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+--- Thread: Why no Titration? - Follow up on Wednesday (/Thread-Why-no-Titration-Follow-up-on-Wednesday)
RE: Why no Titration? - Follow up on Wednesday - Tacoma Droner - 11-20-2015
Following up on what Sleeprider just posted, my first thought would be to try more pressure relief. That means, turning EPR "ON" then setting it at "3". Try it for one night. The other settings look OK to me (not a medical person, just a hosehead like you), though if you change Essentials to "Plus" I believe that will give you more info on those screens.
I'm also kinda wondering if your machine is actually working right? Any chance it's a lemon? Can you check with Resmed to make sure the software installed on the machine is up-to-date?
RE: Why no Titration? - Follow up on Wednesday - DonC - 11-20-2015
Hello Again,
I just wanted to thank you for all your help. Sleeprider I undertand the similarities and differences between CPAP - APAP - BIPAP (BiLevel I think).
CPAP is constant on one pressure
APAP is variable pressure according to Apneas occurrence
BIPAP is two levels of pressure of pressure depending on inhale or exhale
But I am confused as to VPAP, IPAP and EPAP unless VPAP does positive pressure when you should be inhaling and negative when exhaling. In that case IPAP would mean inhaling pressure and EPAP negative for exhaling.
Is VPR the same as VPAP? Do I have it right? How many other types are there? I need to learn!!!!
Tacoma Droner I have turned the EPR on and set it at three. I chose full time. Essentials are now on Plus (there are no other settings showing up) and I am going back to a FFM for tonight in preparation for Tritation. Another reason is that I am not controlling the leaks with the nasal pillows. It is, but not always, when I get high pressures and I have not learned how to control them yet.
The Amara View was comfortable, I have the Simplus in reserve, and I may try to use a light chin start with it to keep ready for nasal pillows if I need.
Does that sound like a reasonable course of action?
Don
RE: Why no Titration? - Follow up on Wednesday - Sleeprider - 11-20-2015
Don, most of the acronyms are in the Wiki: http://www.apneaboard.com/wiki/index.php?title=Acronyms
VPAP=BPAP=BiPAP=Bilevel All the same thing.
Never heard of VPR, but EPR is Resmed's expiration pressure relief.
No machine imposes negative pressure. Inhalation (IPAP) is higher than exhalation (EPAP) pressure, and IPAP minus EPAP equals Pressure Suppport (PS), which is simply the pressure difference in any bilevel scheme. Seems confusing, but it's fairly simple.
Good luck Don!
RE: Why no Titration? - Follow up on Wednesday - Tacoma Droner - 11-21-2015
Don--all sounds good. If you can use the Amara View without leaks or discomfort, that is. Let us know if the numbers improve.--TD
RE: Why no Titration? - Follow up on Wednesday - DonC - 11-21-2015
Hi,
The leaks were pretty low last night. They were classed as major leaks for 2.5% of time but that was nearly all while I was messing with the mask so pretty good overall. The issue was that my AHI was up to 15.24 - 12.22 were CAs. They will not go away.
The good news is that the Sleep Study manager called yesterday and they have arranged for me to go in tonight, yes Saturday night, for the Titration. They have arranged this and got insurance OK in 4 days. I will not complain again.
My only concern is that the manager talked about this as if it was a Sleep Study and even sounded a little surprised when I said it was a Titration. As it is Saturday I can't get to anybody to clarify things but I am not giving up the appointment. I am sure it will be OK but I am going in armed with information. If anybody can think of anything I should do or say please let me know.
Wish me luck.
Don
RE: Why no Titration? - Follow up on Wednesday - cate1898 - 11-21-2015
Good luck DonC!! Let us know how it worked out!
RE: Why no Titration? - Follow up on Wednesday - Tacoma Droner - 11-22-2015
Are you awake yet? Survive the titration study? So . . . what'd they say? 
RE: Why no Titration? - Follow up on Wednesday - DonC - 11-22-2015
Hi Everybody,
Thanks for the good wishes Cate1898 and here is the update TD. There are good and not so good things to report, but no bad. That in itself is good.
The one thing I didn't understand was that this Titration was for BPAP / BiLevel only, so if it didn't work we could not move up to ASV.
One good thing is that I did get through this better than the original Sleep Study and surely feel better this morning. Another is that the gentleman who administered the test is actually a member of Apnea Board. It is good to know that there are professionals out there, who are hose-heads themselves, giving what advice they can.
Anyway, I slept solidly with only one wake up, for a technical malfunction, and I woke up feeling fresher than I have for some time.
Now we come to the not so good - Whilst I didn't get actual numbers (could I have asked for them?) we were able to reduce the CAs, particularly when I was sleeping on my side. The trouble is that we didn't get rid of enough; in fact, there were a lot when I was on my back.
I am not sure but I believe, as DeepBreathing stated some time ago, that I am going to end up taking the next step and will have to go the route of ASV. Does that mean that the doctor will give me a BPAP machine and I will use it until I get another night in the Sleep Center? I really do not like that glue!! What a pain but, as the wife says, it will be worth it in the end.
Help again please - Is there any way I can shortcut this?
Thanks for all the advice and good wishes,
Don
RE: Why no Titration? - Follow up on Wednesday - DariaVader - 11-22-2015
Your doc is the one who should have shortcutted this - by asking for an ASV titration based on the number of CA. This kind of thing really yanks my chain!
RE: Why no Titration? - Follow up on Wednesday - OpalRose - 11-22-2015
What DV said. ^^^^
A bilevel cannot treat CA's. I also get angry with all the nonsense that we hoseheads are put through, but it could be that insurance required that it be done this way.
