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+--- Thread: Is it hard to change DME? (/Thread-Is-it-hard-to-change-DME)
RE: Is it hard to change DME? - BeepBeepNoSleep - 11-28-2018
(11-28-2018, 10:08 AM)Sleeprider Wrote: BeepBeep, don't worry too much about keeping that BiPAP. You have central apnea, and need a ASV. I think your doctor knows this, and prescribed BiPAP to see if your central events would be treated. It's not, and you would more likely succeed with a fixed CPAP pressure of 7.0 with no pressure support.
That is interesting. I was wondering about that as it seems like the most common event is "clear airway".
Also I found out the lady I thought was the Dr. is actually a nurse practitioner. I'm not sure that matters, but she made the comment "the treatment is working" as the AHI from my sleep study was 25 and the average over my best compliance period was around 7. When we started the conversation she said she would lower the pressure to help with me repeatedly waking up and then later she said she would bump the pressure up to try and get it better than 7. I've never spoken to the doctor directly although I found out my insurance paid one during the sleep study (which I'm working on getting copy of).
I have attached the best period of data I have which spanned two weeks. Most of the treatment time at night is low, and it didn't really improve over the period (maybe not enough time to adjust). I will confess I have struggled with making treatment a priority when dealing with family and life events. But never too late to start trying harder!
Does the extra data still support the argument for ASV? My biggest concern is my insurance deductible resets in Jan., so I am wondering if I need to try and talk to Dr. (nurse?) asap.
RE: Is it hard to change DME? - BeepBeepNoSleep - 11-28-2018
Some more data.
RE: Is it hard to change DME? - Sleeprider - 11-28-2018
I actually think the BiPAP is going to work for you, but the PS needs to be lowered. Your settings are currently 5-15 PS 5. I think you can get consistently lower AHI at 5-15 PS 2-3.
RE: Is it hard to change DME? - BeepBeepNoSleep - 11-28-2018
And last bit of charts. I hope this isn't too much. If so feel free to delete or I can.
RE: Is it hard to change DME? - Sleeprider - 11-28-2018
As I said, your results are pretty good, but you need less pressure support. Most of these sessions are very short. There are a few exceptions, but what do you think is causing you to break therapy after a short time?
RE: Is it hard to change DME? - BeepBeepNoSleep - 11-28-2018
(11-28-2018, 12:51 PM)Sleeprider Wrote: As I said, your results are pretty good, but you need less pressure support. Most of these sessions are very short. There are a few exceptions, but what do you think is causing you to break therapy after a short time?
I'm not sure. It seems like I wake up either gagging, short of breath, or disoriented every 30-45 minutes. After repeating that a few times I get frustrated and take the mask off so I can go to sleep. That is the part I am going to try and power through now. I am hoping I can improve length of treatment through willpower or at least try to identify what is causing it.
My thought processes are not very good when I'm half asleep. I know the quality of sleep is bad without the treatment but it's hard to convince myself of that in the middle of the night.
RE: Is it hard to change DME? - Sleeprider - 11-28-2018
The sense of gagging or inability to exhale is typical for CA Try my suggestion to lower minimum PS to 2.0, and if it doesn't make you a believer, then just change it back. This is not my first rodeo.
RE: Is it hard to change DME? - BeepBeepNoSleep - 11-28-2018
(11-28-2018, 02:49 PM)Sleeprider Wrote: The sense of gagging or inability to exhale is typical for CA Try my suggestion to lower minimum PS to 2.0, and if it doesn't make you a believer, then just change it back. This is not my first rodeoI will give it a try. I did not mean I was not sure about your advice. I meant I was not sure why I keep waking up. Is there a list of acronyms somewhere? I think I puzzled out CA is central apnea. What is PS?
And thanks again.
RE: Is it hard to change DME? - jaswilliams - 11-28-2018
(11-28-2018, 03:03 PM)BeepBeepNoSleep Wrote:PS is pressure support the difference between EPAP and IPAP(11-28-2018, 02:49 PM)Sleeprider Wrote: The sense of gagging or inability to exhale is typical for CA Try my suggestion to lower minimum PS to 2.0, and if it doesn't make you a believer, then just change it back. This is not my first rodeoI will give it a try. I did not mean I was not sure about your advice. I meant I was not sure why I keep waking up. Is there a list of acronyms somewhere? I think I puzzled out CA is central apnea. What is PS?
And thanks again.
our Wiki has and explanation of common terms
http://www.apneaboard.com/wiki/index.php?title=Acronyms
RE: Is it hard to change DME? - BeepBeepNoSleep - 11-30-2018
I just wanted to share some updates.
For the original question about DME:
Doctor sent order to new DME, and they called and confirmed I was ready to go. It was really easy. I will call my insurance tomorrow to make sure there's no gotchas on the original order and if not I will be calling old DME and requesting they delete me from their systems.
More importantly, I think I had a couple break throughs last night. First after reading about PS I had an epiphany. I feel like a bozo for admitting this but for whatever reason, I was fundamentally misunderstanding how bipap works. I was thinking that the EPAP part actually reversed the flow of air (suction instead of blowing). I was equating exhale pressure to it supporting MY exhale thinking it was some kind of magic suction. Understanding how it actually works helped me to better link the settings to what I was experiencing during use.
Next I decided to really take some time to really get a 1 on 1 with the machine, mask, and what I felt was comfortable. The new doctor settings were noticeably less comfortable so I changed those back to original. I also set pressure support to 3 instead of 5 as advised by SleepRider. Both of these changes helped a lot.
I went back to square one on the mask and readjusted everything in a mirror. I used some of mask adjustment methods I had read here. More importantly I realized the mask size of my wisp the DME had setup for me was too small! A lot of the resistance I was feeling wasn't pressure at all. It was the seal blocking 60% of my nostrils. I dug around in the stuff the DME left and found a larger mask for the wisp. It was much easier to breath through.
I slept most of the night without any problems. This was one of my best nights!
Woke up feeling great. I'm not sure how much of that was excitement of a good night vs the treatment but we will see going forward. I've attached data
Thanks again everybody!