wife's home titration?

My wife had her initial sleep study a while back, but the sleep doctor was such a jerk at her consultation that she refused to go back for the titration. (I can't really blame her...I've never met anyone as condesending as he was.) She's lost about 50 pounds since then, and if anything, her apnea is worse. She goes to sleep instantly, sleeps all the time, snores like crazy, is constantly exhausted, and has NO short-term memory. I want to wipe everything off my auto bi-pap and titrate her at home. I have the software. My question for the experts here...what would be a good starting range? Should I just start with it wide open? Thanks for any opinions.

If I were going to do that, I'd try the first night in just bilevel mode, with "auto" turned off...so that a person could get used to the feel of it.

I'd set it like this if it's an M series BiPAP Auto:

Bilevel
IPAP 10.0
EPAP 8.0
Bi-Flex Setting 3 (will work like C-flex at 3)
ramp time 0:00 (unless the person really needed to start out lower)
Mask Alert Feature OFF
Auto Off Feature ON
Show AHI/Leak Feature ON
Patient Reminder OFF



I'd set it like this if it's an older non-M BiPAP Auto:

BFLE mode (bipap mode with bi-flex turned on.)
10.0 IPAP
8.0 EPAP
3 Flex
0:00 Ramp
0 Patient
1 Light
Nights - leave this number as is.

I'd keep it simple (using various IPAP/EPAP combos) and take a look at the data for awhile before trying "auto bilevel." That would give a better idea what range (mainly, what "minimum EPAP" to set) if autotitration were added into the mix later.

EPAP is what needs to be high enough to prevent all/most apneas when using a bilevel, whether it's being used as just a bilevel machine or as an autotitrating bilevel. If you see obstructive apneas on the data, it usually means the EPAP needs to be raised.

Thank you, ma'am...can always count on a fellow Tennessean!

An update. A month after my original post, my wife was finally ready to try the machine, so Saturday night about midnight I got it set up pretty much like Rested Gal told me to, and got her settled in with the Quattro. She was asleep in minutes. I don't sleep much, so I checked on her frequently...last time was when I went to sleep about 4:15 am, and she was still sleeping peacefully. The software tells me she took it off about 5 am (she vaguely remembers going to the bathroom) and that her AHI was 7. Even with that, when we got up at 8 am, she felt fantastic! She went on all day about how great she felt, and was excited to try again last night. Of course the mask wouldn't cooperate...would not stop leaking! (This is what I don't understand...same face, same mask...why is it good one night and not the next?) Anyway, after much fooling with it, it was better and she went to sleep. It was off again this morning...we have to work on that...but she still felt good. She's back asleep now with it on, no leaking tonight...so we're off to a pretty good start. I'll tweak the pressure after a while, but 7 AHI is much better than she was. I had a feeling she'd do well with it...have to admit I'm a little jealous! I also found out what's its like to sleep on the other side of the mask...the exhaust never bothered her when I was trying, but it drives me crazy! Its worth it, though, for her...and really, my sleep can't be any more screwed up than it is, so it doesn't matter.

Thanks again, Rested Gal, and I may ask for more advice down the road.

Hi ! - Just listen to this man - how much he cares - ! ! ! - I sincerely want to thank our husbands/wifes/partners for
all the help, understanding, care and love they give us to succeed with this therapy.

THANK YOU..........YOU ARE THE GREATEST ! ! !

Thanks Marietjie. She kept the mask on all night last night, and is feeling good this morning!