snore much anymore.

palerider wrote: burying your snarky response in the middle of something ....

And nobody hates snarky responses as much as Palerider....

dvejr wrote:

palerider wrote: burying your snarky response in the middle of something ....

And nobody hates snarky responses as much as Palerider....

it's not the snarky responses that I mind, it's the lazy, poor delivery

HST wrote:AHI of 5.0 or greater is considered positive. I get patients all the time that have been on CPAP for 10 years or more but the doctor orders a diagnostic followed by titration if positive. IMO its dumb because apnea doesn't usually go away without surgery of weight loss. But in order for insurance to pay for study and equipment, they want proof that you still have apnea. If you haven't had a study in the past 2 years then insurance would require new data. The newer machines are a lot smaller and have some neat functions included. The answer to your question about just adjusting your machine would be how much does it need to be adjusted. That could be a long process of trial and error. A titration study would be more effective with active monitoring.

Getting way back to the original post ....I went and talked with a tech about my readings. Looks like the machine is already auto adjusting to 19. I guess 20 is the max, and I still have an AHI of 13.8. When he went back and looked at my original study, it did show 49 Central Apnea events and 53 Obstructive Hypopnea events. No one ever mentioned the central events when I got my original machine 10 years ago. So, the supposition is that the Central Apnea might be what is keeping my AHI up. Does that make sense?

ICS1955 wrote:

HST wrote:AHI of 5.0 or greater is considered positive. I get patients all the time that have been on CPAP for 10 years or more but the doctor orders a diagnostic followed by titration if positive. IMO its dumb because apnea doesn't usually go away without surgery of weight loss. But in order for insurance to pay for study and equipment, they want proof that you still have apnea. If you haven't had a study in the past 2 years then insurance would require new data. The newer machines are a lot smaller and have some neat functions included. The answer to your question about just adjusting your machine would be how much does it need to be adjusted. That could be a long process of trial and error. A titration study would be more effective with active monitoring.

Getting way back to the original post ....I went and talked with a tech about my readings. Looks like the machine is already auto adjusting to 19. I guess 20 is the max, and I still have an AHI of 13.8. When he went back and looked at my original study, it did show 49 Central Apnea events and 53 Obstructive Hypopnea events. No one ever mentioned the central events when I got my original machine 10 years ago. So, the supposition is that the Central Apnea might be what is keeping my AHI up. Does that make sense?

Of course it does. And, using an APAP in a range of pressures may also be adding to the problems, even though most APAP algorithms are supposed to try to avoid Centrals. But, they'll respond first to Flow Limitations and Snores. So, if it's Flow Limitations that are driving your pressures up AND you're in the percentage of people who are susceptible to "pressure induced Centrals", then it can be a nightly combination of ingredients that are wreaking havoc.


Den

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ICS1955 wrote:

HST wrote:AHI of 5.0 or greater is considered positive. I get patients all the time that have been on CPAP for 10 years or more but the doctor orders a diagnostic followed by titration if positive. IMO its dumb because apnea doesn't usually go away without surgery of weight loss. But in order for insurance to pay for study and equipment, they want proof that you still have apnea. If you haven't had a study in the past 2 years then insurance would require new data. The newer machines are a lot smaller and have some neat functions included. The answer to your question about just adjusting your machine would be how much does it need to be adjusted. That could be a long process of trial and error. A titration study would be more effective with active monitoring.

Getting way back to the original post ....I went and talked with a tech about my readings. Looks like the machine is already auto adjusting to 19. I guess 20 is the max, and I still have an AHI of 13.8. When he went back and looked at my original study, it did show 49 Central Apnea events and 53 Obstructive Hypopnea events. No one ever mentioned the central events when I got my original machine 10 years ago. So, the supposition is that the Central Apnea might be what is keeping my AHI up. Does that make sense?

Your first post read, ." I went to a local sleep specialist who read my machine and told me my Apnea Index is 4.8, my Hypopnea index is 9.1 and my AHI is 13.8"
So it looks like your hypopnea is the biggest problem. If you need insurance to pay for a machine, then you are going to have to do the study. Other wise you could do it yourself with a bi-level. Pressure goes up to 25.

lilly747 wrote:

ICS1955 wrote:

HST wrote:AHI of 5.0 or greater is considered positive. I get patients all the time that have been on CPAP for 10 years or more but the doctor orders a diagnostic followed by titration if positive. IMO its dumb because apnea doesn't usually go away without surgery of weight loss. But in order for insurance to pay for study and equipment, they want proof that you still have apnea. If you haven't had a study in the past 2 years then insurance would require new data. The newer machines are a lot smaller and have some neat functions included. The answer to your question about just adjusting your machine would be how much does it need to be adjusted. That could be a long process of trial and error. A titration study would be more effective with active monitoring.

