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I am brand new to the world of CPAPs, VPAPs and APAPs.
The doctors orders that went to the DME provider were 25/8, which I believe means 25cm H2O insiratory pressur and 8cm H2O expiratory pressure. First of all, 25 is a pretty high pressure, and second of all it seems to me that the delta of 17cm is also a pretty high number. Do these seem reasonable numbers to you more experienced users and respiratory professionals out there?
The doctors orders that went to the DME provider were 25/8, which I believe means 25cm H2O insiratory pressur and 8cm H2O expiratory pressure. First of all, 25 is a pretty high pressure, and second of all it seems to me that the delta of 17cm is also a pretty high number. Do these seem reasonable numbers to you more experienced users and respiratory professionals out there?
Views: 102
Replies to This Discussion
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Permalink Reply by sleepycarol on
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Someone with bipap experience will come along and help you. I usually thought that the numbers were closer as 25/8 is pretty wide -- but I haven't any first hand knowlege.
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Permalink Reply by Jan on
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Hi-- yes-- 25 is pretty high. I'm a newbie myself so unable to give you any advice ...however, I know that there are others on this forum who will respond to your questions. Undoubtedly, they will be curious about your test results, AHI numbers and other data from your sleep test so that they can have a context for providing guidance. I mention this so that you can post it now in anticipation of other, more experienced members, asking you for the information.
I just went onto a bipap with a setting of 6-17. I think that is a pretty wide spread and anticipate that it will be clamped down as further information emerges from the nightly data collected.
In the meantime, welcome! I'm glad that you found Sleep Guide. The members here have really helped to get me on the right track and I'm sure will be able to offer you valuable advice.
Good Luck
Jan
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Permalink Reply by Charley K on
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The machine that was supplied to me and I have been using for 5 nights now, is a ResMed VPAP AUTO 25. I do not believe it is an APAP or it is not set up for automatic mode even if it is capable. I start it in RAMP and it slowly builds pressure over a 30 minute or as much as a 45 minute period depending on time adjusted by user. But when it settles out it is always at the same reading.
The only data screen I can access on the LCD reads: SPON 8.0 - 25.0 on the top line and S>C PS 17.0 on second line which I am told stands for Spontaneous Cycle, the > sign increases in numbers as I inspire (up to 6 or 7 > signs) and falls back to one > sign on expiratory cycle. The PS stands for Pressure Support which is basically just the difference between the inspiratory pressure and the expiratory pressue (25.0 - 8.0 = 17.0). I was told by a clinician that each > sign equates to roughly 2.0 cm Pressure Support (pressure above the minimum pressure).
I have not seen a copy of the script witten for the machine as it was sent dirrectly to the DME by my Doctor. I did get a copy of the sleep study but was unable to read most of it. I will try and locate it if any of the forums professionals have questions about it. Since they must have most of the data screens on my machine's LCD locked out I am looking forward to getting enough nights to download on Smart Card and having reprt printed out of my actual usage to see if it is doing what I need it to do. The clinician siad I should have at least two weeks data before they could tell anything, but I do not know if I should wait that long. So far, I can not tell the machine is changing my sleep pattern any, though I have been able to use the machine for 5 to 6 hours each night.
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Charley, I strongly suggest that you contact your sleep doctor or sleep lab and request a copy of 1] the doctor's dictated results (1-2 pages each) AND 2] the full scored data summary report w/condensed graphs (5+ pages each - also called "full disclosure report) from BOTH your in-lab sleep evaluation PSG AND your in-lab titration PSG as well as 3] a copy of your equipment order (prescription). They are part of your medical records and as such you have a LEGAL RIGHT to them under HIPAA. I'm guessing you have more going on than just plain old vanilla obstructive sleep apnea.
Very few people are scripted a bi-level right from the get-go w/o good cause. MOST insurances insist that you fail CPAP therapy before they will pay for a bi-level except under certain quite stringent circumstances and usually involve a lot of communication and verification and Letters of Medical Necessity and what not to get them to pay for a bi-level right from the get-go. And a bi-level auto! YOU are fortunate! Are you going to be able to keep this device or is there a good chance you will be switched to a straight bi-level w/in the month?
Congratulaltions on getting 5-6 hours sleep w/your VPAP Auto 25 already!
The Resmed VPAP Auto 25 was released in January 2008. The VPAP Auto 25 was released in July 2008. I've never been able to get a good answer from our local Resmed Rep WHY the Auto 25 followed the release of the VPAP Auto so soon. I have the Clinicians Manual for both my VPAP Auto and for the VPAP Auto 25. The VPAP Auto's Clinicians Manual (not the Users Manuel patients are given) is so much more comprehensive that the VPAP Auto 25's Clinicians Manual .... I'm curious as to WHY that is too. The 25's Clinicians Manual is ..... no where near as explanatory as the VPAP Auto's. I've only glanced thru the 25's Clinicians Manual so am not sure of all the differences between the two but they appear to be fairly minor other than my VPAP Auto's maximum is 20 cms rather than 25 and some minor differences in LCD screen data sequences, info, etc.
