I went to bed at 2:15 AM, up at 3:15 AM and yet another night of maybe 20 minutes sleep.

My Respironics MSeries Bpap was set for AutoBiPap, with an 18/4, ramp pressure of 4, ramp time of 45 minutes but the pressure hasn't moved from 6/4 in over an hour of my breathing into a strange mask as well as my usual lifelong drooling while on my side.

Whenever I push the ramp button, the ramp signal displays and immediately disappears. I also tried the "holding my breath" test and no, the pressure never moved...........I'm pretty sure I have a defective machine but here's the reason why a tech won't come over to fix it...........

To start off, some of you know about my conflicts with my doctor. My doctor is highly regarded in his field and he's a board certified sleep doctor, he's highly honored, well respected by fellow doctors and I realize how well qualified and knowledgeable he is but he someone got the wrong impression that my questions (such as asking about him giving me a data capable machine and his reply that "they don't make such a thing" then storming away) were intended to say that "I knew better than he did" or to question his knowledge but no, when I was confused and wanted to know more for health reasons, I asked him questions or questioned him about something he said.

I just saw my titration study, I twice ordered it from his office but never got it until I went to another doctor who got my titration study faxed to him and the study showed that apneas stopped completely for me at 19/17.

The faxed study did leave out a few things though. The parts of Apnea/Hypopnea frequency by Sleep Stage REM NREM  and by position supine non supine plus the apnea/hypopnea desaturations NREM and REM and the Apnea/Hypopnea Durations NREM REM Average nadir were missing and perhaps a few other things were missing as well

Ok, going back to last week when I received by Bpap, the tech (a nice guy) told me that the doctor wanted it set at 19/17 but that he (the tech) would set it at 20/4 instead saying that it would be easier. There also had been a question as to what machine the doctor had ordered for me (I heard two different stories) as well as having heard both the 19/17 and the 20/4 stories from two different sources.

The 20/4 didn't work due to my waking up not breathing over the weekend and seeing that the pressure was still at 6/4, I back then was still sleeping a few hours and I knew something was wrong. I called an emergency tech at the DME, he directed me to set it up the 19/17 way and guided me through all the changes but the problem here was that 19/17 was too powerful. It was off the AutoBipap and I now understand why but most importantly, the machine was loud, hot, and my cheeks were going like a blowfish..................I could understand the need for a low start and a ramp instead of a 19/17.

I called the tech back to ask what he thought were stupid questions. He began screaming at me and giving me advice but in angry tones.

Now the DME techs and their supervisor consider me to be a hysterical nuisance. It turned out that the same weekend emergency tech came over here to adjust the machine to the doctor's specifications on Monday (back to 18/4 Autobpap) and he wanted to leave to go to his other calls because I couldn't get the doctor on the phone. He started yelling and screaming, I panicked and demanded he stay while I waited for the doctor to call...............Finally got the DME office to tell him to wait for the doctor to call.  Then the tech refused to even let me talk to the doctor on my own phone when I finally got the doctor on the phone and then the doctor told me once I spoke to him that I "was acting bizarrely", that he knew the technician and thought highly of him.
  
 Why can't I get the DME to check this machine? its a combination of 1. Lacking of sleeping, lack of breathing is making me very anxious and panicky and both of these guys seem to think that I'm challenging their knowledge rather than confused and asking for help. The tech reported me to his supervisor, his supervisor called me and asked me to stop calling the DME
  
2. The tech wasn't supposed to direct me to change my own settings. I guess he covered himself by his claiming something like I "demanded" or "pushed" or "yelled and screamed" at him to change my setting. So I now have a bad reputation with the DME and they won't do a thing for me unless the doctor himself ok's it.

What do I do?

3:56 AM, I left the machine running (don't know if it would change if I'm not on it) and its still at 6/4.

Buck,

Please do give the DME a call and nicely but firmly ask to have the machine tested for correct pressure, and if the machine is working correctly, to verify the settings match your prescription.  

