How to get prescribed Bipap?

I have some upcoming appointments soon and plan on asking for a Bipap. I'm trying to come up with some legitimate reasons so I'm hoping some of you can help with that.

I am concerned that my tidal volume is low (on average SH says median is 360) and I am 6' tall. From what I have read Bipap can increase tidal volume.

When I was switched to straight 10cm pressure I had trouble with it at first but my leaks and everything were fine. Now my leaks are worse and I wake up with bad dry mouth from mouth breathing which wasn't an issue before. Would that be considered trouble exhaling against the pressure?

Waiting on official results from latest pulmonary function tests. Original spirometry test showed mild restriction. Had another spirometry with other tests and just know that I was able to inhale more so not sure if that bumps me up to normal or not. So depending on those results it's possible I might have a restrictive issue which could also warrant Bipap.

Anything else I might be missing?

Here is a recent nights data

Thanks

You have agood autoset model now that you are using as a fixed pressure machine. Perhaps your problems could be resolved with an adjustable pressure with the minimum lower than 10. IMHO I don't see where you would qualify or need a bipap.

I was at 6 to 20 with 90 or 95% pressure around 8. Was still having Hypoxemia despite treatment of OSA so the higher fixed pressure had helped with that but my oxygen saturation still drops below 88% more a little bit most nights.

This is my data from night I did overnight oximetry which showed I was under 88% for 93 minutes and under 80% for 5 hours out of 9 hour night.

"BPAP is an optional therapy in some cases where high pressure is needed and the patient experiences difficulty exhaling against a fixed pressure or coexisting central hypoventilation is present. . . . BPAP may be useful in treating some forms of restrictive lung disease or hypoventilation syndromes associated with daytime hypercapnia." -- https://j2vjt3dnbra3ps7ll1clb4q2-wpengi ... essure.pdf

Color added by me, to show they use almost as many weasel words as I do.

Ultimately all I want to do is improve oxygenation some more at night, reduce pressure if possible so I stop mouth breathing and getting dry mouth.

Here is a recent report while on current settings that titration study said would stop Hypoxemia. My issues are always right in the beginning of the night too for some reason.



Here is titration study stuff too.

Interesting that in the charts you post your inspiration to expiration ratio shows as inverted, meaning that the inhalation portion of a breathe is longer than exhalation. That could be an error I suppose - I don't know how precise the various graphs are, especially if you are having some mouth leak.

As far as getting prescribed a bi-level, I would tell the doctor your symptoms and also show some of the oxygen saturation reports showing low spo2 while at the same time showing that your sleep apnea is being very well treated.

Waking up with headaches that go away during the morning and feeling short of breath during the day can be signs of hypoventilation, aka under ventilation, which means you're probably retaining carbon dioxide when you sleep.

I think you are spot on with the tidal volume...mid 300's is very low if you're 6ft tall. Your tidal volume should be around 620 mL/kg. https://www.mdcalc.com/ideal-body-weight

Matt00926 wrote: ↑

Mon Mar 19, 2018 5:11 pm

Interesting that in the charts you post your inspiration to expiration ratio shows as inverted, meaning that the inhalation portion of a breathe is longer than exhalation. That could be an error I suppose - I don't know how precise the various graphs are, especially if you are having some mouth leak.

Every chart of mine that I can remember has it that way. Here is one when I was in auto mode and really low leaks and no issues with month breathing.


I completely forgot to look into the inverse relationship further thanks for mentioning it. I see RT tomorrow for regular see how things are going with CPAP appointment and see what he says.

Shortness of breath is one of my current complaints. Was started on symbicort to see if that does anything before I had these latest tests done which I'm waiting on results for.

Hopefully you get some more definitive answers soon. If you have a restrictive airway defect, I don't think symbicort will help at all since that is a bronchodilator used for asthma/copd - obstructive airway diseases.

I would write down a list of your symptoms, especially how you feel when you wake up after a night of sleep. Then hit the doc with your printouts.

Matt00926 wrote: ↑

Mon Mar 19, 2018 5:11 pm

Interesting that in the charts you post your inspiration to expiration ratio shows as inverted, meaning that the inhalation portion of a breathe is longer than exhalation. That could be an error I suppose - I don't know how precise the various graphs are, especially if you are having some mouth leak.

As far as getting prescribed a bi-level, I would tell the doctor your symptoms and also show some of the oxygen saturation reports showing low spo2 while at the same time showing that your sleep apnea is being very well treated.