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The Sleep Dr. imphasized in his report on my sleep study that I could not tolorate the required 25cm on staight CPAP. I guess alot of it is in the language the Dr. uses in comunicate with insurance reps. He said virtually no one could tolorate a expiratory pressure of 25cm, but insurance reps do not all know that, so he was very clear in report summary that I could not tolorate a straight CPAP. The data from the in-lab titration seemed to bear this out as I continued apnea until switched over to a bi-level machine, then I finally went into normal sleep cycle. They did both evaluation and in-lab titration PSG the same night, I think, even though no one ever used this terminology with me at lab or Dr follow-up. The lab clinician said my apnea was so severe that she had reason to start what I guess would be termed an in-lab titration PSG after about first hour of sleep study. That is when they put me on a CPAP machine and ramped it up. I fought that thing all night long, including lots of mask leaks, until they switched machine to a bi-level. After switching to biPAP and adjusting pressure levels, my graph shows that apnea stopped and I had a mormal sleep pattern for the last two hours of night. After reading some posts and comments on this site, I feel the PSG they did on me was awfully abreviated. Another thing that kind of bothered me was they wanted me to sleep on my back if I was able to in beginning of study. I do not normally try to sleep on my back due to habits formed years ago when suffering lower back pain, it was better to sleep on my side, and I know gravity is not your friend in keeping airway open when laying on your back. I can not help but believe the apnea is not as severe when sleeping on my side as the first hour of that PSG showed with me sleeping on back. Another thing that bothers me about my report is it is very hard to read the graphs, and there was no data provided on O2 saturation. They had a O2 sensor on my finger through the night, but no data in graph on O2 saturation. It was mentioned in his written summary report, but I do not know where the data is to back that up. I have ranted on enough now. I am not trying to ctritize the Dr. I just want treated properly. Maybe with better communication from the sleep Dr, and education I will be less sceptical.
Judy said:Charley, I strongly suggest that you contact your sleep doctor or sleep lab and request a copy of 1] the doctor's dictated results (1-2 pages each) AND 2] the full scored data summary report w/condensed graphs (5+ pages each - also called "full disclosure report) from BOTH your in-lab sleep evaluation PSG AND your in-lab titration PSG as well as 3] a copy of your equipment order (prescription). They are part of your medical records and as such you have a LEGAL RIGHT to them under HIPAA. I'm guessing you have more going on than just plain old vanilla obstructive sleep apnea.
Very few people are scripted a bi-level right from the get-go w/o good cause. MOST insurances insist that you fail CPAP therapy before they will pay for a bi-level except under certain quite stringent circumstances and usually involve a lot of communication and verification and Letters of Medical Necessity and what not to get them to pay for a bi-level right from the get-go. And a bi-level auto! YOU are fortunate! Are you going to be able to keep this device or is there a good chance you will be switched to a straight bi-level w/in the month?
Congratulaltions on getting 5-6 hours sleep w/your VPAP Auto 25 already!
The Resmed VPAP Auto 25 was released in January 2008. The VPAP Auto 25 was released in July 2008. I've never been able to get a good answer from our local Resmed Rep WHY the Auto 25 followed the release of the VPAP Auto so soon. I have the Clinicians Manual for both my VPAP Auto and for the VPAP Auto 25. The VPAP Auto's Clinicians Manual (not the Users Manuel patients are given) is so much more comprehensive that the VPAP Auto 25's Clinicians Manual .... I'm curious as to WHY that is too. The 25's Clinicians Manual is ..... no where near as explanatory as the VPAP Auto's. I've only glanced thru the 25's Clinicians Manual so am not sure of all the differences between the two but they appear to be fairly minor other than my VPAP Auto's maximum is 20 cms rather than 25 and some minor differences in LCD screen data sequences, info, etc.
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Cindy,
To answer your definitive question. NO, so far I can not tell any difference in the way I feel. Still groggy in the morning, get into second gear mid-morning, say 9:30'ish then trouble staying awake afternoon, and at night if sit down to watch the tube, forget it, I am asleep halfway through Jeopardy! In bed I am able to fall asleep pretty much the same as before, but still wake up every 90 minutes like clockwork. Sleep Dr says that is when I first hit REM - Airway closes enough to wake me up.
I beliveve two nights ago, based on clock watching (is that a bad habit?), I slept for two hours straight. I was excited about that in the morning, as I do not remember the last time I slept for more than 90 minutes at a time. But last night was not a good night. I still have hope though, and am committed to trying this thing every night for at least one month! When should I insist on someone reading info I can download to smart card the first time to see what it is doing through the night. DME Resp Tech told me to wait two weeks, but I think if there are adjustments that need to be made, why wait that long?
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Permalink Reply by Mary Z on
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Charley K, I say good for you for getting on the forum with your questions.