Or you might ask the doctor's office if they can test the pressure.   (Some are only prepared to test straight CPAPs.)  

In either event, be polite but firm in requesting the machine be checked out.  

Consider asking a trusted friend or family member, one who is calm and level headed, to call on your behalf and make the appointment to bring the machine in for testing.  And perhaps go with you to the appointment as well.  After the experiences you've described, many people would not be able to keep their cool when trying to get service from either this doctor or DME.  Taking along a friend or loved one who is calm and assertive, could make all the difference in getting this sorted.

If it turns out your machine is fine, and it is performing as the doctor prescribed, that friend you have along may also be helpful in getting the doctor or DME to help you understand what to expect from your machine, and why.

Blessings,
--pseudonym

Thanks for the advice, Pseudonym. I did call the DME supervisor. He will send a tech over on Monday but asked me to make this my last time. I hope I get a good, caring tech who knows what he or she is doing and does what is needed if the machine has to be fixed.

Buck222 wrote:

My doctor is highly regarded in his field and he's a board certified sleep doctor, he's highly honored, well respected by fellow doctors and I realize how well qualified and knowledgeable he is but he someone got the wrong impression that my questions (such as asking about him giving me a data capable machine and his reply that "they don't make such a thing" then storming away) were intended to say that "I knew better than he did" or to question his knowledge but no, when I was confused and wanted to know more for health reasons, I asked him questions or questioned him about something he said.

Good luck with your doctor, but remember that a "Highly Honored a$h***" is still an "a$h***".  

Evidently this guy isn't so wonderful if he doesn't even have the basic ability to answer simple questions without "storming off".  This tells me he either (A) - Doesn't know the answer or (B) - Could care less about you and your therapy.  Either would cause me to look for another Doctor.  There are plenty of brilliant, highly honored Docs in the world and many actually know how to communicate with other human beings without being jerks.

Were it me, I would do this and then send the man & his staff a letter explainging exactly why I left.  But then again I have very little tolerance for medical arrogance.

This forum is terrific for asking about masks, fit, rainout, and any of the myriad other issues that come up for us during our use of CPAP or other treatment for apnea.  But when it comes down to machine behavior, pressures, settings, the place to go is to your doctor and pronto.  This forum can be sympathetic and that's a good thing, but we can do nothing to help you in this area.

I agree with BarryKaraoke, I encourage you to find a replacement doctor and DME, there are people out there who will care about you and will partner with you in your health care and sleep apnea therapy.  This is YOUR life and health.  Find your replacements before you ditch the current doctor and/or DME, so that you are not out on a limb for care while you're searching.  You may have to search awhile to find a doctor you like, that will explain things clearly and be patient with you if you don't understand at first.  It may take you awhile to find the right people, but it is so worth it!

I'm on my 3rd sleep doctor and I drive an hour to see him.  In the beginning there were a lot of trips and that was a major inconvenience and disruptive to my work schedule, home life, etc.  But now I see him once twice a year for followups.  That's not so tough to manage, and it was worth it.

Blessings,
--pseudonym

Just FYI....  If the Auto BiPAP M Series is set in AUTO mode with the low of 4 (default lowest setting) the Ramp function will be disabled...due to there being no way one can ramp from 4 when the IPAP lowest value is set at 4.  Since it is already doing it.  Therefore you will not see a slow increased pressure change over the course of the ramp time...because it is in AUTO.


_________________

CLICK HERE FOR MORE INFO~ http://tinyurl.com/69q52a

BiPAP Auto M 13/8 Mirage Nasal Swift. 20 years+ undx'd. RLS/PLMD, Hypersomnia & more.

