Newbie - intro and question about Dreamstation C-Check Mode

[linuxman]

Hi everyone. James here from the snowy and currently very cold state of Indiana.

After a 6 month saga of utter incompetence by both my primary physician and DME (post diagnosis) I now have a CPAP machine as of a couple of days ago. I won't go into those details - it's too sad to even discuss . In any case, I ended up here because of my wife's astute observations of my terrible snoring and its apparent progression into OSA over the last year or so. I didn't have any daytime symptoms (well, at least that are apparent to me), just the occasional sudden waking from sleep, gasping for air. Diagnosis was somewhat sketchy - no in-person sleep study, just an at-home nose canula test (showed around 26 AHI), followed by another at-home test using Novasom equipment (nose canula + oxymeter + chest strap). The doc never shared the results of that with me, but I presume it confirmed the first test. No titration of the ordered CPAP.

He set me up with a local DME for a Dreamstation Auto. My first two nights have been very easy with the Amara View Mask (major life-long mouth breather here). I don't even notice it on. The RT said the unit was in auto mode, but looking at the provider menus after I got home I see it is in C-Check mode, with a pressure set at 6. My read of the provider manual (very conveniently left in my packet ), I see that that mode is more or less "auto in slow motion". It starts at the set pressure, then re-evaluates every three days for event history, then adjusts pressure up/down as required. It can only adjust +/- 3cmH20 total and only 1cmH2O per day. I welcome any thoughts on this mode, and why they might have selected it over just the regular auto mode. Pros/Cons?

My AHI for the first two days was around 25 both days - pretty similar to the test numbers - so sounds like it'll be adjusting up. Any comments on C-Check mode vs the regular Auto mode? I honestly don't know if the RT intended to set that mode, or may have done so accidentally. This was only their second CPAP setup ever. I'll assume for now they knew what they were doing and refrain from messing with things. I don't know if a 9 is going to clear up my events or not, but at this point I'll just wait and see. It can only adjust 1cmH2O per day in this mode, so it'll take a while to get up to 9. This all said, my wife did report that she didn't hear any snoring these two days, so it is helping at least somewhat even at this lower pressure level.

Being an engineer, I couldn't resist taking a look at the detailed data in SleepyHead. Neat software package there. Most of my events were obstructive (and mostly seem to be "real" not SWJ). I did have a couple of clear airway apneas, but it seems that's not uncommon. I woke a few times due to noise (gurgling sound) from rain out in the tube and bathroom visits. Funny, I told the RT that I may need a heated tube since I keep the house in the low 60's. They said "you don't want a heated tube..those cause condensation when your room is cold". I held my tongue and refrained from giving them a lesson in what a due point is .

Anywho, thanks in advance to the owners, mods, and everyone else on the forum. It looks like like a wealth of great information that I'll be absorbing post haste.

[bonjour]

Welcome to the board,
The best way to get help is to ask for it as you have.
And post your sleepyhead data, please see my sig for the how too.

Fred

[linuxman]

Welcome to the board,
The best way to get help is to ask for it as you have.
And post your sleepyhead data, please see my sig for the how too.

Fred

Thanks Fred I'll do that here in a bit. Other than the question about the choice they made to use C-Check mode (vs regular Auto) I don't think I had any particular questions about the Sleepyhead data..it seems pretty straightforward, but I will post it just for general interest and comment.

[linuxman]

SleepyHead screen cap:

[bonjour]

My read of the provider manual (very conveniently left in my packet ), I see that that mode is more or less "auto in slow motion". It starts at the set pressure, then re-evaluates every three days for event history, then adjusts pressure up/down as required. It can only adjust +/- 3cmH20 total and only 1cmH2O per day. I welcome any thoughts on this mode, and why they might have selected it over just the regular auto mode. Pros/Cons?

A General rule of thumb is to make small changes then see what happens. Frequently adjustments can be over 3 cmH2O, especially on the low end. But the charts will give the best insight.

[linuxman]

My read of the provider manual (very conveniently left in my packet ), I see that that mode is more or less "auto in slow motion". It starts at the set pressure, then re-evaluates every three days for event history, then adjusts pressure up/down as required. It can only adjust +/- 3cmH20 total and only 1cmH2O per day. I welcome any thoughts on this mode, and why they might have selected it over just the regular auto mode. Pros/Cons?

