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Attached is last nights OSCAR. I had a discussion yesterday with my RT about my therapy settings and BiPAP. She looked at my therapy data and asked me to bring my pressures back down from 11-20 back to 4-20. She claimed that should get rid of a lot of the CAs. Per my OSCAR data today that appears to be what happened. MY AHI went from 4.9 2 days ago which was mostly comprised of CAs to .65 last night. I only had 3 CAs last night as opposed to a whole bunch the 2 previous nights. But I couldnt handle a pressure as low as 4cm. It just wasnt enough air coming in. BY trail and error I bumped it up to 7cm last night. I left EPR at 2. But my flow rate was pretty ragged at times and I dont understand whats going on with the pressure curves.
As for my discussion with her about BIPAP she said they only way Id be able to get on BIPAP is if I did another sleep study because they have to set those pressures when you are sleeping and it has to be done in a sleep lab. Is that accurate and always the case. Im not going back into a sleep lab. So BIPAP may not be an option for me. Or can I just buy one and figure it out myself with help here?? Would that even be wise to do oneself??
Are you using F12 to do a screenshot?
We need to see the device setting.
Are you using the ramp? If so, what is the ramp pressure?
Using ramp for at least 5 minutes, might give you comfort and delay the pressure increases for the 5 minutes as you try to fall asleep.
Your flow limits are high, so increase EPR to 3.
If you feel air-starved raise the minimum to at least 7.4cm
Your pressure increases are due to the aggressive approach Resmed takes to flow limits. They want to prevent hypopneas or other events, so the pressure increases sharply. Since these machines are reactive, many times these pressure increases are too late and too large.
That is why I recommended a tighter pressure range.
Try 7.4 - 9.4cm, might be more comfortable, less pressure swings.
Your obstructive events seem well controlled, so try that for a few nights and see how you feel.
05-03-2025, 08:45 AM (This post was last modified: 05-03-2025, 08:47 AM by SarcasticDave94.)
RE: Pokey49 - Therapy Thread
You had a sleep study already, correct? There's the proof of machine necessity. No more sleep studies needed. RT would like you to help pay for their boat.
You are editing settings on an AutoSet, therefore you can edit settings on the VAuto. It is exactly the same concept, just with more settings.
You post OSCAR charts, tell us what needs to improve, here's the suggestion. Same exact assistance for CPAP or BPAP. It'll only change in regard to what settings will be suggested to edit.
You want to buy your own bilevel VAuto, yep you can do that. Talk to the DOCTOR, not the RT. "Doc give me a script for ResMed AirCurve 10 or 11 VAuto. I'm buying a ResMed with cash, not an insurance claim." Here ya go. "Thanks doc."
Shop Supplier #2 for used machines, or Google DOTMed for a second option.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Why do RTs keep pushing 4-20 pressures and not narrowing the range more like a BiPap Sleep doc that I had a falling out with did the same, but 10-20
How will BIPAP be better for me? I don’t totally understand the difference and it’s advantage. I need to have an argument of why a BIPAP would better help me for when I go to my PCP to ask for a script
What do I do with my AS11? I’ve only had it for 3 months so it’s not fully paid for by Medicare Turn it back in to my DME?
Most patients just follow the orders and do not change settings. Then 50% stop using CPAP.
Benefits from bilevel cpap are :
1.) EPR replaced by PS, pressure support. PS is not limited to 3 and is very,very fast transitioning from exhalation to inhalation unlike EPR with it's delay which affects therapy.
The PS will help you exhale easier.
The larger PS deals with flow limitations well without adding CAs.
2.) Bilevel have a decent method of dealing with CAs which you have. The bilevel has a trigger setting which can help with inhalation ,with just a little user effort. It senses a inhalation start and the pressure is added, where with a normal cpap machine, no pressure would be added and you would have a CA marked. Not much help there.
Bilevel will give you a more comfortable sleep with less fragmentation/arousals in it.
This will enhance your willingness to comply and get more usage.
You might use a BiPAP machine if you have certain ongoing conditions. Providers can treat the following conditions with BiPAP:
Heart failure.
Chronic obstructive pulmonary disease (COPD).
Obstructive and central sleep apnea.
Hypercapnic respiratory failure. This happens when carbon dioxide builds up in your blood and you aren’t effectively getting rid of it when you exhale.
If you pay for the bilevel out of pocket, then the AirSense 11 will be a decent backup.
If Medicare pays for your bilevel, then hold on to the AirSense 11 until instructed to return it
JDoug & Sarcastic Dave: I had a sleep study which included a Rx for the APAP. Do I actually need my PCP to write a RX specifically for BIPAP? I ask because I know my PCP may ask what my DME/RT has to say about switching to BIPAP since my PCP works regularly with my DME. I may need to figure out how to convince my PCP regardless of what the DME might say. The fact that I will have to pay for it myself may make it easier to convince him.
The bilevel has more PS than your AutoSet with EPR 3. Both give a pressure differential between inhale and exhale, but again the VAuto can go up to PS 10 I think. I don't recommend really using PS 10, but it's there.
Why 4-20 or 10-20? They are lazy AND they want to make you rely on them to change settings, all for a price. Typically this means making an appointment in the future to explain you need the settings edited.
If they agree to edit, they'll do so remotely. When they get to it.
This visit has a copay typically. You pay to go. They get a fee. They do not like you setting this, because you're not paying them if they're not editing the settings.
They set it at default 4-20, you pay them to edit maybe 5-10 X with you paying them. Or you edit it yourself free regardless how many times you change it.
If/when you doctor issues the bilevel script, you get the VAuto ordered or self pay. The AutoSet gets returned to the DME. Call them to set up the return and make sure 100% they do not continue to bill you. Demand a return receipt that clearly states what you returned, when, and they accepted the return.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Your DME does not dictate your therapy. It seems rather a too close relationship between your doctor and DME. They're probably sending you back and forth to the other to keep the boat payments flowing. Full stop. Do not buy from any DME that is connected to the doctor that's scripting it. One or both need fired.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
I was looking at a ResMed VAuto Bipap machine on the websites of Respshop and Cpap.com. Looks like to me if you have a credit card they will sell and ship you one. No Rx appeared to be required???? They are pricey for sure.
No Im wrong. A Rx is required for buying a BiPAP. My PA for sure would write me a script for one. He has no connection to my DME and certainly to none of the online outfits . I don’t think my PCP has a connection to my local DME either but he does look to them for advisement and my RT insists I have to get a titration study. Not going to do that.
