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+--- Thread: [Treatment] John70's Therapy Thread (/Thread-Treatment-John70-s-Therapy-Thread)
RE: John70's Therapy Thread - John70 - 04-16-2021
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Last night I used my F30 mask as I was a little congested. My events went up considerably with the same settings using my P10. It is normal for events to go up using a FF mask? If so, I am guessing raising pressure say 2 cmH2o may be appropriate? Any thoughts?
My doctor is questioning the need for a BiPap Machine. Today I am going to see if any local DME suppliers will rent a machine for cash.
RE: John70's Therapy Thread - Gideon - 04-16-2021
John, take the PS out of your CPAP, for demonstration purposes. Put your machine on equal footing with other brands, turn EPR off.
DME suppliers will require a prescription. You can ask your doc for a prescription, and tell him then you wi) pay cash for one.
Do you have a copy of your prescription? You should have a copy. Call supplier#2 and ask if that is good enough to get a VAuto. '
VTW on your chart you are tucking your chin. The fix is a soft cervical collar, let your doc try and figure that one out. Help to prove that this machine isn't working for you.
RE: John70's Therapy Thread - Sleeprider - 04-16-2021
The clusters of obstructive apnea are a strong indicator of positional apnea or "chin-tucking". Read the positional apnea and soft cervical collar wiki so you understand.
Positional Apnea http://www.apneaboard.com/wiki/index.php/Optimizing_therapy#Positional_Apnea
Soft Cervical Collar http://www.apneaboard.com/wiki/index.php?title=Soft_Cervical_Collar
I think EPR has improved your comfort of therapy and significantly reduced flow limitations. The way we know that you may need more pressure support (difference between inhale and exhale pressure) is that you have a relatively long inspiration time compared to expiration time. This happens when a person has considerable airway resistance or obstruction which requires more work and more time to get the volume of air needed to satisfy respiratory needs. In your case, this excessive inspiration time is pretty significant. Pressure support from bilevel therapy can actually off-load some of the physical effort of inspiration to the machine and help you fill your lungs easier and more rapidly. The increase in ventilation can reduce your CO2 which affects respiratory drive. This is what causes some of the CA events. We sometimes can offset this by conserving some exhaled CO2 in a system called Enhanced Expiratory Rebreathing System (EERS), which is a fancy term for keeping some space in the CPAP tube that is not flushed through the mask vent. http://www.apneaboard.com/wiki/index.php/Enhanced_Expiratory_Rebreathing_Space_(EERS)
I see Gideon is suggesting you turn off EPR for now, and I presume that is to show the full impact of flow limitations without EPR, perhaps to make the case for bilevel with your doctor. It will be less comfortable, and will replace CA events with more hypopnea and RERA. You have assumed that you may need a new sleep study. The reality of sleep studies is that they do not solve problems like yours, but serve to demonstrate efficacy of the cheapest possible machine for insurance by documenting a low AHI. In your case, CPAP results in a lower AHI than bilevel and a sleep test will not even measure flow limitation. So I don't see this strategy working out well.
RE: John70's Therapy Thread - John70 - 04-17-2021
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Gideon I do not have a copy of my prescription. #2 & #26 supplier need the Rx to purchase. # 30 supplier has a Rx service for $99.99 which will allow me to buy outright a new AirCurve VAuto. I called a local DME supplier who will rent The AirCurve VAuto for $150.00/month.
I messaged my doctor twice in MyChart, he or his staff are reading the messages but still no reply. I have attached my 2nd sleep study from 2-12-2018. Also attached is my Oscar report from last night using a "flat pillow" similar to "My Pillow". The pillow I have been using is a "neck pillow" which has a low and a high ridge to support my neck. It occurred to me it that may be partially responsible for my "chin tucking". Well last nights Oscar report indicates, I made my Events worse, especially my CSA's.
I looked at some Cervical or soft collar options on Amazon, also I will go to CVS today to find one that fits, not too tight. However, I like to see if it would help with my mouth opening rather than using tape. So I like the one that cradles my chin, my wife measured my neck 15 inches.
What would be a good settings for the AirCurve VAuto BiPap to start with? VAuto or S Mode? VAuto Mode Settings: Max IPAP 25.0, Min EPAP 4.0, PS 4. S Mode Settings: IPAP 12 / EPAP 5, Easy-Breath "On", Ti Max 2.0s / Ti Min 0.3s, Trigger Med, Cycle Med, Mask Full Face (for now) Ramp off, Start EPAP 4, Climate Ctrl & Tube Temp. Auto, Smart Start On.
My doctor could drag on for weeks or months. It possible I can have an BiPap to rent for a month next week from my local DME. Well see what happens. I am really disappointed in my Events last night. I really thought it could be the pillow. Sometime last night I raised the adjustable bed up without a pillow. I did not sleep during that time, so I lowered it back down and used the flat pillow.
Thank you Gideon and Sleeprider for your responses.
RE: John70's Therapy Thread - Gideon - 04-17-2021
You are entitled to a copy of your prescription per hippa. Request a copy from your doctor.
RE: John70's Therapy Thread - Sleeprider - 04-17-2021
The other solution if you are buying out of pocket, is to purchase from Supplier #2. They will accept your CPAP prescription and provide a Vauto. They normally simply call your doctor's office and confirm they have prescribed PAP therapy. When they do this, it may come setup with your CPAP settings, and where you take it from there is your business. A "Gently Used ResMed S10 AirCurve VPAP Auto (VAuto) w/ Heated Humidifier" costs $799, and if you call, they will tell you how many hours the machine has. They provide a warranty and excellent service. This can save quite a bit of money compared to prescription services, studies and new machines.
RE: John70's Therapy Thread - John70 - 04-19-2021
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Sleeprider,
Order my BiPap Machine from Briar @ SecondWind. I chose random settings with a PS 4 to start. Once I start using it, it will be great to see a reduction in events.
Thank you.
I will be back once I get the machine and have questions.
John70
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RE: John70's Therapy Thread - Sleeprider - 04-19-2021
Sounds like it worked out for what you wanted. I did not see the image you posted but we're here to help as you start the new machine, and a PS of 4 is a good start.
RE: John70's Therapy Thread - John70 - 04-22-2021
Hello Sleeprider,
I asked SecondWind to hold my shipment as my Sleep Doctor finally responded to me yesterday. His coordinator will work to "document" the reason to change to a BiLevel machine for the DME company who then gets "prior authorization" from the insurance company to rent the BiLevel machine to me. I have no idea what the monthly rental cost would be. Once I find out I just may just tell SecondWind to ship my order. Since I will never own the machine, it may make more sense to pay for it out of pocket.
In the meantime, I am back to using my ResMed F30 mask to get some much needed sleep. I using my AirSense 10 on APAP mode min 10; max 15 as shown in the Oscar report. It appears that I am doing better with a lower pressure around 12 cmH20 with no EPR. Would you agree? Does the recommended Min/Max pressure change with the type of mask using APAP or a BiLevel machine?
I purchase a new ResMed S9 SD card for my BiLevel machine. Will Oscar know it is a BiLever machine when I do the CPAP Importer? ReMed myAir report does allow me to change the equipment for reporting purposes.
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I value you comments, Thank you.
John70
RE: John70's Therapy Thread - Gideon - 04-22-2021
As before you are tucking your chin! That needs to be fixed first. A soft cervical collar is what works for most for that.
Your Flow Limits are out of control (You need EPR/PS to tame those) Your RERAs alone have an arousal on average every 36 minutes.
I suspect that it is a Rent to own on the rental. Request to see the total to be expended before you choose, ask what your share will be.