Waking up with headaches that go away during the morning and feeling short of breath during the day can be signs of hypoventilation, aka under ventilation, which means you're probably retaining carbon dioxide when you sleep.

I think you are spot on with the tidal volume...mid 300's is very low if you're 6ft tall. Your tidal volume should be around 620 mL/kg. https://www.mdcalc.com/ideal-body-weight

Isn't it normal to have an inspiration time longer than expiration?

TedVPAP wrote: ↑

Mon Mar 19, 2018 7:17 pm

Matt00926 wrote: ↑

Mon Mar 19, 2018 5:11 pm

Interesting that in the charts you post your inspiration to expiration ratio shows as inverted, meaning that the inhalation portion of a breathe is longer than exhalation. That could be an error I suppose - I don't know how precise the various graphs are, especially if you are having some mouth leak.

As far as getting prescribed a bi-level, I would tell the doctor your symptoms and also show some of the oxygen saturation reports showing low spo2 while at the same time showing that your sleep apnea is being very well treated.

Waking up with headaches that go away during the morning and feeling short of breath during the day can be signs of hypoventilation, aka under ventilation, which means you're probably retaining carbon dioxide when you sleep.

I think you are spot on with the tidal volume...mid 300's is very low if you're 6ft tall. Your tidal volume should be around 620 mL/kg. https://www.mdcalc.com/ideal-body-weight

Isn't it normal to have an inspiration time longer than expiration?

I know I've read somewhere what he is talking bout a while ago. I did find a random sleepyhead chart on here of someone else with the inspire longer the expire. So unless I found a fluke I think your right at least as it being normal.


ETA:
https://www.scottishintensivecare.org.u ... i-e-ratio/

Matt00926 wrote: ↑

Mon Mar 19, 2018 7:04 pm

Hopefully you get some more definitive answers soon. If you have a restrictive airway defect, I don't think symbicort will help at all since that is a bronchodilator used for asthma/copd - obstructive airway diseases.

I would write down a list of your symptoms, especially how you feel when you wake up after a night of sleep. Then hit the doc with your printouts.

Dr said symptoms wise she was thinking asthma but original spirometry didn't show that. I agree though not sure the symbicort will help but going go keep taking it for the month to see if it helps at all. If not Dr said to stop taking it.

USMCVet wrote: ↑

Mon Mar 19, 2018 11:55 am

I have some upcoming appointments soon and plan on asking for a Bipap. I'm trying to come up with some legitimate reasons so I'm hoping some of you can help with that.

I am concerned that my tidal volume is low (on average SH says median is 360) and I am 6' tall. From what I have read Bipap can increase tidal volume.

You'll just drive yourself into hypocapnia and start having centrals.

palerider wrote: ↑

Mon Mar 19, 2018 8:27 pm

USMCVet wrote: ↑

Mon Mar 19, 2018 11:55 am

I have some upcoming appointments soon and plan on asking for a Bipap. I'm trying to come up with some legitimate reasons so I'm hoping some of you can help with that.

I am concerned that my tidal volume is low (on average SH says median is 360) and I am 6' tall. From what I have read Bipap can increase tidal volume.

You'll just drive yourself into hypocapnia and start having centrals.

I'm confused. Are you saying my current tidal volume is not low? I haven't been able to find something that specifically tells me what it should be during sleep . I have seen the ventilation guides which may not reflect what I should actually have.

I have been peeking at others tidal volume on here and most seem to be higher then mine.

You don't want a BiPAP, you want a machine that will give you the same readings on your body as everyone else in the world, all bodies are different the even react different from minute to minute.

If they ever do perfect that machine you want, it won't be a good thing, because everyone that gets one will die on the same day, from the same cause. We are all different, that's the way it is. Jim

Some of us accept it, some waste their lives worrying about changing it. We were built be someone that grades on the curve not a straight line.

USMCVet wrote: ↑

Mon Mar 19, 2018 9:39 pm

I'm confused. Are you saying my current tidal volume is not low? I haven't been able to find something that specifically tells me what it should be during sleep . I have seen the ventilation guides which may not reflect what I should actually have.

I have been peeking at others tidal volume on here and most seem to be higher then mine.

What I'm saying is that you don't know what you're doing, and you're liable to end up causing yourself problems because you're going about things wrong.

https://www.youtube.com/watch?v=BdeOiDJmbrk