Almost new here.

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
Noctuary
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Re: Almost new here.

Post by Noctuary » Sun Oct 05, 2014 5:35 pm

Hm. Not sure what my next move should be. I have a doctor's appointment next week; I'll ask about my fatigue. Maybe its testosterone.

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Re: Almost new here.

Post by Guest » Sun Oct 05, 2014 5:43 pm

Noctuary wrote:Hm. Not sure what my next move should be. I have a doctor's appointment next week; I'll ask about my fatigue. Maybe its testosterone.
More likely thyroid but then I'm not a doctor.

Noctuary
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Re: Almost new here.

Post by Noctuary » Wed Oct 15, 2014 11:33 am

I went to the doctor Friday; he said my thyroid was fine (checked it last visit). I am getting blood work done to see if there is any anemia at play.

Last night my AHI was 1.3.

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Julie
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Re: Almost new here.

Post by Julie » Wed Oct 15, 2014 11:50 am

Why don't you be daring and try raising your low pressure setting by just a very little bit (1-2 cms) for a couple of days... considering how low it is anyhow, the likelihood of you're getting CAs at e.g. a pressure of 7 in a few nights (when most of us are higher to begin with) is pretty remote. You're not being treated properly, yet are worrying about CAs, which are far less likely to harm you than untreated OSA as things stand.

Janknitz
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Re: Almost new here.

Post by Janknitz » Wed Oct 15, 2014 12:00 pm

If there was a chance of you developing CSA from a pressure increase, then they wouldn't have set your machine to go up to 20! Don't worry about it. There are no CPAP police, and I doubt your doctor would even notice if he/she bothered to look at the limited efficacy data your semi-brick machine provides. If he/she cared about efficacy in the first place (as someone already pointed out) he or she would have made sure you had a fully data capable machine. Your doctor doesn't care, your insurer doesn't care, and there are no CPAP police.

You may be having most of your apnea episodes during REM sleep as indicated by the time you wake and the fact that you are waking to toilet in the middle of the night (when apnea is well treated, most people no longer have to get up at night to urinate, unless there are underlying prostate or bladder issues). If the machine is set to catch those apneas before they get so out of hand the pressure has to go way up which may possibly waking you, then you may sleep through the night and that would go a long way to help your fatigue.

I'm also wary of a doctor who says that your thyroid is "fine". What does that mean? The lab report will say that the normal range of TSH (which is probably the only part of your thyroid panel they checked) is 1 to 5 (or even 5.5). But endocrinologists will tell you that anything above 2.9 is indicative of thyroid dysfunction. Yet your doctor will see that you are within the lab norms, and say you are "fine". Therefore you need to request a copy of your lab report and see what the number is. In my case, for example, my HMO lab said "normal" was up to 5.5, and I had a 5.4. My doctor told me I was "fine" when I clearly was not.

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Noctuary
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Re: Almost new here.

Post by Noctuary » Wed Oct 15, 2014 12:01 pm

Julie wrote:Why don't you be daring and try raising your low pressure setting by just a very little bit (1-2 cms) for a couple of days... considering how low it is anyhow, the likelihood of you're getting CAs at e.g. a pressure of 7 in a few nights (when most of us are higher to begin with) is pretty remote. You're not being treated properly, yet are worrying about CAs, which are far less likely to harm you than untreated OSA as things stand.
To tell the truth, I scared of getting into trouble. I don't want to break any laws or at least my service contract. I'm still renting the machine.

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Pugsy
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Re: Almost new here.

Post by Pugsy » Wed Oct 15, 2014 12:22 pm

Which mask are you using? I quickly scanned the prior posts you made and didn't see it but I may have overlooked it.
What kind of nasal mask? Is your mouth uncovered?
I was diagnosed with mild apnea AHI 10. I use a ResMed 9 Escape Auto with a nasal mask, and do feel a lot better. I still though have daily fatigue that I wish could be overcome.

After playing around with my machine I found that for the last 30 days my AHI average is 2.9, pressure range is 5-20, 10.4 the ideal pressure, if I understand it right. I sleep 7-8 hours a night, with only one interruption, to go to the bathroom. I also take Lorazepam most nights.
What is the dosage of the Lorazepam?

Your AHI per the machine is fine...whatever those events are they aren't numerous enough to worry about or cause any urgent need to change your pressure unless you just want to try more pressure to see if it helps or not.
There are NO cpap police and no one will even likely notice if you change that minimum to 6 or 7...there's no law that says you can't change your own pressure...none...we hear "only a doctor can do that" but no one has ever been able to show us law that says the patient can't do it.
But don't do it if you aren't okay with doing it.

Now here's some possibilities that might be going on.
First thing that stands out to me....nasal mask..you may be doing a lot of mouth breathing or having big leaks of some other kind and that AHI might not be accurate due to big leaks...we have zero way to evaluate leak status with your current machine.. So we are just guessing at this point.

You mention some improvement noticed but just not as much as you had hoped for. I wish I had a dollar for every time I hear that mentioned.
Are leaks maybe causing sub optimal therapy??? Maybe..maybe not. We have no way to fathom any idea in that regards so everyone is flying blind.

Assuming leaks aren't an issue there are any number of reason why you may not feel as good as you want.
Your meds for one. Look up the side effects for it.
Also...there's simply more to feeling better than a nice low AHI and nice low leak and 8 hours of uninterrupted sleep...it just doesn't always work out to be the way we want it.
Sometimes it just take a lot longer than we expect or maybe we are expecting too much. We expect the machine to fix all our problems and it just can't fix stuff unrelated to what it is designed to fix.

How long is your rental period and what is your insurance coverage?

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Noctuary
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Re: Almost new here.

