What happens when the max pressure isn't enough???

I've been thinking this lately...I have had my bipap at 20/14 for a year after my last titration sleep study. Lately, after losing 65 lbs., I am having lots of waking up with the gasping for air feelings at night. I'm sleeping 12-16 hours a day for the last 6 weeks, despite being on 400 mg. of Provigil to keep me awake. I have been begging my primary and sleep apnea doctors for help for three weeks to no avail until today. I will have an overnight pulse oximetry test tonight, which was my suggestion. I need a sleep study, but it will take at least 6 weeks to get in, and another 2 weeks to be interpreted with how everything is here in southwestern Michigan.

What happens if my oxygen levels are still low at 20 cm? It is the highest the bipap goes to. I was wondering whether bipap and cpap therapy is 100% effective with all patients. I have been compliant since day one. Maybe the highest therapy pressure is not enough to open my airway??? My initial AHI was 81, I think--very severe.

It has been a nightmare to get the doctors to do anything. It doesn't help that I am poor and can't afford any out of pocket expenses, such as for an apap, etc. My christmas wish list consists of one item--a power supply backup...yes, I know sad, sad, sad...

Does anyone have experience of the bipap not being effective at the highest and maximum pressure levels??? Thanks, Laurie

Your Bipap machine is the very basic machine, it is not data capable, meaning it doesn't report how you are doing with current settings.

This is WHY we always recommend a person obtain a data-capable machine, you don't have to spend $3,000 for another titration study to find out what's up, machine reports it with a printout from the SmartCard. So in the end, it is always better to complain, complain, complain and fight for that data-capable machine, in your case the Bipap Auto would have been a better choice. Initial cost outlay would have only been about $200 difference. DME's always take advantage of the new patient who doesn't know better for their profit greed. Doctors aren't any better the greedy bastards, they want to keep you coming back for that reoccurring revenue instead of what's in your best interest.

Your machine is NOT at its maximum pressure, Bipaps usually go to 25 cm pressure. CPAPS are limited to 20 cm pressure. IF you LOST weight, your pressure requirements may have gone down. The result could leave you over-titrated (pressure too high), it can result in arousals seen during REM sleep since that is where you are "most awake" or closest to wake compared to other non-REM stages of sleep, so it doesn't take much to wake you during REM. If you time the awakenings they probably happen 2 hrs after going to sleep or in a multiple of 90 minutes, so they can happen ever 1.5hrs., 3hrs, 4.5hrs etc.

If you had the setup guide for your machine, I would try:

Lowering both pressures by 1 cm (i.e. 19/13). Your current Pressure Support is 6 cm (difference between IPAP and EPAP), with the loss in weight, you may not need that much PS. I would even try 16/12 settings.

If you started any new type of medications, that can also disturb your sleep. I would list out the medications you are taking, SSRI's have been found to disturb the quality of sleep you get.

The overnight Pulse Oximeter is a good idea, make sure you get a copy of the results. It is also a good idea to ask your doctor for a copy of your last PSG titration.

Just in case you don't know how to access the setup menu....

Someone else (Wulfman?) probably knows this answer better than I, but I THINK you can access the setup menu by doing this (this is what works on my M Series APAP):

Unplug the power cord from the round hole right above the foam filters.
Wait a moment or two.
Hold down the TOP two buttons (there are four buttons on either side of the LCD screen, two on each side, stacked)
While holding those buttons down, plug the round cord back into it's hole

Yes, you need three hands. Well, I've learned to do it, you can too.

Wait a moment. The machine will blink, and then the LCD screen will show something like "Setup" in the lower right quadrant. I can't remember what it says, actually, but it's in that lower right box.

Now hit the arrow button just to the right of that box.

You will begin scrolling through the "clinician's menu". You can change your settings there.

When you are all done, hit your "Power" button, and it will close the setup menu.

Cheers,
Barbara

I did have a thought to look at my model, and you are right, it does go up to 25 cm--big suprise!! Luckily, I do know how to change the pressures...my DME was acting like she was giving me a trade secret to know how to unlock my machine when my doctor asked her to teach me!!!

I will leave the pressures the same tonight for the pulse oximetry test to see what I have been dealing with. I'll try to reduce and see if that makes a difference, especially the difference between IPAP and EPAP. If not, then maybe I'll try higher pressures. It sure is hard to be your own doctor.

Last year, when I received my bipap, I was only on COBRA health insurance and had to pay 30% of everything, the bipap, sleep study, etc. This year, I still have COBRA health insurance but I also have Medicaid. Greedy doctors love this new setup. So a new sleep study won't cost me a dime. A new machine wouldn't cost me if I could prove that the APAP would be better than Bipap and the insurance company went along with it... so there are possibilities here.

Even with these great monies available to doctors for me right now, all I get is generalities...the cardiolite stress test "looked good". The gastric endoscopy last week, "looked good". When I ask for details I don't receive them. I'm seen as a pain in the ass because I actually want to know details on my health.

I did have some med changes in the last two months. One was Effexor (SSRI?) which was decreased from 225 a day to 150 day. That could be a possibility too. It could be the 15 medications I am on. It could be I am having additional cardiac problems. It could be a lot of things. But I have to pull teeth to get anything done. My primary doctor is just plain stupid, but there are not many other choices around here. Aagghh.

Hoping to be able to stay awake today, Thanks, Lovey

I did the overnight pulse oximetry test last night. At times, when I woke up and looked, my oxygen level was 81%. When I was just laying down and not sleeping, it was 93%-94%. Since you get oxygen at 95% at the hospital, I think there is a problem!!! Nobody has been listening to me, when I said there was a problem with my oxygen levels.

Do you guys want to bet how long it will take them (any of my docs) to react in anyway to this news?? Being pessimistic, Lovey