Is my thinking right?

[RoRo]

Hey everyone!
I've been on cpap for almost 90 days now. Next Monday I have my first follow-up with my sleep doc at the 90 day mark. I've been using sleepyhead software to track my "progress". When first diagnosed I had an AHI of 43.2. I have a good machine, REMstar ds460 with heated tube humidifier, and I'm pleased with it. My RX was written for 9cm pressure. My AHI after 1 1/2 months was anywhere from 4-7 so I used the clinical settings and put it into auto mode for 7 days.(This model can do this for up to 30 days, then it resets back to straight cpap) During the 7 days, my pressure averaged 10.5 cm., so I reset my machine to 10cm. Now my AHI is down to 0.4 - 1.5 range.
Now after all the above, here is my concern......
I'll be retiring from military duty with 40 yrs service on 1 November. At that time, I'm sure my insurance will undergo some changes. When I meet with the doc next week, would I be overly concerned if I asked him if I should change to an auto machine such as the S9 Autoset? My thinking on this is that I will be using whatever machine I have for the next 5 years when I retire in 6 months. If my needs change during that time, my current machine is straight cpap and may require me to incur a large out of pocket expense to get a different machine.
Anyone else have a similar situation? If so, how did you handle it? Or, should I just back off of this and stay with my current machine?

Thanks in advance......

[Pugsy]

Your existing humidifier (60 series) will also work with the APAP model of your PR S1...that would be the model 560.
So you could ask for the model 560.

Or you could request the S9 Autoset if that is what you have your heart set on.

If you don't ask....the answer is always "no"

You've got a great machine but I understand where you are coming from with the APAP. I was the same way and for me it worked out well because I actually have some considerable pressure variation needs during REM sleep as opposed to non REM sleep. I bought my machine privately so that I could have what I wanted.

There are ways to get the S9 Autoset if they say "no" if you are willing and able to pay out of pocket. From gently used low hour machines to zero hour brand new machines.

Besides...it's always good to have a second machine available for a back up just in case something happens to the first one.

[chunkyfrog]

By all means, a full-time autotitrating machine will serve you better, if you can get one,
even if you only run it on auto for a week at a time every few months.
If your current machine is an IQ, the auto can be restored,
but I believe this deletes compliance data, which would be very bad.

[tetragon]

The current 60 Series REMstar Pros have the modes that were added in the AutoIQ 450 firmware. Not sure about the earliest 60 series firmware revisions, but the AutoIQ name was rather short-lived, with the functionality living on in the Pro.

[cobra4x4]

An auto machine is always a better choice as it covers both scenarios ... Straight CPAP or Auto adjusting which ever works best for the individual.

A straight CPAP does just 1 setting and should your needs change, you must manually make the change after you figure out what the change needs to be, while an auto machine adjusts to your needs within the limits (Minimum & Maximum) that you or your doctor set. Auto capable machines can run in straight cpap mode, but not the other way around.

An auto adjusting machine is also better used to monitor trends when your therapy just isn't quite right. One good night doesn't make a trend, every nights sleep is different so why would one night in a sleep study determine your long term pressure needs until the next sleep study (which in my case has yet to happen ... 4yrs & counting).

Here is how my cpap life has gone ...
My 1 night split sleep study determined my cpap pressure was 7cm (This was done in a hospital), I ran with that for 6 months before adjusting to 8cm on my own (made me feel better, still no data to look at). Once I got my S9 auto I found out my pressure over a period of 3 weeks averaged 10.5cm with great numbers to boot ( 2yrs later I'm still averaging 10+ cm ). I have my backup/travel machine (Straight CPAP) set to 10.5cm and I feel great.

This just shows that a 1 night sleep study can't possibly give correct long term data, that is why monitoring on your own is so very important.

[DoriC]

Cobra, what pressures did you use in auto to find your optimal pressure? And what settings do you use now? Thanks.

[cobra4x4]

Cobra, what pressures did you use in auto to find your optimal pressure? And what settings do you use now? Thanks.

I set my auto at 7cm minimum to start (as this was my hospital titrated pressure) that way I never fell below the titrated pressure and followed the suggested 2-3cm above and no more than 2cm below titrated pressure (obviously I chose not to go below my titrated pressure). So my initial autoset setting was min 7cm and max 10cm and that was for about a week, as I kept hitting my maximum 10cm I bumped up my pressure to 11 then to 12 (as I felt I didn't leave enough wiggle room). After week 2 I discovered my max pressure was consistently about 10.5cm so I then played with bumping up my minimum pressure to 8cm (felt much better) then 9cm (Not so good, felt like hell), I then lowered back to 8.4cm and made minor adjustments of .2cm up or down on both minimum & maximum until I found the optimal feel with good numbers.

With my Swift FX mask I finally settled on Min 8.2 and Max 11.6 .... Average AHI around 1.2 - 1.8 ... 95% pressure 10.5cm according to Rescan software
With my Wisp mask the pressure needs increased I'm at Min 9.4 Max 15.8 .... Average AHI 0.2 - 0.6 ... 95% pressure 14.6cm according to Rescan software

I should add that I still use my Swift FX on my old backup machine (Phillips Respironics DS100H which is my travel machine), I now only use the Wisp on my S9 autoset exclusively as its my preferred mask and since I only have one I'm not taking it when travelling. Once I get another at the end of the year I will have a wisp for each machine.

[RoRo]

Lots of great info.....Thanks everyone!

[deerslayer]

Bottom line RoRo , you have the final call. When the VA furnished my first machine - an auto machine adjusted to their settings. it worked well, but like all of us here that want to take charge of our health & track therapy much closer than the DME after initial period of compliance. so we start looking for the holy grail of (0) apnea .in doing this we change settings which is not necessarily a bad thing . i had been very satisfied all these years by self adjusting machine & went so far as obtaining a used bipap auto. however after using for over a year and getting a second sleep study it was determined i did not need a bipap and was advised i should try straight cpap at a lower pressure. low and behold my AHI dropped. especially obstructive & leak data.
if you have insurance provided equipment be careful to self titrate and if you do give each change to settings a week or so to avg. out before changing.
just my 2 cents.
Good Luck
tim

[RoRo]

Again everyone, thanks for your input, it's really helpful to see how others coped with similar situations.....

To update, I saw my sleepdoc today. He readily agreed to write a prescription for an autoset. So, my DME ordered an S9 autoset with climateline and it will be in tomorrow. One note; my DME noted that it was good that I came in today as it was my 90th day, and they were ready to submit paperwork to my insurance (Tricare Prime) to change billing from rental to purchase of my original machine. They were able to replace the original with the autoset with no out-of-pocket expense to me.

Almost forgot...when I went to the sleepdoc, I took printouts of both sleepyhead and EncoreBasic reports. He had never seen sleepyhead reports, and asked a lot of questions about it, such as what does it cost, who wrote the software, etc and compared the two reports. He was impressed with sleepyhead and said he will study the report, check the software out himself, and probably end up recommending it to others who may be needing software......cudos to JMARK for the sleepyhead program!!