Titration report received in the mail today

Stevoreno_55 · Post by **Stevoreno_55** » Sat Jun 21, 2014 9:06 pm

So in looking at these machines I need to try and get a machine like machine #5 on this chart and not machine #7?

https://www.cpap.com/cpap-compare-chart/all-BiPAP#d

Stevoreno_55
MS Gulf Coast
06/21/14

The Latinist · Post by **The Latinist** » Sat Jun 21, 2014 9:16 pm

[quote="Stevoreno_55"]So in looking at these machines I need to try and get a machine like machine #5 on this chart and not machine #7?

https://www.cpap.com/cpap-compare-chart ... AP#d/quote]

That is the more flexible machine, yes.

palerider · Post by **palerider** » Sat Jun 21, 2014 9:16 pm

Stevoreno_55 wrote:So the ResMed VPAP Auto is the machine you recommend in the ResMed line? The doctor will write a script saying what? BIPAP Auto; pressure 18cm/22cm or something like that? I remember reading comments by another member discussing a BIPAP auto; the member said the auto feature or the pressure changing feature disrupted his sleep. I've slept for almost 7 years on 18cm straight CPAP; no ramp; just put my mask and headgear on and hit go; will there be some time in me adjusting to a BIPAP or BILEVEL or whatever kind of a machine at 18cm/22cm? Will there be times when I might experience pressures of 22cm during the night; waking up to a turbo hair dryer effect blowing up my nose or if I go to a FF mask that volume of air blowing into my mouth as well? I'm not looking forward to 22cm on a FF mask if my mouth opens up because I've been there at 18cm and waking up in the morning hasn't been that pleasant; waking up to a very dry mouth.

others may have explained it well enough, but I'll give it a try too.

1) yes, I recommend the ResMed S9 VPAP Auto. you may not *need* the auto function, but it's nicer to have it and not need it than to need it and not have it.

2) you already have a bilevel recommendation, 22/18 bilevel, not bipap.

3) if you've slept for years at 18, then 22 isn't going to be much difference to you.

4) you'll experience 22cm with every breath, that's the *point* of bilevel, when you start to inhale, you get 22, when you stop inhaling, it drops to 18, up and down with everybreath, to make it easier to breath.

5) at no point in time, ever, is there "a turbo hair dryer" blowing up your nose or down your mouth.. (well, unless you're using a nasal mask/pillows and you open your mouth, then yes, there's a lot of air blowing through) it's a PRESSURE that helps inflate your airway, there's no more air moving in and out of your lungs/nose/mouth at 25cm than there is without the mask on at all.

again, there's not much difference between 18 and 22. nothing at all like the difference between 4 and 18.

Stevoreno_55 · Post by **Stevoreno_55** » Sat Jun 21, 2014 9:19 pm

robysue wrote:
Stevoreno_55 wrote:The RT working for my DME has told me they deal primarily in ResMed machines; she didn't know if they could order me a Philips Respironics machine but they would try to do it when the time comes which is much closer today than it was yesterday. I've been using a gently used ResMed S9 Elite CPAP machine with heated humidifier from my DME for 2 months now since my P.R. DS400S finally died 2 months ago. The loaner from my DME is set to 18cm straight CPAP. So I need to try and get an auto adjusting machine and not a fixed machine. The fixed machine wouldn't be set for 22cm straight pressure I hope. It would have a range from 18cm to 22cm?
No. There's no real point in trying to get an S9 AutoSet or a PR System One APAP set to 18-22cm at this point.

First: APAPs can't go up to 22 cm. So you need a bi-level machine anyway. The suggestion is to try to get an auto adjusting bi-level so that you have the option of running in either fixed bi-level mode or auto adjusting bi-level mode.

Second: Once you have a bi-level, the first thing to try is fixed bi-level mode with IPAP = 22cm and EPAP = 18cm. The pressures won't auto adjust (so there's one less thing to get used to), but the pressure WILL switch from IPAP to EPAP at the start of every exhalation and it will switch from EPAP to IPAP at the start of every inhalation. The switch between IPAP and EPAP should follow your respiration---in other words, the switch to IPAP should occur right as you start to inhale and the switch to EPAP should occure right as you start to exhale.

For a few people, the changes between IPAP and EPAP don't seem to quite "sync" with the natural respiratory pattern. On the Resmed S9 VPAP there are additional settings (Ti max, Ti min, Trigger and Cycle) that can be used to fine tune the transitions between IPAP and EPAP. On the PR System One, the rounding in Bi-Flex provides a bit of flexibility in helping the machine match your breathing; if Bi-Flex is uncomfortable, then the Rise setting may help.

So the feature which would make it easier to breath on the auto BIPAP machine; would that be something like C-FLEX? I will say when I got my P.R. DS400S machine with C-FLEX it made it much easier to breathe on a pressure of 18cm than my first CPAP machine; a Sullivan with a passover humidifier I think which was set on 16cm straight CPAP which is going back a few years in time.

