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cindyY
Unread post  Post subject: Second sleep study just for titration  |  Posted: Sun Jun 04, 2017 7:00 pm

Joined: Sun Apr 23, 2017 8:34 pm
Posts: 439
Location: Southern California
PAP Mask: AirFit P10, Swift FX, Swift FX Nano, Eson2
PAP Machine: Resmed AirCurve 10 VAuto in S mode
Humidifier: Integrated set to 5 @ 81F; ClimateLineAir heated hose
Pressure Setting: IPAP 19 EPAP 15

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I am currently on bilevel therapy, I think because during my first sleep study I had a LOT of difficulty breathing out against the pressure. I remember that being true for the whole study, not just when they raised my pressure higher and higher. Eventually during my study they switched from CPAP to bilevel and found:
"Regular use of nasal Bi-Level PAP in the spontaneous mode at 20/16 cmH20 via a medium F&P Simplus full facemask and a heated humidifier was tentatively successful through a significant period of supine REM sleep. Note is made that events were still very frequent at the penultimate pressure settings of 19/15 cmH2O pressure (AHI of 40/hr). As such there does not appear to be much of an extra cushion of safety of the 20/16 cmH2O pressure. For this reason, a full night Bi-Level PAP titration is recommended after at least a month of regular PAP therapy to determine if higher pressures are required for more reliable treatment or conversely, whether the patient might be effectively stabilized at slightly lower pressures after resolution of upper airway snore trauma related edema which can often contribute to obstruction and after better consolidation of sleep after the patient becomes acclimated to BPAP."

When I started my therapy in mid-April, I had to use the ramp setting on my machine, but now I have been able to start at my 20/16 pressures with no problem. Also, when I started, I couldn't use the Mask Fit Test option because it increased pressure too fast. I can and do usually use the Mask Fit Test whenever I have changed something on my mask, i.e., after tightening or loosening straps (I still have to tweak things). The main reason I stopped using the ramp setting is that it started too low for me to be comfortable. It was fine in the very beginning, but after about 3 weeks or so, I felt like I wasn't getting enough air because the ramp is set for 10/6 cmH2O. I started setting the ramp for just 5 minutes so it would get up in pressure faster, if I got up in the night, I would turn it off so that when I turned the machine back on it would start at full pressures, then I just turned it off completely a little bit ago.

I guess what I am wondering is that if I have adapted to 20/16 cmH2O, is it possible that I can also now exhale against 20 cmH2O? Would they even check that during a titration study for a "full night of Bi-Level PAP"? I don't think they will change my IPAP pressure (20) because my average AHI is under 3, which is "technically treated", but will they try to raise my EPAP? And if they do, couldn't I use my machine in CPAP MODE with the EPR on if necessary? Is there a benefit to Bi-Level PAP therapy over CPAP if the differential between IPAP & EPAP would be covered by the EPR differential?

Also, spontaneous mode means what, exactly? Is it that it regulates my breathing pattern? If yes, why would my breathing need to be regulated?

During my titration study, do I take my own mask(s)? Can I ask to try a different kind of mask, like the nasal pillows? During my original study I couldn't take the pressure, even though it looks like we started at 5 cmH2O, but again, I'm used to my pressures now, so who knows if I could take it now. Also during my first study, the nasal mask felt odd to not be able to breathe with my mouth and I told my tech I wasn't comfortable with that option either, not being offered a chinstrap or anything, but now I use a nasal mask with more success than the FFM, so maybe I can handle the pillows also, just to open my options.

And do I take my SD card to the titration? Will they want to see how I've been doing? or do I just take the SD card to my doctor's appointment?

I know this was a lot, but I want to go back to the sleep center with more information at hand, not to mention my doctor's appointment when that eventually happens again.

And why wouldn't they suggest putting the machine on Auto, since it's an AirCurve VAuto?

Thanks,
Cindy


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diamaunt
Unread post  Post subject: Re: Second sleep study just for titration  |  Posted: Sun Jun 04, 2017 7:32 pm
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Joined: Wed Mar 02, 2016 2:26 am
Posts: 2010
Location: Dallas(ish)
PAP Mask: Resmed P10
PAP Machine: Resmed S9 vpap auto
Pressure Setting: 18/13-25/19

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there are two methods bilevel machines use to switch between base pressure (epap) and inhale pressure (ipap) spontaneous and timed.

timed means that after x amount of time, (usually translated from a Respiration Rate) it switches to IPAP to cause you to breath.... like a ventilator you see on medical tv shows.

spontaneous means it just sits there, and waits for you to initiate a breath, it detects this happening, and switchs to ipap to help you with that breath. S mode is the most basic, least advanced, most common bilevel mode.

there are, unfortunately, a lot of 'providers' out there that can't wrap their ossified little brains around the potential benefits of auto machines :D

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cindyY
Unread post  Post subject: Re: Second sleep study just for titration  |  Posted: Sun Jun 04, 2017 10:05 pm

Joined: Sun Apr 23, 2017 8:34 pm
Posts: 439
Location: Southern California
PAP Mask: AirFit P10, Swift FX, Swift FX Nano, Eson2
PAP Machine: Resmed AirCurve 10 VAuto in S mode
Humidifier: Integrated set to 5 @ 81F; ClimateLineAir heated hose
Pressure Setting: IPAP 19 EPAP 15

Offline
Ok, so after my titration, I can ask my doctor, if it's not already being recommended, and that'll be a good gauge on whether I want to keep him or not. Because I can't see why auto isn't a good idea. Even if it's a small window, I already know my AHI goes up when I'm on my back, but I'm not usually on my back. Otherwise, I'm mostly around a 1, when I get a good seal.

Thanks.

Any insight on the titration study and how detailed they get?


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