How to get prescribed Bipap?

USMCVet wrote: ↑

Tue Mar 20, 2018 10:41 am

but admitted sleep centers probably like it better under 25

That's irrelevant on your type of machine.

The only way you can have leak numbers under 25 is to have a pressure of 6 or less.

The sleep center is probably thinking in terms of ResMed leak numbers and not Respironics way of reporting leak numbers unless they are using Encore for the reports and have it set to show only unintentional leaks (which is the default setting for Encore) and they may not know of the other way of reporting leaks.

Like PR said.....no way you can have under 25 total leak number unless your pressures are really, really low.

As long as the machine doesn't flag a large leak...don't worry about leaks unless they are waking you up.
And even an occasional large leak flag isn't the end of the world.

palerider wrote: ↑

Tue Mar 20, 2018 11:47 am

USMCVet wrote: ↑

Tue Mar 20, 2018 8:13 am

I already know that won't be given to me IF I even needed it. My VA is only resperonics.

Respironics won't work, their bilevel machines don't have the settings you need to accommodate restrictive lung disease.

Not a fan of AVAPS for restrictives?

https://philipsproductcontent.blob.core ... 51cbfe.pdf

RT uses Encore I saw him load it in front of me. So unintended leaks must be what he is talking about.

I also asked about today volume and said probably high 400s to 600 would be normal but was guessing. I told him my median values and he questioned how I got those numbers and the accuracy of software and that leaks also effect it.

Could my low FRC be reason for oxygenation issues? Now seeing those low numbers on some things during last test the person doing test said "huh".

This sort of thing (esp. p. 8 and beyond) may, or may not, be useful to you beyond a way of asking the RRT for clarifications for your personal comfort regarding any questions you may have about your results.

http://www.clevelandclinicmeded.com/liv ... CME.v2.pdf

jnk... wrote: ↑

Tue Mar 20, 2018 11:58 am

palerider wrote: ↑

Tue Mar 20, 2018 11:47 am

USMCVet wrote: ↑

Tue Mar 20, 2018 8:13 am

I already know that won't be given to me IF I even needed it. My VA is only resperonics.

Respironics won't work, their bilevel machines don't have the settings you need to accommodate restrictive lung disease.

Not a fan of AVAPS for restrictives?

https://philipsproductcontent.blob.core ... 51cbfe.pdf

Sorry, I meant the regular auto bilevels won't work, vaps could work. the iVAPS does says it can be set up for restrictive conditions, I'm less familiar with the respironics version. I do know that the respironics doesn't report any useful data.

Dr who ordered tests told me to send her an email after taking them so she could look at results and let me know. She responded back today saying the following.

"I reviewed the PFT's. They show normal oxygen delivery (very good news) and improved lung volumes from the test you did in the office. There is some mild restriction, meaning that you don't take as big as a breath as one would expect based on your age and height, but it is the mild range. All in all, though, the results are reassuring."

So I guess I'm just going to go back to trying not to care until they tell me otherwise.

So I'm assuming since it's mild then Bipap isn't needed?

Just raise your minimum pressure...

remember, oxygenation happens at epap/peep.

palerider wrote: ↑

Tue Mar 20, 2018 3:37 pm

Just raise your minimum pressure...

remember, oxygenation happens at epap/peep.

Thanks I won't forget that. April 8th I see a new Primary Care Dr. I am going to see if I can get permission then to bump up my pressure or ideally get permission to make my own changes.

I just don't want to get off on the wrong foot with this Dr.

palerider wrote: ↑

Tue Mar 20, 2018 7:47 am

USMCVet wrote: ↑

Mon Mar 19, 2018 10:31 pm

Ok I may or may not need a Bipap for tidal volume if it's confirmed I have restrictive issues and to help tidal volume.

*IF* it's confirmed that you have restrictive issues, then you may benefit from a *RESMED* (not respironics) aircurve 10 vauto machine, because they have breath shaping settings that can be adjusted to give you more time to inhale, thus getting the air into your lungs.

