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New user - help with titration
#1
New user - help with titration
Hello everyone, 

Initial sleep study:

pRDI: Total events 88. 14.6/hr in REM, 12/hour nREM. Average all night 12.3/hour. (18.7 when supine)

AHI: Total events 46. 8.3/hr in REM, 6.2/hour nREM. Average AHI 6.4 (11.4 when supine)


Likely UARS + OSA (tall thin male with retrognathic facial structure). 

Please see attached charts from Resmed VAuto 10 (currently using S mode, EPAP 5 PS 4) 


1. Would appreciate advise re Vauto mode vs S mode.
2. Advice on how to titrate Bipap. 
3. Any other advice to treat UARS.

Many thanks


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#2
RE: New user - help with titration
Auto vs fixed is the eternal conundrum. We can discuss the merits of each, but in the end it is a personal preference. Either you let the machine do the work or you figure out what works for you.

Personally, I use S mode as well. No specific reason other than I find it comfortable and like to use fixed pressures anyway. If something is going on that I can’t figure out with the flow rate graph, I’ll go to VPAPauto mode with similar settings to see if something shows up in the data. Basically same thing as below.

The simplest way to titrate is to set a range, for you something like the following:

EPAP min 5
IPAP max 15
PS 3

and see where it goes. You can experiment with other settings like PS=4 to see how you respond. You slowly narrow down the pressure range and pressure support. No magic is needed, just perseverance. 

Regarding UARS, that is even more of a mystic art. The first step is identifying it. Once identified, the only tools we have are pressure and response to deal with it. You have to find that pressure “edge” where you are not creating more problems than solving whilst looking for a smoother flow rate. Not a perfect flow rate, just smoother. Trial and error is the only way to find it.
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