"please keep me updated about oximeters "
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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.
Views: 22
Replies to This Discussion
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Permalink Reply by Melinda Hertel on
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How well are you sleeping on the machine now? And, how is your mask fitting? Are you struggling with leaks? Is your machine actually set in the auto mode?
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Permalink Reply by Chris on
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Yes It is in auto. I raised the minumum pressure to 6 after the first week and just raised it to 7 today. Here are my settings and the average of one months use. Do you know what MV and VT mean?
MAX IPAP 15.0
MIN EPAP 7.0
PRESS SUP 4.0
TI MAX 2.0
TI MIN 0.3
EXHALE MED
MASK MIR FULL QUATTRO
LEAK 0.04 L/S
VT 420-740
RESP RATE 12-18
MV 7.3-10.5
PRESS 12.8
AHI 6.4
AI 1.0
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Permalink Reply by Judy on
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Okay. In Auto mode w/a Pressure Support of 4 your EPAP can range from 7 to 11 cms and your IPAP can range from 11 to 15 cms.
At an IPAP of 15 and EPAP of 5 and PS of 4 in auto mode your EPAP could range from 5 to 9 cms and your IPAP from 11 to 15 cms.
At an IPAP of 15 and EPAP of 6 and PS of 4 in auto mode your EPAP could range from 6 to 10 cms and your IPAP from 11 to 15 cms.
MV=minute ventilation=the volume of air breathed in (or out) w/in any 60 second period and is measured in Litres per minute
VT=tidal volume (I think)=volume of air inspired or expired in one respiratory cycle (breath) and is measured in milliLitres (mLs)
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What do you think of the results? AHI is 6.4 AI is 1.0 with a setting of 6/15. I just bumped it up to 7/15. Am i doing the right thing?
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I'm only a patient, Chris. "They" do say EPAP for OSA and IPAP for HSA but, again, I'm only a patient. My understanding is that ideally "we" want AI under 1.0 and AHI under 5.0. Also, "my understanding" is that most often the best results are reached when the EPAP is one over half of the IPAP typically. ie: 10/6, 12/7, 14/8, 16/9, 18/10, 20/11. BUT, if you were to try that rationale I'd do as you are doing and proceed GRADUALLY.
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It won't hurt anything to raise it to 7cm. It just means you won't go any lower than 7cm, which is probably a good thing. Since your AHI is 6.4 you very well could be having symptoms as a result of that. Some people are fatigued even with an AHI of 2 or 3. In those cases it's usually called "restrictive airways" and some people are still very symptomatic.
Did you have a titration study where the technician actually put you on CPAP and attempted to determine your ideal pressure? Why were you started on a bilevel instead of CPAP?
Did raising your EPAP to 7cm help?
Chris said:What do you think of the results? AHI is 6.4 AI is 1.0 with a setting of 6/15. I just bumped it up to 7/15. Am i doing the right thing?
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Permalink Reply by Daniel on
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It's only five weeks. Sometimes it takes more time before daytime sleepiness abates. Hang in there. Don't go rushing to fill the Provigil prescription. If you use your VPAP every night for six months, and you still feel sleepy, that could be another story. Don't forget that your prescription for Provigil is good for one year.
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Melinda Hertel said:It won't hurt anything to raise it to 7cm. It just means you won't go any lower than 7cm, which is probably a good thing. Since your AHI is 6.4 you very well could be having symptoms as a result of that. Some people are fatigued even with an AHI of 2 or 3. In those cases it's usually called "restrictive airways" and some people are still very symptomatic.
Did you have a titration study where the technician actually put you on CPAP and attempted to determine your ideal pressure? Why were you started on a bilevel instead of CPAP?
Did raising your EPAP to 7cm help?
Chris said:What do you think of the results? AHI is 6.4 AI is 1.0 with a setting of 6/15. I just bumped it up to 7/15. Am i doing the right thing?
No titration thats why the doc wanted to go with bi level.
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The doc I work with would have insisted on a CPAP titration first. A lot of people do okay on an auto-titrate machine. However, there are people who use an auto-titrate and have a lot more trouble adjusting to it. Once we put them on straight CPAP they do just fine. I'm not certain that this is your problem, but I feel that you might not have been given an adequate evaluation. I especially do not understand why you were put on a bilevel instead of an auto-titrating CPAP if the doctor wasn't sure which pressure to use. Very few people need a bilevel--most do just fine with CPAP.
It sounds like your doctor is not very helpful. We try to fix everything else first before going to medication. Some people still need a stimulant like Provigil even with PAP therapy. However, they are few in number and drugs should really be the last resort. There are a lot of things that can be tried with your PAP therapy first. Maybe finding a new doc is the answer.
From your results, it looks like you are averaging about 12.8cm for your max pressure. If you know how to change your settings, you could put the VPAP Auto 25 into CPAP mode and set it for 13cm and see how you do. If 13cm is too difficult to exhale against, set the EPR to 3cm and you can exhale on 10cm.
Chris said:Melinda Hertel said:It won't hurt anything to raise it to 7cm. It just means you won't go any lower than 7cm, which is probably a good thing. Since your AHI is 6.4 you very well could be having symptoms as a result of that. Some people are fatigued even with an AHI of 2 or 3. In those cases it's usually called "restrictive airways" and some people are still very symptomatic.
Did you have a titration study where the technician actually put you on CPAP and attempted to determine your ideal pressure? Why were you started on a bilevel instead of CPAP?
Did raising your EPAP to 7cm help?
Chris said:What do you think of the results? AHI is 6.4 AI is 1.0 with a setting of 6/15. I just bumped it up to 7/15. Am i doing the right thing?
No titration thats why the doc wanted to go with bi level.
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I just set the machine to 7/15 today. I will give it a little time and see how it works out. If it dont look good Ill try the CPAP settings you suggested and start looking for a new sleep doctor. Thanks for all the help
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Daniel said:It's only five weeks. Sometimes it takes more time before daytime sleepiness abates. Hang in there. Don't go rushing to fill the Provigil prescription. If you use your VPAP every night for six months, and you still feel sleepy, that could be another story. Don't forget that your prescription for Provigil is good for one year.
Thanks for the info. I just might use the Provigil till I get this all sorted out. It seems to me that seeing this ding bat ears nose and throat doc who seems to think he knows something about sleep apnea was my first and worst mistake in dealing with this.
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Permalink Reply by RockRpsgt on
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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.
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