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Yet another newbie - I'm clueless...
#21
Sleeprider - WOW! Granted one data point does not make a trend, but last night with the settings you suggested netted me an AHI of 4.86!! The lowest I've ever experienced and under 5 for the very first time!!! I'll update you again in another 4 to 5 days...
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#22
This thread is of interest to me, thanks for the care-
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#23
Awesome!
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#24
Glad to hear of the good result. Let's hope it gets a bit better or at least continues. I'm concerned that this might be a bit of complex apnea, so these results are encouraging.
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#25
(03-16-2017, 10:19 AM)Sleeprider Wrote: Let's try min EPAP 8, Max IPAP 12 PS 0.  This will basically mimic an auto CPAP with no EPR / pressure support.

This setting began to show really good results, however my Doctor's PA was not happy that I made changes and set my Bi-PAP from 12/8 over PS 0.0 to 12/4 over PS 4.0.  The results were that my AHI increased by 50%.

Today I met with my Doctor AND his PA, and he agreed that I was adjusting in the right direction, however I shouldn't be making changes without at least updating them (ok, message received).  Anyway, he went ahead and set my machine from vAUTO to CPAP and set the pressure at 12.  He said that with a PS of 0.0, then I had programmed it as a CPAP, not a Bi-PAP and that the EPAP set to 8 made no difference - as a CPAP there's only one pressure and that I had set it to 12.

My question is:  Is there a difference between...

1) vAUTO with EPAP 8, Max IPAP 12 PS 0 <--- this the setting that worked best for me, so far
2) CPAP and pressure at 12 <--- the setting the Doctor programmed today

In my uneducated opinion, I don't understand why he didn't just set it to exactly the way I had it.  I don't know enough about this machine and how it works to argue (constructively) with him, assuming the two settings above a really different.  I think the main difference is that in setting #1 above, the pressure will adjust automatically between 8 & 12, yet in #2, the pressure will remain constant at 12 and not adjust.  Is this correct?

Attached is my best night's sleep, which I would love to duplicate.

Thanks in advance,
Randy...


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#26
Randy, the doc is clueless. Set the machine to what works, and leave a message at the office you have made the settings that work best...you can prove it. Put the machine in Airplane mode to cut-off wireless access, and inform the DME you will verify compliance by calling in the compliance code or providing a copy of the SD card.

At EPAP min 8, IPAP max 12, the machine auto-adjusts from 8-12 cm as an auto CPAP. Your problem was centrals caused by the high pressure support or pressure difference between IPAP and EPAP. It's obvious whoever performed the titration got it wrong, but when you find what works, you should stick with it. It is your health, and your right to refuse any changes proposed by your doctor that does not perform as well. Your doctor's recommendation of CPAP mode give you 12 cm pressure all the time. Based on the chart you posted, I think I might lower the max pressure to 11 as it seems to cause problems above that. Imposing CPAP pressure of 12 is just an awful idea. You don't need it all the time, in fact you might not need pressure that high ever. That was a maximum I suggested based on the upper bounds of what I thought COULD be needed. Your AHI responds best to lower pressure without pressure support.
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#27
Thanks Sleeprider...   Machine settings restored, email sent to Doc, however at this time, I'm not turning on Airplane mode unless he (or his PA) change the settings without my approval.

I really appreciate your support!
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#28
Randy, it's obvious your doctor has a pretty bizzare perspective of how your therapy should be managed. He seems to want to enforce his ego over your demonstrated good results and sense of well-being. I strongly recommend you obtain all of your sleep study records and copies of prescriptions, then promptly transfer your care and management of sleep apnea to your primary care doctor. I'm sure you can explain this to your doctor, show him compliance reports, efficacy results and talk with him briefly at each routine visit how your CPAP therapy is proceeding and benefiting you. You won't need a specialist again until you need another sleep study for some reason, and even then you should let your primary care doctor be your primary caretaker and prescriber, in consultation with such specialists as he deems necessary.
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#29
Thanks Sleeprider for your support and advice. Granted a single data point does not make a trend, however I'm pleased to report that last nights AHI (after resetting my machine to the settings you recommended that worked) was 4.29. Huge improvement!!!
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#30
We can keep working to bring that down a bit. What were your results at 12 CPAP and what kind of events?
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