Post by Noctuary » Wed Oct 15, 2014 12:30 pm

Which mask are you using? I quickly scanned the prior posts you made and didn't see it but I may have overlooked it.
What kind of nasal mask? Is your mouth uncovered?
Nasal mask, not sure which kind.
What is the dosage of the Lorazepam?
It was 1mg. But now I have Temazepam 15 mg (or 30 if I choose).
Now here's some possibilities that might be going on.
First thing that stands out to me....nasal mask..you may be doing a lot of mouth breathing or having big leaks of some other kind and that AHI might not be accurate due to big leaks...we have zero way to evaluate leak status with your current machine.. So we are just guessing at this point.

You mention some improvement noticed but just not as much as you had hoped for. I wish I had a dollar for every time I hear that mentioned.
Are leaks maybe causing sub optimal therapy??? Maybe..maybe not. We have no way to fathom any idea in that regards so everyone is flying blind.
Is there a better machine, that's not too pricey?
How long is your rental period and what is your insurance coverage?
I'll get back to you on that; I need to call and find out.

thanks

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palerider
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Re: Almost new here.

Post by palerider » Wed Oct 15, 2014 12:32 pm

Noctuary wrote:
Julie wrote:Why don't you be daring and try raising your low pressure setting by just a very little bit (1-2 cms) for a couple of days... considering how low it is anyhow, the likelihood of you're getting CAs at e.g. a pressure of 7 in a few nights (when most of us are higher to begin with) is pretty remote. You're not being treated properly, yet are worrying about CAs, which are far less likely to harm you than untreated OSA as things stand.
To tell the truth, I scared of getting into trouble. I don't want to break any laws or at least my service contract. I'm still renting the machine.
read this: http://www.apneaboard.com/adjust-cpap-p ... tup-manual

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Pugsy
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Re: Almost new here.

Post by Pugsy » Wed Oct 15, 2014 12:36 pm

Do you wake up in the AM with dry mouth kind of thing?

Yes..there are "better" machines in both terms of data availability and the algorithm used.
The S9 Escape Auto uses older not so great algorithm. Long elaborate explanation that I just don't feel up to typing right now.

You could get a S9 Elite (fixed cpap machine) or the S9 Autoset (APAP auto adjusting) and still use your current humidifier.
Depending on your insurance...I bet that isn't a rental and you already own it.
Cost...depends on if you want new or used and what happens to be available used.

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Noctuary
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Re: Almost new here.

Post by Noctuary » Wed Oct 15, 2014 12:44 pm

Do you wake up in the AM with dry mouth kind of thing?
Sometimes, yeah.
You could get a S9 Elite (fixed cpap machine) or the S9 Autoset (APAP auto adjusting) and still use your current humidifier.
Depending on your insurance...I bet that isn't a rental and you already own it.
I've only had it about 5 weeks, so I think its still a rental. Last time I stopped by the supplier they told me I owed $18.

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Pugsy
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Re: Almost new here.

Post by Pugsy » Wed Oct 15, 2014 1:01 pm

Most of the time this is the way it goes with "rentals"..now it all depends on the insurance but typically...
The blower unit is rented for however many months that insurance wants to use...if Medicare it's 13 months and then you own it...it's called a "capped rental"
But the humidifier is a one time purchase as it is typically not returnable if you fail compliance.... they might repossess the blower unit but most the time the humidifier isn't returnable and the patient is stuck with it after the machine goes back.
That's how I got a spare S9 humidifier from craigslist locally for not nearly what they cost online.

If you have Medicare....you own that humidifier.
If you don't have Medicare you may or may not own it and you need to find out from whatever insurance you have what their procedure is and the "rental" time period.

The dry mouth could mean mouth breathing and if that is happening to any great degree you may be having some big leaks to the point the machine isn't able to compensate for them and it might be missing apnea events.

Now mouth breathing doesn't always means the entire night's therapy is in the toilet. You might mouth breath for 15 minutes and the rest of the night you don't and 15 minutes out of 7 hours isn't a big deal and believe me..15 minutes is enough to dry out the mouth. I see it all the time on my reports.
But until we know for sure just how much mouth breathing is going on (that leak data thing) we have to assume the worst and people will tell you that you need a full face mask so that the therapy pressure isn't blowing out of your mouth instead of going down your airway like it is supposed to go.
When people don't want to do the full face mask thing....I always tell people "let's look at the leak report to see if maybe you aren't being bad the entire night and maybe only doing it 15 minutes which isn't the end of the world".
Without the data to back me up...people are going to tell you to go get a full face mask...all well and good if you want to do that but full face masks leak too and you still need to know that they aren't leaking too much also.

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Noctuary
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Re: Almost new here.

Post by Noctuary » Wed Oct 15, 2014 3:22 pm

Sometimes I hear a loud whistling in my sleep, like an air hose. It wakes me up but then silence. Could I be blowing out air through my clenched jaw?

As for monitoring my own therapy, I spent $100 for a refurbished laptop just so I could use sleepyhead. SleepHead either crashes or gives me incomplete reports (no AHI readings).

Also, at night sometimes I get stuffy. Last night I went to bed with one nostril clear. However when I awoke, both were clear.

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palerider
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Re: Almost new here.

Post by palerider » Wed Oct 15, 2014 4:00 pm

Noctuary wrote: As for monitoring my own therapy, I spent $100 for a refurbished laptop just so I could use sleepyhead. SleepHead either crashes or gives me incomplete reports (no AHI readings).
I hope you don't expect anybody to be able to help you with the near total lack of information you've provided there.

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Noctuary
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Re: Almost new here.

Post by Noctuary » Wed Oct 15, 2014 4:06 pm

nm

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