I agree with Barry , the best doctor in the world is useless if you and he don't communicate well. I'd look for a doctor with a good bedside manner, perhaps a phychiatrist who specializes in sleep disorders.  Your doctor needs to understand the effects of sleep deprivation on a person's  mental health, and be able to walk you through this journey with compasion.  Good luck, Virginia


_________________
Resmed elite , 17, mirage quattro ff . 25 + years of untreated OSA

Mrs RVW,

Let me explain that I still stop breathing upon falling asleep and used ambien to relax me enough to fall asleep..................On either Bpap or auto function, I still stop breathing upon falling asleep and I wake right up. Whether I breathe first and the machine follows or the machine breathes first, I'm aware when I stop breathing (while awake) and I notice that the machine doesn't give any air until I breathe again............this is true whether on auto or on bpap.

I know about the ramp function being disabled while on 4 and on auto but I tested it by changing to 4.5 and waiting for the ramp time to finish......... the pressure still didn't change. I also went on bpap and went off auto (set to 4) and pressure still doesn't go up. When the tech comes on Monday, I'm hoping that he'll be understanding and patient enough to allow me to explain the above to him and that he'll take the time to disable the ramp function or set it for five and observe if the pressure changes or not..................IF faulty pressure change can be observed through this manner.............How else can faulty pressure change be observed?

You did write a post saying that pressure won't go up until I'm asleep but when I wake up after a few hours, I feel, then see I'm still on 6/4.............This morning I did sleep close to 6 hours, felt better for awhile and hopefully I got good sleep, checked that my 7 day AHI was 13.6 and since it was 21 yesterday, I figured that I may have had a very sound sleep even if on 6/4 (though set for 18/4 Bpap with auto off).

I'm not a pessimist but I am a realist and I'm bad rapped by both the doctor and the DME personnel for being a NUT! so I fully expect (and hope I'm wrong) that Monday's visiting tech will be "warned" about me and might be "prepared" for I guess bizarre demands if its IS bizarre to ask for what I mentioned in the second paragraph.

I'm worried about the machine not doing the job and feel that I have solid reason to be worried. How can I know whether or not my fears are valid and my questions, requests, "demands" are viable? I don't know anything about the proper way of dealing with people in this field, three months ago I never expected.............

Pseudonym,

I had found another doctor. Turned out that my doctor was his teacher when he was learning, he liked the doctor and thought he was a nice guy..............I wasn't surprised.

Also the new doctor didn't have the correct equipment to read my card. He suggested I give my present doctor another chance.

You know, guys like my doctor know how to play the game, they know how to make a good impression on whoever they want. The doctor is considered an expert in the field and seems like lots of others might owe him for his support. It could be my manner where I unawarely might come off to certain brusque, not so tolerant types as though I'm challenging their knowledge. LOL, if we "went to the playback" so to speak, it might show that I come off in a manner which I don't see but which some others have said I use.

In other words, the doctor isn't as nice a guy as he seems and I have a manner which might mask my fear through a smug facade and the combination in this case won't work.

I have a girlfriend who has offered if possible to go with me on my next visit to the doctor.



Last edited by Buck222 on Sat Jun 21, 2008 9:10 pm; edited 1 time in total

Barry,

I'd leave the doctor if I found one who had decent manner and who was set to read my card but I wouldn't bother writing a letter explaining why.

Why should I waste my time complaining to anyone who wouldn't feel it and anyway, that guy wouldn't exactly be upset about my going elsewhere.

Virginia,

I agree, please read my other answers and thanks for caring.

Quote:

I have a girlfriend who has offered if possible to go with me on my next visit to the doctor.

Now, THAT is a great idea!  My DH and I accompany each other on many of our appointments.

Quote:

You did write a post saying that pressure won't go up until I'm asleep but when I wake up after a few hours, I feel, then see I'm still on 6/4

It will show that you are on the 6/4...because you are not having an apnea/hypopnea event.

I hope the tech can figure it all out with you...last thing one needs is a faulty machine.

Good Luck...hope it goes well.


_________________

CLICK HERE FOR MORE INFO~ http://tinyurl.com/69q52a

BiPAP Auto M 13/8 Mirage Nasal Swift. 20 years+ undx'd. RLS/PLMD, Hypersomnia & more.

