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Unread post  Post subject: finding best cpap prescription without a titration study  |  Posted: Sat Sep 19, 2020 10:50 am

Joined: Sat Sep 19, 2020 9:37 am
Posts: 1
Location: Dallas, TX
PAP Mask: Respironics Amara View Mask - Small
PAP Machine: DreamStation AutoCPAP w/ Humidifier/Heated Tube/Cellular Modem SKU:DSX500T11C
Humidifier: the default one within my DreamStation

CPAP referenced: DreamStation AutoCPAP w/ Humidifier/Heated Tube/Cellular Modem SKU:DSX500T11C

TL;DR: How can I get a prescription number, instead of a range, for my elderly mom without having a titration done in a sleep study center? I have a BS in Neuroscience, but am not a sleep tech or a doctor. Im good with computers, but haven't used OSCAR yet due to grad school eating up too much of my time.

Mom has severe sleep apnea with an event number of somewhere in the mid-40s. She was diagnosed around 3 years ago when she had a sleep study done, including a titration. She got a CPAP and after 6+ months became noncompliant, claiming always feeling smothered and without enough air. I tried on her mask myself to verify. It was very low, smothery, and felt like hardly any air was coming out. Adding to the doubt of her prescription, she said her sleep tech who did the titration was young and had been flippant and non-detailed when tending to her during her study. After she'd had enough frustration, she lost it irretrievably in the abyss of lost dryer socks, never to be found again. I think her prescription was 6 because I looked at it when she was complaining about being smothered, a few months before she misplaced it. Now after open coronary bypass, paroxysmal afib, and congestive heart failure, she's open to trying a CPAP again, because her cardiologist says she might have staved such big heart issues off for a while had she used her CPAP. Furthermore, she may be able to stay out of afib more if she uses her CPAP to treat her severe sleep apnea.

At this point, the sleep study 3 years old so her pulmonologist ordered an at-home study to appease medicare, hoping they'd cover the replacement costs of the lost one (HA!) That wasn't happening, so I just bought her a replica of my CPAP on using the lefty16 code (Thanks Lefty!!). I personally love my own CPAP, so maybe she'll like that better than her previous ResMed.

Mine is operating at a specific number, and not a range, which I would also like to set up for her. How can I find her optimal prescription number, so she won't have to use the autopap feature of the CPAP as much? Will they allow us to just do a titration at home due to the pandemic? If not, is there anything I can offer to do myself instead of sending her to a sleep study center to have it done? We don't have a copy of the entire digital file of the old titration study. I asked for one when the titration was done a few years ago, but they said it was proprietary and not allowed. I have a BS in Neuroscience, but am not a sleep tech or doctor. My grad studies are in artificial intelligence and machine learning, not neuroscience. Does anyone have any ideas about what I can do here to help her?

Unread post  Post subject: Re: finding best cpap prescription without a titration study  |  Posted: Sat Sep 19, 2020 11:19 am
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Joined: Sat Jul 04, 2020 8:38 am
Posts: 303
Location: Greencastle, Pennsylvania, USA
PAP Mask: ResMed F20 N30i P30i, a F&P Simplus & soon to have Vitera
PAP Machine: I will likely tell the doc it's going to be ResMed Astral 150
Humidifier: Accessory Humidifier will be requested
Pressure Setting: 0 setting for now, soon to be using AVAPS settings

Welcome to the forum.

The best advice I can give if you're doing it yourself is to use the PAP machine and post OSCAR data from the overnight use. Once posted here, we can offer suggestions to make the therapy better by pressure optimization. Note that the good part on a Auto mode is that the machine can range over settings to show what is best. Yes it can be done manually as well via setting a pressure number, viewing the results, adjusting in response to data, and repeating until best results are found.

I'm not attempting to start a this vs that debate, but I've found it myself and with comments and viewing data, ResMed typically does better in providing more comfortable and more accurate, useful therapy. That does not mean we can't or won't help you with a Respironics.

OK onward. This is a straight CPAP if I'm correct. Titration is basically what I described above. Use the machine at pressure X, view data, respond by adjusting from X to Y, repeat. You can do this yourself for free via feedback here. You will want to set it at a minimum of 6 as as the absolute lowest. Most adults need at least that to avoid feelings of air starvation. Are you planning on using exhale pressure relief called Flex on Respironics? If yes, try 1 or 2. Flex of 3 has been noted to be less effective and less comfortable to most that post on the forum with feedback. For reference, ResMed has EPR that mimics a Bi-Level Pressure Support but working in reverse. EPR of 3 for example reduces pressure by 3 chH20 on exhale. Respironics Flex is similar but the actual values are vague.

Bottom line: try the CPAP on 6 or 7 with an SD card in the PAP. Use the SD to upload the data into the PC, upload it into OSCAR, view the Daily chart, use F12 to capture a screenshot, and then insert it here as an Upload Attachment. We will see the chart, and give suggestions to make it better. Best wishes we can get it working better ASAP.

Dave K9DWB 73s

Unread post  Post subject: Re: finding best cpap prescription without a titration study  |  Posted: Sat Sep 19, 2020 12:06 pm
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Joined: Wed Aug 02, 2017 8:01 pm
Posts: 1988
PAP Mask: Bleep/DreamPort nasal mask
PAP Machine: ResMed AirCurve 10 VAuto

Is there a SD card in the DreamStation Auto CPAP? She still has this that correct?

That SD card will contain past settings history and using available software it can be seen easily and figure out what she was using in the past and then when she starts using it again there is a way (using the available software) to do a DIY home titration to figure out an optimal pressure to use both for her comfort level and optimal therapy level.

Dave has links to the software in his signature line.

I may have to rise but I refuse to shine.

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