Stevoreno_55
MS Gulf Coast
06/21/14

palerider · Post by **palerider** » Sat Jun 21, 2014 9:20 pm

Stevoreno_55 wrote:So in looking at these machines I need to try and get a machine like machine #5 on this chart and not machine #7?

https://www.cpap.com/cpap-compare-chart/all-BiPAP#d

just tell 'em you want a "36006 S9 VPAP Auto"

Stevoreno_55 · Post by **Stevoreno_55** » Sat Jun 21, 2014 9:27 pm

palerider wrote:
Stevoreno_55 wrote:So in looking at these machines I need to try and get a machine like machine #5 on this chart and not machine #7?

https://www.cpap.com/cpap-compare-chart/all-BiPAP#d
just tell 'em you want a "36006 S9 VPAP Auto"

Get this machine? https://www.cpap.com/productpage/S9-VPA ... chine.html

So this machine must be the fixed BIPAP by ResMed? https://www.cpap.com/productpage/S9-VPA ... chine.html

Stevoreno_55
MS Gulf Coast
06/21/14

palerider · Post by **palerider** » Sat Jun 21, 2014 10:15 pm

Stevoreno_55 wrote:
palerider wrote:
Stevoreno_55 wrote:So in looking at these machines I need to try and get a machine like machine #5 on this chart and not machine #7?

https://www.cpap.com/cpap-compare-chart/all-BiPAP#d
just tell 'em you want a "36006 S9 VPAP Auto"
Get this machine? https://www.cpap.com/productpage/S9-VPA ... chine.html

I don't know how to say it many more ways... the resmed model names are pretty straightforward.

VPAP S plain bilevel
VPAP Auto - auto capable bilevel, can also be set to plain cpap mode, and VPAP S mode.

palerider · Post by **palerider** » Sat Jun 21, 2014 10:18 pm

Stevoreno_55 wrote:So the feature which would make it easier to breath on the auto BIPAP machine; would that be something like C-FLEX? I will say when I got my P.R. DS400S machine with C-FLEX it made it much easier to breathe on a pressure of 18cm than my first CPAP machine

cflex/aflex/EPR is a form of pressure relief on exhale.

bilevel machines are like cflex on steroids.

you can get 1-2 cm difference on cflex, up to 3 with resmed EPR. the resmed VPAP Auto will go up to 10cm.

Stevoreno_55 · Post by **Stevoreno_55** » Sun Jun 22, 2014 12:06 am

palerider wrote:
Stevoreno_55 wrote:So the feature which would make it easier to breath on the auto BIPAP machine; would that be something like C-FLEX? I will say when I got my P.R. DS400S machine with C-FLEX it made it much easier to breathe on a pressure of 18cm than my first CPAP machine
cflex/aflex/EPR is a form of pressure relief on exhale.

bilevel machines are like cflex on steroids.

you can get 1-2 cm difference on cflex, up to 3 with resmed EPR. the resmed VPAP Auto will go up to 10cm.

I think I've got it; good night.

Stevoreno_15
MS Gulf Coast
06/22/14

robysue · Post by **robysue** » Sun Jun 22, 2014 7:45 am

The first and fifth machines on the list are:
the PR 60 Series BiPAP Auto
and
the S9 VPAP Auto BiLevel
These two machines are equivalent to each other, they're covered by your script, and they are both more flexible that the last two machines on the list.

The third machine on the list, the IntelliPAP AutoBiLevel is also an auto adjusting bi-level machine. Intellipap bi-levels are not seen as often on the board as the Resmed S9 VPAP and the PR System System One BiPAP. That's the reason I omitted them from my detailed comparison of the S9 VPAP and the System One BiPAP: I don't think I've ever seen any actual data from an IntelliPAP AutoBiLevel. It's not clear whether this machine would be compatible with SleepyHead; the Help notes on the most recent version of SH say that the DeVilbiss Intellipap (Auto) is supported, but does not necessarily mean that the DeVilbiss Intellipap AutoBiLevel will work with SleepyHead.

The machines #3, #6, and #7 on the list are the fixed pressure equivalents of machines #2, #1, and #5 respectively. They're all covered by your script, but they don't offer as much flexibility as the auto adjusting bi-level machines. Machines #6 and #7 are known to work with SleepyHead; machine #3 won't work with SleepyHead.

Machine number #4 (the PR BiPAP ST) is NOT covered by your script since your script does NOT have a so-called "back up rate" in it.

Stevoreno_55 · Post by **Stevoreno_55** » Sun Jun 22, 2014 1:56 pm

robysue wrote:The first and fifth machines on the list are:
the PR 60 Series BiPAP Auto
and
the S9 VPAP Auto BiLevel
These two machines are equivalent to each other, they're covered by your script, and they are both more flexible that the last two machines on the list.

The third machine on the list, the IntelliPAP AutoBiLevel is also an auto adjusting bi-level machine. Intellipap bi-levels are not seen as often on the board as the Resmed S9 VPAP and the PR System System One BiPAP. That's the reason I omitted them from my detailed comparison of the S9 VPAP and the System One BiPAP: I don't think I've ever seen any actual data from an IntelliPAP AutoBiLevel. It's not clear whether this machine would be compatible with SleepyHead; the Help notes on the most recent version of SH say that the DeVilbiss Intellipap (Auto) is supported, but does not necessarily mean that the DeVilbiss Intellipap AutoBiLevel will work with SleepyHead.

