Bipap titration?

[Michaely6]

How do I go about getting a bipap titration? I already had a sleep study done over a year ago with a different company that I no longer associate with so can I just use those results to get a bipap titration done or do I have to start all over with another sleep study first with a different company? I was never originally prescribed a bipap machine either. I was prescribed a Resmed autosense 10 and didn't feel like it was working so I went out and got an aircurve 10 on my own after reviewing the data on sleepyhead so technically I never qualified for the bipap machine so will this be a problem in getting a bipap titration done?

[Walla Walla]

You can do the titration with the Air Curve you own. Just set it at minimum EPAP of 6cm Pressure Support of 4cm and maximum IPAP of 25cm. Post your results here using sleepyhead and someone can help you get setup for the pressures you need. Best of all it's free.

[Michaely6]

I 100% agree with you. The only reason why I was interested in a titration is because I wanted to see what stages of sleep that I reach and wanted to know how many arousals I'm having. I can get really good results with sleepyhead and the flow chart will look good but yet im still sleepy in the morning and waking up prematurely after 3hours or so on the machine. I also wanted to know how much RAM sleep I'm getting.

[Sleeprider]

If you have a therapy thread with results from your CPAP that would be helpful to see or link. We usually try to have members keep their therapy together because it avoids hunting for it. To answer your questions, we need to review why you are using bilevel instead of CPAP and what your results are on both. If there is a quantitative improvement with bilvel that supports an argument for medical necessity, or if you did not tolerate CPAP but find bilevel comfortable, those are both valid rationale for justifying bilevel. You do not need a new diagnostic study assuming you kept your records. A titration study for bilevel would be used to determine the efficacy of bilevel and your appropriate pressure settings. Since you own one, the machine data is an acceptable substitute. There is no "requirement" for a titivation study if the insurance approval criteria are met with actual use. Insurance wants to see medical necessity as demonstrated by a PSG diagnostic, intolerance or lack of efficacy for CPAP, and the efficacious use of the bilevel machine.

[Michaely6]

I will look for my old CPAP data and the reason why I switched. I have very bad flow limitation on straight CPAP and used EPR and noticed a huge decrease in flow limitation and the flow chart. I believe straight CPAP was causing expiratory intolerance and it looked like I needed higher inhale pressure than exhale pressure. I wanted to try even more exhale relief than EPR which is why I got the aircurve.

[Sleeprider]

That makes sense, and is a good argument. It's very easy to show with data in Sleepyhead. Most doctors want to hear this in terms of your "experience" and how you "feel", but we know high levels of flow limitation are very disruptive to sleep and good therapy.

[Michaely6]

Will flow limitations always knock you into a lighter sleep stage and do they always cause an arousal?

[Walla Walla]

Will flow limitations always knock you into a lighter sleep stage and do they always cause an arousal?

No not always. I found what usually woke me up was the mask leaks I would get from the pressuring increasing as a result of flow limitations. Most people here allow a range so the machine can react to events. But for myself once I found the pressures that worked for me, I sleep better by using fixed pressures with enough pressure support to knock down most flow limitation. Another approach is to just use a narrow range of pressure to avoid high pressure increase.

[Michaely6]

Will flow limitations always knock you into a lighter sleep stage and do they always cause an arousal?

No not always. I found what usually woke me up was the mask leaks I would get from the pressuring increasing as a result of flow limitations. Most people here allow a range so the machine can react to events. But for myself once I found the pressures that worked for me, I sleep better by using fixed pressures with enough pressure support to knock down most flow limitation. Another approach is to just use a narrow range of pressure to avoid high pressure increase.

When you say that you use fix pressure with enough pressure support are you saying that you use your aircurve vauto in S Mode? If so, why do you think fixed pressure works better for you compared to VAuto mode?

[Sleeprider]

Will flow limitations always knock you into a lighter sleep stage and do they always cause an arousal?

Flow limitations are incomplete apnea. If you find the flow rate shows a reducing flow rate from FL and recovery breathing, that is an arousal. If the flow reduction is severe enough it will get flagged as hypopnea or apnea.

FWIW, there is no "always". Your response to therapy or events is not necessarily like mine.  Your experience and success depends on finding what works for you and leaves you feeling like you slept reasonably well.  Flow limitation is generally not something that works in a beneficial way, but for some people it's better than higher pressure or pressure support. Aerophagia or sleep disturbance from pressure changes may be a problem. 

The big picture is finding what lets you sleep and experience a good day, and what works for me or someone else may not be your formula. Here is the problem; your doctor may not have figured this out. You may need BiPAP, and all he cares about is obstructive apnea that can be resolved with CPAP. Positive pressure therapy is more defined by insurance parameters and costs than performance. You may know what works for you and have tools that let you experiment to find the best solution.  With CPAP it is simple pressure, and with bilevel it is a combination of pressure and pressure support. Once you find what makes you feel best, the data is likely to confirm.