A General rule of thumb is to make small changes then see what happens. Frequently adjustments can be over 3 cmH2O, especially on the low end. But the charts will give the best insight.

Roger that. I'm in no hurry so I'll probably just let it auto adjust up to the limit of 9, then look at tweaking on my own if need be. I guess I should at least try to involve the RT at that point, but we'll see. I'm a real do it yourself sort of guy, and so far my doc and RT haven't impressed me.

[OkyDoky]

The Cpap Check mode works in a single pressure mode to check and adjust your pressure every 30 hours. It's not an auto mode. It's possible they are monitoring this through the modem. If it is changed from what was ordered the DME might change it back. Get a written copy of your prescription and sleep study to help answer the question of setup orders. Keep those medical records and you can use copies if you need to order online or use another DME at some point.
Now for why your doctor would choose CPAP instead of AUTO, you would have to ask him. Also sounds like the DME doesn't know how the heated hose works. I would tell them I want one. If they require an order for it, they should get the order from your doctor.

[Guest]

After a 6 month saga of utter incompetence by both by primary physician and DME

The sleep industry is mixed with rip-offs, those who don't know what they are doing (except collecting money) and those who both know what they are doing and are helpful. It is truly unfortunate that in a sleep deprived state you have to sort thru the mess in order to help yourself.

IMO Primary docs are seldom any good with the details of Sleep Disordered Breathing - you will do best to find a good sleep doc. The sleep doc may specialize in Neurology, Pulmonology, or something else. Most good ones are not only hard to find but hard to see. You may have to go first to the nurse or PA. Word of mouth seems to be the easiest and best way to find a doc in your area. BTW - all of that also applies to the DME.

For DME's if your insurance allows it avoid the A's & L's -- meaning Apria, AHP, & Lincare.

If you let the good folks on this forum know where in IN you are located they may be able to offer some suggestions on both.

By all means do request a copy of the results of that (PSG) - Sleep Study you had and any and all future Dr visits or tests.

[linuxman]

The Cpap Check mode works in a single pressure mode to check and adjust your pressure every 30 hours. It's not an auto mode. It's possible they are monitoring this through the modem. If it is changed from what was ordered the DME might change it back. Get a written copy of your prescription and sleep study to help answer the question of setup orders. Keep those medical records and you can use copies if you need to order online or use another DME at some point.
Now for why your doctor would choose CPAP instead of AUTO, you would have to ask him. Also sounds like the DME doesn't know how the heated hose works. I would tell them I want one. If they require an order for it, they should get the order from your doctor.

I guess academically they could do that, but they won't be able to in my case because I live so far out in the boonies. They included just a regular cellular type modem which has zero chance of connecting where I live. I mentioned that to the RT so they could potentially switch to a WiFi modem, and they said - "meh..that's ok... this is just for insurance compliance. Your doc can look at the SD card in a few months". Clearly they're not interested in being very engaged on this journey .

On the heated hose, yeah I'm just going to order one. I have a high deductable w/HSA type plan so it's pointless to even go through insurance for such things.

[OkyDoky]

The Cpap Check mode works in a single pressure mode to check and adjust your pressure every 30 hours. It's not an auto mode. It's possible they are monitoring this through the modem. If it is changed from what was ordered the DME might change it back. Get a written copy of your prescription and sleep study to help answer the question of setup orders. Keep those medical records and you can use copies if you need to order online or use another DME at some point.
Now for why your doctor would choose CPAP instead of AUTO, you would have to ask him. Also sounds like the DME doesn't know how the heated hose works. I would tell them I want one. If they require an order for it, they should get the order from your doctor.

I guess academically they could do that, but they won't be able to in my case because I live so far out in the boonies. They included just a regular cellular type modem which has zero change of connecting where I live. I mentioned that the RT so they could potentially switch to a WiFi modem, and they said - "meh..that's ok... this is just for insurance compliance. Your doc can look at the SD card in a few months". Clearly they're not interested in being very engaged on this journey .

Lucky you. There is no WiFi on the machine. The SD card works fine for compliance.

