hookedonstitch - Therapy

[cathyf]

I'm not sure how things work in Canada, but is it possible to rent a bipap as a trial? Maybe that is something that your sleep doctor might agree to?

(The problem, of course, is that it's going to be tough to find one to rent! Well, unless you want one of the disintegrating foam ones, LOL... Sleep medicine is such a clusterf...)

[hookedonstitch]

Renting is a good thought.  I will wait for this recall to settle down and will look further into it.

[hookedonstitch]

So lets see if I understand my situation with flow limits and the Airsense machine I am using:

1. Regardless of how high I set the pressure the autoset will probably chase the maximum pressure to try to correct the flow limited breathing? That's what it is doing right now and I've tested it before up to 11.0 and it's still maxing out pressure at that number.

2. At what point and/or pressure will signal to the Dr. that there is an issue with my sleep and the current machine I am using? What I am asking is at what point does a Dr. consider switching therapy to a bipap machine? Is there a specific pressure number? What can I say to get her to listen to how badly I am feeling?

I notice that as I am turning up the pressure , I am getting more CA events and my AHI is increasing. Although it is still well under the acceptable AHI to be considered treated. I think from what I have been reading the CA events should decrease as I get used to the higher pressure?

[hookedonstitch]

Last night's OSCAR charts.  Should I be concerned about the small increase in CA events?

[hookedonstitch]

At least my machine is flagging more RERA events now, which I think are the next step up from flow limitations?

[hookedonstitch]

One last question about Tidal Volume, what should that number be for someone that is around 90 kg? And if it's lower than it should be is that linked to the issue I am having with flow limits being high?

[hookedonstitch]

Just finished making a couple of calls and unfortunately I need a prescription from my Dr. to even rent a BiPAP machine.  So looks like I'm in this for the long haul anyways so hopefully I can get my Dr. to understand the therapy as it is right now is not working as good as it should!  Or I will have to go rogue 

[Sleeprider]

I don't know how it works in Canada, but in the U.S. authorization for bilevel therapy can be made for intolerance or non-compliance with CPAP. Either your doctor is concerned about your sleep quality in addition to AHI or not. It will be very difficult to convince one that does not prioritize your comfort and understands the impact of flow limitation and RERA on your sleep that a change is needed. RERA is a direct consequence of flow limitation, and it is measured a arousals in sleep tests using EEG. A high RDI (respiratory disturbance index) which counts both apnea and respiratory effort related arousals can be justification for bilevel, but again it is going to be difficult to get your sleep doctor's attention when he is busy patting himself on the back for solving your apnea. Do your best to explain the situation and see if you can get any response. Most people have to change doctors when the one responsible for their care doesn't listen or care about patient input.

Regarding CA events, they are insignificant in your therapy and are often a reflection of arousal or sleep stage changes, and may be further consequence of flow limitation. They will be consistently inconsistent. Your tidal volume appears to fall within a normal rangey good, however it is normally estimated based on ideal weight based on height. Here is a chart https://mpog.org/files/quality/toolkit/i...chart1.pdf

[hookedonstitch]

Thanks Sleeprider, I will stress to my Dr. at the next consult that I still feel awful (I suspect I will ).  She suggested I needed a pressure increase because my machine is maxing out every night.  Does she know why and not sharing that with me?  I should have asked her why she was recommending that when my AHI was already low.  

If I ever get the $ together to try a bipap does it matter if I get the Aircurve or the Vauto version?  Both are similar in price here new.

[Gideon]

Different Models of BiLevel are for different conditions. AirCurve is a model line with many models.

"S" Spontaneous.. this is the manual mode/model of BiLevel
"ST" as above but with "Timing" or a backup breathing rate.
"VAuto" the APAP of BiLevels, automatically adjusting pressures, also contains an "S" mode. This is our preferred model for non-complicated OSA..