The machines #3, #6, and #7 on the list are the fixed pressure equivalents of machines #2, #1, and #5 respectively. They're all covered by your script, but they don't offer as much flexibility as the auto adjusting bi-level machines. Machines #6 and #7 are known to work with SleepyHead; machine #3 won't work with SleepyHead.

Machine number #4 (the PR BiPAP ST) is NOT covered by your script since your script does NOT have a so-called "back up rate" in it.

Thanks Robysue.

robysue · Post by **robysue** » Sun Jun 22, 2014 3:16 pm

Stevoreno_55 wrote:So the feature which would make it easier to breath on the auto BIPAP machine; would that be something like C-FLEX? I will say when I got my P.R. DS400S machine with C-FLEX it made it much easier to breathe on a pressure of 18cm than my first CPAP machine; a Sullivan with a passover humidifier I think which was set on 16cm straight CPAP which is going back a few years in time.

Bi-Flex on the System One BiPAPs is indeed like C-Flex. With Bi-Flex turned on when the machine is set to IPAP = 22 and EPAP = 18, the pressure will drop a bit below 18cm at the beginning of each exhalation and then be raised back up to 18cm during the second half of the exhalation. The actual drop below 18cm will vary depending on both the BiFlex setting and the forcefulness of the exhalation.

If you liked C-Flex, you would probably also find BiFlex comfortable and potentially useful.

Stevoreno_55 · Post by **Stevoreno_55** » Sun Jun 22, 2014 6:52 pm

robysue wrote:
Stevoreno_55 wrote:So the feature which would make it easier to breath on the auto BIPAP machine; would that be something like C-FLEX? I will say when I got my P.R. DS400S machine with C-FLEX it made it much easier to breathe on a pressure of 18cm than my first CPAP machine; a Sullivan with a passover humidifier I think which was set on 16cm straight CPAP which is going back a few years in time.
Bi-Flex on the System One BiPAPs is indeed like C-Flex. With Bi-Flex turned on when the machine is set to IPAP = 22 and EPAP = 18, the pressure will drop a bit below 18cm at the beginning of each exhalation and then be raised back up to 18cm during the second half of the exhalation. The actual drop below 18cm will vary depending on both the BiFlex setting and the forcefulness of the exhalation.

If you liked C-Flex, you would probably also find BiFlex comfortable and potentially useful.

Thanks again Robysue.

Stevoreno_55 · Post by **Stevoreno_55** » Mon Jun 23, 2014 6:58 pm

I spoke to the RT at my DME today about my recently received titration report where the sleep doctor recommended this as my new pressure: Recommended pressure of 22/18cm H2O; [ IPAP 22cm H2O, EPAP 18cm H2O ] so I asked the RT today what kind of a machine I would be getting from them when the time comes to get a machine from them. The RT said it would probably be a "fixed" BIPAP. I asked about an "auto" BIPAP since so many members on this board have recommended getting an "auto" BIPAP and not a "fixed" BIPAP; the RT said no; it will most likely be a "fixed" BIPAP.

I then asked the RT if my doctor writes my Rx with the words "Auto BIPAP" on it and then lists my new pressures as I have them listed above would I then be able to get an "auto" BIPAP from them; the RT said no because my pressure as listed on my titration report is a "fixed" pressure. Having said that; this DME has already told me they deal mainly in ResMed machines but would try to order me a Philips Respironics machine if I wanted one; if I'm going to be receiving a "fixed" BIPAP and not an "auto" BIPAP should I ask my DME for a Philips Respironics machine instead of a ResMed machine or are both brands about the same?

Stevoreno_55
MS Gulf Coast
06/23/14

Pugsy · Post by **Pugsy** » Mon Jun 23, 2014 7:10 pm

Fixed bilevel pressure machines
PR System One 60 Series Pro BIPap model 660
and the
ResMed VPAP S
function pretty much the same except the model 650 has BiFlex exhale relief.
The S9 VPAPs don't offer any exhale relief. They think that the difference between EPAP and IPAP is sufficient exhale relief.

Sounds like the only way you will talk them out of an auto machine is for the doctor to write the script for a range of pressures and not the 18/22 which is a fixed pressure setting. I warned you this might happen with this RX.
With a range of either EPAP or IPAP written into the RX then that qualifies for an auto machine.

Titration report received in the mail today

Re: Titration report received in the mail today

Re: Titration report received in the mail today

Re: Titration report received in the mail today

Re: Titration report received in the mail today

Re: Titration report received in the mail today

Re: Titration report received in the mail today

Re: Titration report received in the mail today

Re: Titration report received in the mail today

Re: Titration report received in the mail today

Re: Titration report received in the mail today

Re: Titration report received in the mail today

Re: Titration report received in the mail today

Re: Titration report received in the mail today

Re: Titration report received in the mail today

Re: Titration report received in the mail today

Mask

Additional Comments: Newly diagnosed pressures as of June 05, 2014 are 22cmIPAP and 18cmEPAP; first diagnosed with OSA in 1999.