Sounds to me like the sleep lab treated you aggressively and appropriately. Instead of letting you flounder they tried different machines until they found the one that inhibited your apnea and that you were able to tolerate. Yes, 25 is too much pressure for an expiratory phase, at least that's what I understand. I also am not a back sleeper, but was asked to spend part of the time sleeping on my back during my study. I did not question why as the tech was thorough, professional, and knowledgable. I figured I would do my best to cooperate with him without evidence to the contrary, e.g. someone who was otherwise inept. Also, my Doc likes at least four weeks of data to base his titration on so I don't think two weeks is excessive. Give your body a little time to adjust to the machine.
Don't watch the clock ! I read that even the red glow from a digital clock can inhibit your sleep and clock watching is generally not a good idea anyway.
Why commit for only one month? For many of us it takes much longer to find the right pressures. Get in this for the long haul, relax, don't micromanage. If you don't have any reason not to trust your DME and other sleep professionals benefit from their knowledge and experience. I can understand your frustration at still being groggy in the morning and early at night. I still take Provigil after 18 months to prevent those very symptoms, but am working to get my machine titrated to get over the continued daytime sleepiness. Keep with it my friend, sounds like you're off to a good start, but it should only get better from here, even if it seems slow to you.
Mary Zimlich
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Mary, Thanks for the encouragement. When I said I was a clock watcher, I did not mean I stared at the clock. Only that I glance at it as a reference when I do wake up. I usually fall back asleep easily probably in less than 10minutes each time. I began noticing that I wake up almost like clockwork every 90 minutes. That seems to fit with what the sleep Doc said about start of REM stage being where apnea is bad enough to fully arouse me. I still look at the clock since starting treatment on VPAP, as a reference point when I wake up in middle of night. Whether valid or not, it seems like one more thing to evaluate effectiveness of treatment by. If I do not become fully awake every 90minutes, something has changed. That has only happened once so far, but here is hoping that will happen more frequently soon. I am still able to fall asleep within a few minutes with VPAP on unless there is a leaky mask. I am grateful for that.
Mary Zimlich said:Charley K, I say good for you for getting on the forum with your questions.
Sounds to me like the sleep lab treated you aggressively and appropriately.
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Permalink Reply by Saz RPSGT on
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Nothing like chiming in late!!
That kind of pressure isn't common, but it's not completely out of line either. Typically two reasons a spread like that would be seen:
1. You have been diagnosed with COPD (chronic obstructive pulmonary disease) and need a greater spread to help "blow off" CO2.
2. You were intolerant to straight CPAP of 25cmH20 which was the effective pressure during testing. BiPAP titrations are set based on EPAP (lower of the two pressures for when you exhale) being the first pressure where Obstructive Sleep Apnea events (this includes Mixed Apnea as well) are no longer seen. With OSA gone, this means that your airway is always kept open so that you can initiate a breath and trigger the IPAP pressure (when you inhale) The IPAP pressure is set for when all other Sleep disordered breathing events are gone. This includes Hypopneas, RERAS, and even snoring.
Sorry that last one was wordy, but it's a common question and even confusing for many technicians.
Let me know if that helps out.
Saz
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Permalink Reply by susan mccord on
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And we're damn glad to have you around, Jeff.........:-)
Susan McCord
j n k said:If those are the only two numbers given, it looks to me like your doc ordered APAP (an autotitrating machine, not a bilevel) with the minimum set at 8 cm H2O and the max at 25 H2O. That's my guess, anyway. If the Rx doesn't say specifically "BiPAP" or "Bilevel" on it somewhere, it is not a bilevel Rx. It would be an extremely rare thing for an OSA patient to be prescribed bilevel with a spread larger than 6 cm, I believe.
Your doc is smart not to prescribe the minimum at 4, like so many docs do. Starting at 8 or so is usually best, from what I've read on the boards.
I'm not a pro, just a fellow patient whose life was saved by PAP therapy and helpful forum members.
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Hi Charley--I have to agree with, I think it was Mary (?) who's encouraging you to be patient. I've been 100% compliant on CPAP for over 4 months, and spent a good amount of that time as you describe--foggy in the a.m., for at least an hour, headache many mornings, sleeping anywhere between 3-4 or 4-5 hours tops. Not nearly enough. It's just in the past, maybe 3 weeks that I've REALLY begun to feel a BIG difference in the way I feel. It does take some of us awhile to get that damn sleep debt worked down. I'm one, and it remains to be seen what you find out re: what YOUR body needs. Everyone's a little different in that regard.
It's GREAT that you're getting 6 hours or so already!
Re: clock-watching, I did some of that too but I have a small battery-operated clock that I have to push a button on to light the face. If I had a digital clock, I know I'd go nuts looking at it every time I even slightly woke up. You might want to try turning yours around so #1. the light won't interrupt your sleep (that really is true) and #2. you won't be able to look at it which may help you relax some better. Your body will do what it's gonna do whether you watch the clock or not, so what the heck? Just go to sleep and if you wake up, and don't need to get up, just roll over and go back to sleep. Just a suggestion from a slow-responder who's doing MUCH better now.
Just try to be gentle with yourself. It's not an overnight fix for most of us.
I, too, am glad to see you on the Forum when you have such important questions. It's the best way to help yourself begin to settle down with all this. It ain't easy, my friend, but with the support of SG, you can do it!!
Susan McCord :-)
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