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Today I saw the doctor who set me up with my VPAP Auto 25 five weeks ago. This is the first time I saw him since he set me up with the machine. When I talked to him I explaned how I am still sleepy all day and he suggested Provigil and that was it. When I suggested changing the settings on my machine he said there is no need for it because it is self titration and will set the pressure to what ever it should be. Does this sound right to you? He has the settings at 5/15. I have been around here long enough to know that you have to mess around with the setting to get things just right.

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Well, yeah, probably your biggest mistake WAS working w/this ENT - but - you got one heck of a good xPAP out of the deal since it can be used as an auto bi-level, as a bi-level and as a straight CPAP. So .... yeah, I'd be inclined to find a better sleep doctor. But since they aren't always that easy to find ... the good ones, that is ... you're on the right track on your own here.
I completely agree!!!!

Rock Hinkle said:
Chris if I were you I would ask for a titration study. Especially for a bipap machine. Self titration on a CPAP is one thing, but a BIPAP that is just rediculous. If you had been titrated correctly in the first place you might already be feeling the benefits. I would highly suggest you seek out a pulmonologist with sleep credentials. Not to knock any of the other docs with sleep credentials. I just feel that pulmonologist have a real good feel for what is going on with apnea and its effects on our bodies.
Rock Hinkle said:
Self titration on a CPAP is one thing, but a BIPAP that is just rediculous.
Can you elaborate???????????
You haven't caught on yet to just how complicated these bi-level autos can be? All the various "comfort" options. We could be a YEAR trying to find "just the right" settings for us. Or we can let the pros figure it out.
Generally A person that is given a BiPAP either had CPAP tolerance issues, or failed CPAP for one of many reasons. Since you did not have a titration study I can only assume that your doc saw something a little bit more serious than your normal obstructive apneas. That is easier to believe than your doc predertiming a CPAP failure. From what I have been told it is much harder to get insurance approval for BiPAP over CPAP. There are only a few situations that allow me to put someone on BiPAP without a doc's order.

With a CPAP you are only dealing with one pressure be it auto or straight. The biggest difference with the BiPAP are the two different pressures known as IPAP and EPAP. These represent inhalation and exhalation as you already know. With the sophistication of your machine in essence it is a mechanical lung. Meaning you could actually control or disrupt your breathing pattern. Adjusting these pressures on your own can be a little tricky. ie: When do I raise IPAP or EPAP? When do I raisse them both together. What are my limits. By setting the machine wrong you could hyperventilate at the very least least. Right now you and your doc are guessing, and that is not cutting it.

I think you are doing a great job with you therapy. You are trying to make it work for you. I just feel that you could use the guidance of a proper titration and the education that could possibly come with it. Call it A PAP therapy base or starting point at which you can continue to build upon. I strongly believe that once you put together an apnea support group consisting of a good doc, DME, and yourself, that your treatment will move along at a much more aggreeable pace for you. Imagine a world hwere all three of you can coexist and work together.

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