[linuxman]

The Cpap Check mode works in a single pressure mode to check and adjust your pressure every 30 hours. It's not an auto mode. It's possible they are monitoring this through the modem. If it is changed from what was ordered the DME might change it back. Get a written copy of your prescription and sleep study to help answer the question of setup orders. Keep those medical records and you can use copies if you need to order online or use another DME at some point.
Now for why your doctor would choose CPAP instead of AUTO, you would have to ask him. Also sounds like the DME doesn't know how the heated hose works. I would tell them I want one. If they require an order for it, they should get the order from your doctor.

I guess academically they could do that, but they won't be able to in my case because I live so far out in the boonies. They included just a regular cellular type modem which has zero change of connecting where I live. I mentioned that the RT so they could potentially switch to a WiFi modem, and they said - "meh..that's ok... this is just for insurance compliance. Your doc can look at the SD card in a few months". Clearly they're not interested in being very engaged on this journey .

Lucky you. There is no WiFi on the machine. The SD card works fine for compliance.

Ah, I thought a wifi modem was an option for the Dreamstation. In any case, I'm fine with them not having control as you alluded to .

[linuxman]

After a 6 month saga of utter incompetence by both by primary physician and DME

The sleep industry is mixed with rip-offs, those who don't know what they are doing (except collecting money) and those who both know what they are doing and are helpful. It is truly unfortunate that in a sleep deprived state you have to sort thru the mess in order to help yourself.

IMO Primary docs are seldom any good with the details of Sleep Disordered Breathing - you will do best to find a good sleep doc. The sleep doc may specialize in Neurology, Pulmonology, or something else. Most good ones are not only hard to find but hard to see. You may have to go first to the nurse or PA. Word of mouth seems to be the easiest and best way to find a doc in your area. BTW - all of that also applies to the DME.

For DME's if your insurance allows it avoid the A's & L's -- meaning Apria, AHP, & Lincare.

If you let the good folks on this forum know where in IN you are located they may be able to offer some suggestions on both.

By all means do request a copy of the results of that (PSG) - Sleep Study you had and any and all future Dr visits or tests.

Thanks for tips. I'll look into that if they fail to engage. It takes a month or so to even see my PCP he's so busy, so I doubt he's going to be very helpful. The DME said to check in with my primary care guy in 3 months. My DME is a Rotech franchise. I'm in the Lafayette, IN area.

[Jasba64]

One thing is for sure, you need more pressure. I snore too but I have never seen a snore graph like that. I too use a Dream Station but mine is not an Auto, it's a Pro. I am using mine in straight Cpap mode but the C-check is a nice feature and like you said, it will make small adjustments based on 30 hours of data. Since yours is an Auto, I am surprised your doctor didn't just start you out with a 4-20 range to see where you fall out 95% of the time. Are you sure you have an Auto machine versus the Pro?

[linuxman]

One thing is for sure, you need more pressure. I snore too but I have never seen a snore graph like that. I too use a Dream Station but mine is not an Auto, it's a Pro. I am using mine in straight Cpap mode but the C-check is a nice feature and like you said, it will make small adjustments based on 30 hours of data. Since yours is an Auto, I am surprised your doctor didn't just start you out with a 4-20 range to see where you fall out 95% of the time. Are you sure you have an Auto machine versus the Pro?

Thanks for the feedback. Indeed I'm snoring up a storm and have events galore. I do have the auto, but it's just set in C-Check mode right now with a base of 6 in the provider menus. Strangely, I crossed over 30 hours last night, and it did not bump up the pressure for some reason. I'll see if it does tonight. If it doesn't, I'm probably going to take control and set it to auto or at least start bumping the pressure myself to see how I respond. My doc (just primary care doc) and RT/DME are not engaged..they just said to check back in 90 days :/.

[OkyDoky]

If your DME and doctor are not involved, I would switch to Auto mode Minimum 8cm (since 6 is doing very little). The Minimum will probably need to be increased after monitoring data but this is a starting point. Put you Maximum at 20cm so we can see where and how much your machine increases pressure. Your CA's are insignificant but your OA's and H's need to be controlled and I think we can help you get your pressure dialed in.