Getting way back to the original post ....I went and talked with a tech about my readings. Looks like the machine is already auto adjusting to 19. I guess 20 is the max, and I still have an AHI of 13.8. When he went back and looked at my original study, it did show 49 Central Apnea events and 53 Obstructive Hypopnea events. No one ever mentioned the central events when I got my original machine 10 years ago. So, the supposition is that the Central Apnea might be what is keeping my AHI up. Does that make sense?

Your first post read, ." I went to a local sleep specialist who read my machine and told me my Apnea Index is 4.8, my Hypopnea index is 9.1 and my AHI is 13.8"
So it looks like your hypopnea is the biggest problem. If you need insurance to pay for a machine, then you are going to have to do the study. Other wise you could do it yourself with a bi-level. Pressure goes up to 25.

OK - I guess that makes sense. I do have a bilevel, but i'm told it just goes to 20. Maybe the newer ones go higher. What do you think about the Central Apneas? I apologize in advance if this is a silly question. I need to do some more research to get smarter about this.

I also went back and reread your first post. It's hard to know without seeing some reports, but it could also be the LACK of certain events (FLs & Snores) at certain times and the events are occurring without the machine being able to respond to them. You didn't say what your pressure settings are or how your machine is configured, but if the minimum (or EPAP) is too low, there isn't enough pressure to prevent some of the events.

Are you using Sleepyhead to monitor your own therapy? And, if you are, could you post some reports?


Den

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Wulfman... wrote:

ICS1955 wrote:

HST wrote:AHI of 5.0 or greater is considered positive. I get patients all the time that have been on CPAP for 10 years or more but the doctor orders a diagnostic followed by titration if positive. IMO its dumb because apnea doesn't usually go away without surgery of weight loss. But in order for insurance to pay for study and equipment, they want proof that you still have apnea. If you haven't had a study in the past 2 years then insurance would require new data. The newer machines are a lot smaller and have some neat functions included. The answer to your question about just adjusting your machine would be how much does it need to be adjusted. That could be a long process of trial and error. A titration study would be more effective with active monitoring.

Getting way back to the original post ....I went and talked with a tech about my readings. Looks like the machine is already auto adjusting to 19. I guess 20 is the max, and I still have an AHI of 13.8. When he went back and looked at my original study, it did show 49 Central Apnea events and 53 Obstructive Hypopnea events. No one ever mentioned the central events when I got my original machine 10 years ago. So, the supposition is that the Central Apnea might be what is keeping my AHI up. Does that make sense?

Of course it does. And, using an APAP in a range of pressures may also be adding to the problems, even though most APAP algorithms are supposed to try to avoid Centrals. But, they'll respond first to Flow Limitations and Snores. So, if it's Flow Limitations that are driving your pressures up AND you're in the percentage of people who are susceptible to "pressure induced Centrals", then it can be a nightly combination of ingredients that are wreaking havoc.


Den

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Your machine is a bi-level, calling it a cpap is confusing, just to let you know You stated, 'it was a VPAP 25'

I defer to Wolf, he is more experinced than i am. I am just more apt to wing it than most. Doesn't mean it is a good idea tho...

ICS1955 wrote:OK - I guess that makes sense. I do have a bilevel, but i'm told it just goes to 20.

I've never seen a bilevel that didn't go to 25. which *exact* one do you have? look at the label on the back or bottom for a 'REF' or model number (older ones had model numbers, newer have REF numbers... I think it's a medical thing. everything I saw while I was in the hospital had REF numbers on it

Yeah. I overlooked a few details in the first post. The VPAP Auto 25 is based on the old S8 architecture. You would have to use ResScan software and the proprietary card in the machine (if it has one) would need one of those old ResMed or ACS/ACR-38 card readers to download the data.


Den

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I didn't notice the exact machine mentioned until the last few posts either.
The main reason I would see for a new titration would be to determine whether ASV is required. It would be a shame to buy a BiLevel only to discover it was the wrong machine.
Based on that I would move myself to the side in favor of a titration to determine weather BiLevel or ASV is apparopriate.
It has also not been determined if the OP has any kind of insurance. That answer could have a major impact on decisions since ASV can be expensive.

