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ONLINE home testing?
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nila Offline

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Post: #51
RE: ONLINE home testing?
Hi folks, it's me, back seeking more advice Smile.

I got a prescrip from my doc for a S9 auto bipap, and made an appointment for tomorrow with the DME person, Megan.

But now Megan calls me and says that the prescription is not ok because it does not specify inspritory pressure, expritory pressure, and 'pressure support', whatever that last one is. Luckily, I have an appointment with my doc tomorrow, but I know what she is going to say: I have to find out what to write on the prescription, and then she will write it.

So, can y'all help me? What I'm really going to do, of course, is get the machine and use it for testing. But what can the doc write on the prescrip that will pass muster? (For those just joining us: she is not a sleep doc and I cannot get to a sleep doc.) Megan said, for example, that there has to be the right range between insp and exp, but that she will not tell me what the right range is.

When I had a CPAP, it was set at 10, and the main concern now is getting the expiritory pressure to the absolute minimum, so that it does not aggravate an injury.

I'd sure appreciate any suggestions, and will happily pass them on to my doc at our appointment tomorrow. Someday I will get a machine!
04-30-2012 03:39 PM
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JumpStart Offline

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Post: #52
RE: ONLINE home testing?
(04-30-2012 03:39 PM)nila Wrote:  Hi folks, it's me, back seeking more advice Smile.

I got a prescrip from my doc for a S9 auto bipap, and made an appointment for tomorrow with the DME person, Megan.

But now Megan calls me and says that the prescription is not ok because it does not specify inspritory pressure, expritory pressure, and 'pressure support', whatever that last one is. Luckily, I have an appointment with my doc tomorrow, but I know what she is going to say: I have to find out what to write on the prescription, and then she will write it.

So, can y'all help me? What I'm really going to do, of course, is get the machine and use it for testing. But what can the doc write on the prescrip that will pass muster? (For those just joining us: she is not a sleep doc and I cannot get to a sleep doc.) Megan said, for example, that there has to be the right range between insp and exp, but that she will not tell me what the right range is.

When I had a CPAP, it was set at 10, and the main concern now is getting the expiritory pressure to the absolute minimum, so that it does not aggravate an injury.

I'd sure appreciate any suggestions, and will happily pass them on to my doc at our appointment tomorrow. Someday I will get a machine!

Hi Nila. Let me preface my remarks by saying I do not use a BPAP, nor am I certain I know what your DME wants. However, that said, to qualify for a BPAP you would need an inspiratory pressure [IPAP] which was at least 4 cmH2O different from the exhalatory pressure [EPAP]. So as an example only, if you set IPAP at 11, and EPAP at 4, you would have a difference of 7. Since the maximum difference which can be obtained on xPAP is 3 cmH2O, you would need a BPAP to achieve that difference. I also found the following definition of pressure support on another site:

The difference between the inhalation and exhalation pressures is called the pressure support. For patients with sleep apnea, this pressure support acts as a relief valve, allowing them the benefit of high-pressure air to prevent apneas while also breathing out at a normal rate. Some machines also have auto-adjusting features that will change the pressure support based on indicators from the patient's breathing.

If I am reading correctly, and using numbers I pulled out of the air, your doc could request the machine with IPAP=11, EPAP=4 (or 3, the greater the difference the easier to float the deal, IMO, but I don't have any actual knowledge. I do understand you don't intend to use these figures for therapy). Pressure support would then be the difference between the two, as stated above, or 7. I can't see where that specific phrase, or even that number, should appear on a Rx - it is just a simply calculation, obviously, if the definition I found is correct, and therefore the DME can determine it as easily as anyone else. I suspect she may have been throwing stuff at you, perhaps without any real knowledge herself, or you may have misunderstood what she was asking for. The Rx WOULD have to have both IPAP and EPAP specified.

Don't know how much this will help, but you seem to have little time to get this together. I certainly wish you the best of luck. Please keep us updated.

Breathing keeps you alive. And PAP helps keep you breathing!
(This post was last modified: 04-30-2012 06:15 PM by JumpStart.)
04-30-2012 06:09 PM
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zonk Offline

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Post: #53
RE: ONLINE home testing?
Check with the doc about the pressure range setting and does the doc recommend the auto bipap to be used in straight bipap or auto bipap? The pressure support can be set higher than EPR (3) and is the difference between inhale and exhale pressures so if your ipap 14 and epap 10 than pressure support is 4 (14-10) which can be more comfortable to breathe against pressure 10 than 14 but as I've read the exhale pressure can not be lower than your cpap pressure so the lower pressure to treat your apnea while the higher pressure to fine tune and pressure support to provide some comfort. Try this machine first before buying to make sure it can help you better than your cpap bc its more expensive and make sure you,re not paying for something you don,t really need and as always be guided with your doctor advice and good luck
04-30-2012 06:43 PM
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JumpStart Offline

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Post: #54
RE: ONLINE home testing?
(04-30-2012 06:43 PM)zonk Wrote:  Check with the doc about the pressure range setting and does the doc recommend the auto bipap to be used in straight bipap or auto bipap? The pressure support can be set higher than EPR (3) and is the difference between inhale and exhale pressures so if your ipap 14 and epap 10 than pressure support is 4 (14-10) which can be more comfortable to breathe against pressure 10 than 14 but as I've read the exhale pressure can not be lower than your cpap pressure so the lower pressure to treat your apnea while the higher pressure to fine tune and pressure support to provide some comfort. Try this machine first before buying to make sure it can help you better than your cpap bc its more expensive and make sure you,re not paying for something you don,t really need and as always be guided with your doctor advice and good luck