From the titration manual:

Patients with restrictive lung disease have a difficult time maintaining the inhalation phase long enough to ensure adequate tidal volume and gas exchange. This can be caused by a physical restriction of the lungs or by neuromuscular weakness.
The recommended settings use a low cycle sensitivity and a longer Ti Min time to provide a longer inhalation time to help increase tidal volume and gas exchange.

AFAIK, from others.Resmed vauto mode doesn't have adjustable Ti and rise time.

USMCVet wrote: ↑

Tue Mar 20, 2018 7:51 pm

palerider wrote: ↑

Tue Mar 20, 2018 3:37 pm

Just raise your minimum pressure...

remember, oxygenation happens at epap/peep.

Thanks I won't forget that. April 8th I see a new Primary Care Dr. I am going to see if I can get permission then to bump up my pressure or ideally get permission to make my own changes.

I just don't want to get off on the wrong foot with this Dr.

I think and have said a bump in pressure will help.
When they finally work out what's wrong, then they can give the right machine. I have suggested what I would push for, if you go bpap. I would also use a FFM for the leaks, I think you have given the nasal mask a fair try.

ajack wrote: ↑

Wed Mar 21, 2018 6:10 am

USMCVet wrote: ↑

Tue Mar 20, 2018 7:51 pm

palerider wrote: ↑

Tue Mar 20, 2018 3:37 pm

Just raise your minimum pressure...

remember, oxygenation happens at epap/peep.

Thanks I won't forget that. April 8th I see a new Primary Care Dr. I am going to see if I can get permission then to bump up my pressure or ideally get permission to make my own changes.

I just don't want to get off on the wrong foot with this Dr.

I think and have said a bump in pressure will help.
When they finally work out what's wrong, then they can give the right machine. I have suggested what I would push for, if you go bpap. I would also use a FFM for the leaks, I think you have given the nasal mask a fair try.

Don't know if I said or not but Pulmolnary Dr said she isn't worried but maybe a bump in minimum pressure wouldn't be such a bad thing like you said.

Once I can get my hands on the new Dreamwear FFM I want to give that a try. I don't want to try and find a completely new mask.

Also I can't help myself and have been doing tons of reading and watching of videos. I am definitely not as "freaked out" as I was yesterday with the numbers.

If I understand everything right my total lung capacity is low for my size but not rediculously low or anything based on average people discounting height. Looks like my oxygenation issues are coming from low FRC which CPAP actually treats. FRC does NOT change with age so I don't get double whammy of possible disease progression and age making things worse. Lastly because of the decrease in FRC that doesn't point to a lung issue or at least my guess is the restriction is extrinsic.

ajack wrote: ↑

Wed Mar 21, 2018 6:01 am

AFAIK, from others.Resmed vauto mode doesn't have adjustable Ti and rise time.

What are you babbling about?

adjustable Ti and rise time

ResMed dudes" wrote:Inspiratory Time and Trigger and Cycle Sensitivities: ResMed’s S therapy mode includes a number of secondary settings that can be used to fine-tune therapy for your patients. While default values should be appropriate for most patients, these technologies can be used to accommodate their unique needs. TiControl™ provides minimum and maximum inspiratory time limits (TiMin and TiMax settings, respectively) for each breath. TiMin and TiMax can be used to prolong or limit, respectively, the time the device spends at IPAP. Along with Vsync, TiControl can ensure synchronization even in the presence of significant mouth and/or mask leak. Adjustable trigger and cycle sensitivities can be used to optimize synchrony. The device triggers (initiates IPAP) and cycles (initiates EPAP) as it senses changes in patient flow. At higher sensitivity settings, smaller flow changes make it easier for the patient to trigger and cycle the device. -- https://onlinestore.resmed.com/images/p ... 017278.pdf