The following is from the "Fact Sheet" for the VPAP AUTO-25

Den

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VPAP™ Auto 25
The next level in bilevel


VPAP™ Auto 25 is a compact bilevel device designed to deliver effective therapy as
naturally and comfortably as possible. VPAP Auto 25 combines the clinically proven
AutoSet™ algorithm with the supreme comfort of ResMed’s Easy-Breathe technology
to make breathing easier for patients with obstructive sleep apnea (OSA), noncompliant
CPAP users and those who require additional ventilatory support.
Big performance in a small package
The system is exceptionally compact and convenient, and out-performs bulky products
offered by competitors. VPAP Auto 25 is ideal for travel or home use.
Quiet comfort with Easy-Breathe technology
Featuring Easy-Breathe, ResMed’s new comfort technology,
VPAP Auto 25 offers nearly silent therapy and greater pressure
stability so patients sleep comfortably throughout the night.
VPAP Auto 25 uses Easy-Breathe pressure delivery and
synchronizes with the patient’s normal respiration so that
breathing feels more natural and comfortable.
Simple setup
The carefully selected default settings and
auto-adjusting VAuto™ mode provide a one-touch
setup that is appropriate for many patients.
Traditional spontaneous bilevel therapy is also
available along with ResMed’s Vsync™ and
TiControl™ breath synchronization features for
proven, reliable bilevel therapy treatment.
Proven technology, effective treatment
VAuto mode uses AutoSet technology to
automatically adjust to a patient’s pressure needs
as they vary throughout the night. With ResMed’s
clinically proven AutoSet algorithm, VPAP Auto 25 is
able to detect flow limitation and act preemptively to
prevent apneic and snoring events.
Equipped with three modes (VAuto, S and CPAP),
VPAP Auto 25 is the most versatile device available
and is compatible with the S8 ResLink,™ H4i,™ ResScan™
and S8 ResTraxx.™


VPAP AUTO 25 FEATURES SUMMARY
Modes of operation
• VAuto
• S (Spontaneous)
• CPAP (with EPR™)
Product features
• Simplified standard setting menu
• Vsync automatic leak management
• TiControl (Ti max/min)
• Adjustable breath trigger/cycle
• Adjustable exhalation comfort
• 24V DC input (via converter)
• Auto-adjusting bilevel pressures
• Compact S8™ design
• AutoSet technology
• Easy-Breathe pressure delivery


Heated humidification
• Optional, fully integrated
Data storage
• Usage and treatment summary (day,
week, month, six-month, year)
• Usage profile
• Summary data storage
• Detailed data storage
• Remote settings adjustment
Data transfer
• Direct download to PC
• ResLink via SmartMedia card
• ResScan Data Card
• Live oximetry with ResLink


TECHNICAL SPECIFICATIONS
Performance
Operating pressure range: 3 to 25 cm H2O
Maximum single fault pressure: 30 cm H2O
Dynamic pressure characteristics
VAuto mode: 4 to 25 cm H2O
(Pressure support: 0 to 10 cm H2O)
S mode: IPAP: 4 to 25 cm H2O; EPAP:
3 to 25 cm H2O
CPAP mode: 4 to 20 cm H2O
Sound pressure level
< 26 dB (tested in accordance with the
requirements of ISO 17510-1:2002)
Data storage
Data includes usage, leak, pressure, AHI,
AI, tidal volume, respiratory rate and
minute ventilation
Via LCD menu: 365 sessions of summary data
Via ResLink: 365 sessions of summary data,
30 sessions of detailed data
Via ResScan Data Card: 180 sessions of
summary data, two sessions of detailed data
Dimensions (L x W x H): 4.4" x 6.5" x 5.7"
(112 mm x 164 mm x 145 mm)
Weight: 2.9 lb (1.3 kg)
Power supply
Input range 100–240VAC, 50–60Hz, 40VA
(typical power consumption), < 100VA
(maximum power consumption), 12–24 DVC
via ResMed DC 24V/50W converter
Environmental conditions
Operating temperature: 41°F to 97°F
(+5°C to +35°C)
Operating humidity: 10–95% non-condensing
Electromagnetic compatibility
Product complies with all applicable
electromagnetic compatibility requirements
(EMC) for residential, commercial and
light industry environments according to
IEC 60601-1-2.
Air filter
Two-layered, powder-bonded, polyester
non-woven fiber
IEC 60601-1 classification
Class II (double insulated), Type CF
Note: The manufacturer reserves the right to
change these specifications without notice.

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