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BiPap to Cpap? Confused and why???
#1
New here, so confused and need some help! I have searched the site but can't seem to find anything related to my problem.
I have been using a Respironics BiPap autoSV advanced machine for the last 5 years. I have had no problems with it. I was recently at my regular Dr. and asked if I need to be titrated every so often as I have never been. So I just had another sleep study done and they are recommended I be changed to a CPAP. My current settings are 25/15cmH2O. The only thing that I see in the paper work that they are suggestion is that I be changed to 8cm water. I am so confused. Why do I need an entirely different machine and why can't they just make the adjustments on my current machine. If anyone has an suggestions please advise as I would appreciate it immensely!!!
Oh and it says that my ahi at the 8cm water was 4.7.
Thanks!!!
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#2
Welcome!

It sounds like your titration study showed no signs of central apneas and a relatively low pressure needed to treat your obstructive apneas / hypopnea. That does strike me as unusual, people usually switch machines in the opposite direction.

I don't use an ASV machine, but my recollection is that they are very adjustable and could provide the new prescribed therapy. But a drop from 25 to 8 and a diagnosis change from complex to simple apnea is... rather remarkable. How did you get on this machine in the first place if you never had a titration? I'd be questioning the latest titration study myself.

Stick around for some other ideas.

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#3
I would suggest you download sleephead and see how active your CPAP is at night, what level your 95% pressure is at and see if you can make sense of the 8 fixed. It is possible that you were prescribed the highest level machine just in case you needed it or perhaps because it was the most expensive?

You should be able to figure it out with sleephead, post a plot here and we will have a look.
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#4
(08-17-2016, 10:37 PM)chill Wrote: Welcome!

It sounds like your titration study showed no signs of central apneas and a relatively low pressure needed to treat your obstructive apneas / hypopnea. That does strike me as unusual, people usually switch machines in the opposite direction.

I don't use an ASV machine, but my recollection is that they are very adjustable and could provide the new prescribed therapy. But a drop from 25 to 8 and a diagnosis change from complex to simple apnea is... rather remarkable. How did you get on this machine in the first place if you never had a titration? I'd be questioning the latest titration study myself.

Stick around for some other ideas.

Thanks for the reply:
My first sleep study evidently did show central and obstructive! So that's how I got on the ASV in the first place. So I am guessing it didn't show any this time, at least it didn't say on my paperwork. So I guess my therapy has been working the last 5 years? I don't know much about any of this! So trying to figure it all out!
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#5
Have you had any health, medication, or other possibly related changes since the first sleep study?
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#6
My understanding is that the doctor orders what kind of titration study they want done. My first sleep doctor ordered a CPAP study and so that is all they did the study for. When that didn't work I went to another doctor whom looked at my data, lots of central apnea's and ordered the Bipap study. Thing is they said I did not need supplemental oxygen but I cannot cope without it. And oxygen does occasionally drop below 88 even when on the bipap machine.
I have a AirCurve 10 vpap set in S mode. Yes, the machine can be dumbed down to cpap mode, but do not understand why you would want to.
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#7
Meghan, your current machine can be set to CPAP mode at a fixed pressure. I think you will find that is a miserable failure for you, but it beats buying a new machine, only to discover it doesn't work. If you have complex mixed apnea, it isn't going away, and the 4.7 AHI determined by the clinic is NOT an acceptable result. That is simply the best result obtained in CPAP mode during the study. I will assume they never evaluated bilevel or ASV.

For starters, I would encourage you to download Sleepyhead and get to understand the therapy you're currently getting. Second, I would request your detailed sleep study record, including the charts, and recommendations so you can see what happened during the study, rather than rely on a one-line recommendation based on the study. You should examine the study to see what kinds of apnea are present, frequency and what pressures were evaluated. Above all, use your current machine as a baseline...is your current AHI better than the test?
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#8
Meghan,

I'm really sorry.. I'm having a very difficult time trying to wrap my head around all of this.. perhaps you can help me formulate a better picture.

(08-17-2016, 09:11 PM)MeghanRx Wrote: I have searched the site but can't seem to find anything related to my problem.

Um.. not to be thick. but what exactly are you saying is your problem?

(08-17-2016, 09:11 PM)MeghanRx Wrote: I have been using a Respironics BiPap autoSV advanced machine for the last 5 years. I have had no problems with it.

Your statement is in and of itself goodness. The question is, if no one is following your sleep progress, how do you know your not having any problems?

(08-17-2016, 09:11 PM)MeghanRx Wrote: I was recently at my regular Dr. and asked if I need to be titrated every so often as I have never been.

Ok... I'll be thick again... so you initiated the titration request?

Is your Physican a GP, Internist, Cardiologist, ??? and do you know EXACTLY what he ordered?

Did he order a split study or just a straight up titration PRESUMING a problem existed?

If you've never been titratd in the past, where did the prescription for your existing ?PAP machine come from? How was it determined you should be treated using an ?PAP and exactly for what?

(08-17-2016, 09:11 PM)MeghanRx Wrote: So I just had another sleep study done and they are recommended I be changed to a CPAP.

I don't know what happened in your case, but when I went to the sleep study my Dr and I both received written reports on the results. After the titration I also received a technical recommendation about using ?PAP and if I didn't / couldn't tolerate one device to move me to another and if that didn't work move me to yet another.

Apparently during my titration, they tried me on several different types of therapies at various pressure settings. Of course, they didn't try setting the timed events and the like, just the basics to see if they couldn't grapple with which machines i might get the best therapy.

(08-17-2016, 09:11 PM)MeghanRx Wrote: My current settings are 25/15cmH2O. The only thing that I see in the paper work that they are suggestion is that I be changed to 8cm water.

You didn't make mention of it but did you happen to loose a significant amount weight?

(08-17-2016, 09:11 PM)MeghanRx Wrote: I am so confused. Why do I need an entirely different machine and why can't they just make the adjustments on my current machine. If anyone has an suggestions please advise as I would appreciate it immensely!!!
Oh and it says that my ahi at the 8cm water was 4.7.
Thanks!!!

Do you or can you get the plots from your machine? It almost sounds like there are multiple things going on all at the same time...

Honestly, I'm not trying to be critical, just trying to get enough information to try and put the puzzle together.

Warning: Eating chocolate may cause your clothes to shrink!
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#9
Hi MeghanRx,
WELCOME! to the forum.!
I would really question being switched from your presant machine to a CPAP machine.
Good luck to you as you continue your CPAP therapy and hang around for other responses to your post.
trish6hundred
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#10
I just did a search on the old machine being used. It is not a smart machine in todays sense. The cord is not a standard sd card. It physically looks like the old brick I used. All it recorded was time on the machine. Note, there is no data that can be imported for sleepyhead. Here is my guess. Doctor wants to upgrade the machine, but insurance will only pay for cpap until it is proved it will not work. Then a new study months from now to get a standard bipap like I have. If that does not work then go for ASV. 4.7 AHI is not good. Would suggest a bipap titration as soon as possible. At least a new machine will allow data to be taken to qualify to get a better machine. Note: if medicare, the machines are not purchased initially, only rented. So insurance may be the same. At least get a machine that is smart so data can be recorded.
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