It will show that you are on the 6/4...because you are not having an apnea/hypopnea event.  -MrsRVW

Which might mean that the DME will figure that the tech made an unnecessary visit to a "hysterical" person (or whatever term that these people want to use).

So you are saying that I will stay at 6/4 all night long unless I have an event? I've waken up and knew I wasn't breathing but the air pressure was just as low as it was when I first lay down to go to sleep. Can the pressure drop that quickly between an event and an awakening? I doubt it. Can an event quickly move me up to whatever pressure I need to stop the event and then just as quickly drop me back to 4 as I awaken (which I shouldn't be doing with a machine/mask)?  Doesn't make sense so I'm confused, I guess I need more explanation.

I wrote a related post on the Sleep Apnea Help forum.

Thanks for responding and for caring.

Mrs RVW and to all,

 Worried

I still stop breathing upon falling asleep and used ambien to relax me enough to fall asleep..................On either Bpap or auto function, I still stop breathing upon falling asleep and I wake right up. Whether I breathe first and the machine follows or the machine breathes first, I'm aware when I stop breathing (while awake) and I notice that the machine doesn't give any air until I breathe again............this is true whether on auto or on bpap.

I was set for 20/4 auto, then 19/17 bpap, now 18/4 auto..............slept well last night (finally) but might have been because of exhaustion as well as the usual ambien. Did almost 6 hours instead of my lately chopped up 1-3 hours or less, maybe 25 minutes the night before............I tweaked my Respironics M series bpap with auto to take auto off as I think i'm more comfortable following the air and breathing it rather than breathing first but machine air stops when I stop breathing and my problem is that I stop breathing at the moment of falling asleep as well as while trying to sleep and I also sometimes notice that I "miss a beat" while breathing in bed with (possibly without) mask on.

I may have acid reflux, a family doctor gave me medicine to use and will watch to see if the medicine (Omeprazole) works.

Well, it is hard to follow and without phisically being there to see it...hard to say.  I can say that 4 as a low pressure is reallllly low.  Hey, don't worry about what the tech thinks.

If you are in regular BiPAP mode and not in auto...and the ramp is not set...and your IPAP is set at 18...then the pressure will blow 18 when you inhale.  And it will blow whatevr the EPAP pressure is set at when you exhale.

If the ramp is used and the machine is in reagular BiPAP mode...and the ramp is set at 4 for say 45 minutes...the pressure will slowly increase over that 45 minute period until it hits the 18 IPAP pressure.

If the machine is set in auto mode and the Minimum IPAP setting is at 4 and the maximum IPAP is set at 18...the machine will fluctuate between those pressures depending on your apnea/hypopneas.  The EPAP is determined by the Max Pressure Supression which the default is (I believe) 2...unless previously set to a higher number by the tech.  This means the machine drops the IPAP  pressure by 2cm at what ever pressure you are currently receiving.  

Since the IPAP pressure range starts at 4 and goes upto 18 then the ramp will not need to function...because it is already set at the lowest presssure available.

The only way the pressure during sleep can be known is if the machine is  in auto mode and the person looks at the LED display and reads the 90% for the previous night.

If the machine is in regular BiPAP mode and the ramp is not used...then the pressure of say 18 can be seen on the LED screen whe you inhale.

Other than that, I can not explain it any other way and can not tell what is going on.  I do not know if your machine is defective or not...this is just info how the machine works...if yours is not working like that...and if you have checked the 90% pressure used and it is reading 4 or 6...then either something is not right or something is being missed/confused.

I do think that taking someone in to your appointment is a great idea.  A patient representative/advocate is always a positive thing to have available.  After all this you will be a BiLevel expert!


_________________

CLICK HERE FOR MORE INFO~ http://tinyurl.com/69q52a

BiPAP Auto M 13/8 Mirage Nasal Swift. 20 years+ undx'd. RLS/PLMD, Hypersomnia & more.