Zonk, if I understand correctly, her doctor knows little or nothing about PAP of any variety, and is simply providing a script to enable Nila to get a machine for home testing. Of course, as usual, I may be mistaken. :grin:

Breathing keeps you alive. And PAP helps keep you breathing!
04-30-2012 07:59 PM
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PaulaO2 Offline
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Post: #55
RE: ONLINE home testing?
Ah, if you just want one for home testing? You do not want a bilevel PAP. Unless you have an extreme lung condition that would make it difficult for you to breathe against the pressure, you probably are not going to like it.

Ask the DME if you can trial one for a few nights.

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04-30-2012 08:01 PM
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nila Offline

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Post: #56
RE: ONLINE home testing?
(04-30-2012 07:59 PM)JumpStart Wrote:  Zonk, if I understand correctly, her doctor knows little or nothing about PAP of any variety, and is simply providing a script to enable Nila to get a machine for home testing. Of course, as usual, I may be mistaken. :grin:

Yes, that is correct.


(04-30-2012 08:01 PM)PaulaO2 Wrote:  Ah, if you just want one for home testing? You do not want a bilevel PAP. Unless you have an extreme lung condition that would make it difficult for you to breathe against the pressure, you probably are not going to like it.

I do have an extreme condition that prevents exhaling against pressure, though it's not in my lungs. I think I explained it all upthread <smilie>.
(This post was last modified: 05-01-2012 01:54 PM by nila.)
05-01-2012 01:53 PM
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nila Offline

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Post: #57
RE: ONLINE home testing?
(04-30-2012 06:09 PM)JumpStart Wrote:  ...However, that said, to qualify for a BPAP you would need an inspiratory pressure [IPAP] which was at least 4 cmH2O different from the exhalatory pressure [EPAP]. So as an example only, if you set IPAP at 11, and EPAP at 4, you would have a difference of 7. Since the maximum difference which can be obtained on xPAP is 3 cmH2O, you would need a BPAP to achieve that difference. I also found the following definition of pressure support on another site:

The difference between the inhalation and exhalation pressures is called the pressure support. For patients with sleep apnea, this pressure support acts as a relief valve, allowing them the benefit of high-pressure air to prevent apneas while also breathing out at a normal rate. Some machines also have auto-adjusting features that will change the pressure support based on indicators from the patient's breathing.

If I am reading correctly, and using numbers I pulled out of the air, your doc could request the machine with IPAP=11, EPAP=4 (or 3, the greater the difference the easier to float the deal, IMO, but I don't have any actual knowledge. I do understand you don't intend to use these figures for therapy). Pressure support would then be the difference between the two, as stated above, or 7. I can't see where that specific phrase, or even that number, should appear on a Rx - it is just a simply calculation, obviously, if the definition I found is correct, and therefore the DME can determine it as easily as anyone else. I suspect she may have been throwing stuff at you, perhaps without any real knowledge herself, or you may have misunderstood what she was asking for. The Rx WOULD have to have both IPAP and EPAP specified.

Thank you so much!

I have a couple of hours before my appointment, if anyone else has any suggestions to add <smilie>.
05-01-2012 01:58 PM
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nila Offline

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Post: #58
RE: ONLINE home testing?
I found this on another site:

Quote:On the S1 BiPAP Auto, the PS setting is the maximum allowable value for IPAP - EPAP. And the minimum value the S1 will allow for IPAP - EPAP is 2.

...On the VPAP, the PS setting is the fixed value for IPAP - EPAP. Hence IPAP and EPAP are always increased together on the VPAP. (And that's why the ResScan reports for VPAP mahcines can show the pressure info with only one curve.)

So, does this mean that for the S9 if I have her put IPAP=11 and EPAP=4 I should have her do PS=8? Or should I not get fancy and just have PS=7 so i can later try a Resmed machine?

Oi, confusing!
05-01-2012 02:08 PM
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zonk Offline

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Post: #59
RE: ONLINE home testing?
(04-30-2012 07:59 PM)JumpStart Wrote:  Zonk, if I understand correctly, her doctor knows little or nothing about PAP of any variety, and is simply providing a script to enable Nila to get a machine for home testing. Of course, as usual, I may be mistaken. :grin:
Yes I know nila from our old forum but really imo the doctor is not just a script writer he also have a duty of care to his patients
05-01-2012 03:14 PM
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nila Offline

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Post: #60
RE: ONLINE home testing?
(05-01-2012 03:14 PM)zonk Wrote:  
(04-30-2012 07:59 PM)JumpStart Wrote:  Zonk, if I understand correctly, her doctor knows little or nothing about PAP of any variety, and is simply providing a script to enable Nila to get a machine for home testing. Of course, as usual, I may be mistaken. :grin:
Yes I know nila from our old forum but really imo the doctor is not just a script writer he also have a duty of care to his patients


Well, frankly, I have not been able to find a doc like that.
05-01-2012 04:31 PM
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