Another new member from Texas -- a few questions

[Rosenkavalier]

Howdy. (I'm required by law to say that.) New member, first post, etc. Before creating my account, I spent hours and hours going through old posts here, gathering as much info as I could on OSD and CPAP. So much good info, so many helpful folks!

I had my first sleep study (polysomnography) in early February, and I finally saw my neurologist yesterday for my follow-up. He's sending me back for the second study (titration), which I've scheduled for early March. Since this seems to be the thing to do for first posts, here are some of my key results.

Apneas: 1 Obstructive, 2 Central, 1 Mixed -- Apnea Index = 0.7
Hypopneas: 92 -- Apnea/Hypopnea Index = 16.4
Lowest Desaturation = 86%, Time between 81% and 90% = 0.83 minutes
Periodic Leg Movement Index = 5.8, PLM Arousal Index = 0.7
Total Arousals = 79, Total Arousal Index = 13.5, Respiratory Arousal Index = 2.7
Number of Awakenings = 27, Stage REM Latency = 165 minutes
Stage 1 = 4.4%, Stage 2 = 77.0%, Stage REM = 14.5%, Stage 3 = 4.0%, Stage 4 = 0.1%

I saw the link that Rested Gal provided to the 'Sleep Studies' forum over on apneasupport.org (http://www.apneasupport.org/forum-4.html). I had Googled for similar sites, but hadn't found that one. I'll look around there and dig around.

Questions:
-- Of all the items on my study, the one that surprised me was the less than 5% time in Stage 3 & 4 sleep. Taking into account that this was only one night, and it was also in an unfamiliar room and a somewhat constricting position: is an improvement in Stage 3 & 4 sleep something that I might see from CPAP therapy?

-- The dreaded mask question. I'm a triple-whammy: mouth-breather, drooler, with a full beard. Suggestions or pointers?

-- Having read a number of the posts on the difference in how APAP machines appear to deal with hypopnea evens as opposed to full-on apneas, for someone who is so solidly on the hypopnea side does it still make sense to push my DME for an auto? Given my insurance situation (Blue Cross, must use network DME to be reimbursed, hard cap on machine cost, DME cannot bill difference to customer), I'm thinking I'm going to have to fight for an auto if I want one.

Oh, and I did want to add: having read a good number of posts from the folks here has greatly reduced my anxiety over starting CPAP. I feel like I can get a handle on the process and manage it. Thanks.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): Arousal, CPAP, DME, Hypopnea, auto, APAP

[RobertinTX]

Welcome !
And "Howdy" as well.
I've been using a CPAP for many years....a lot....laffin
I use to be a mouth breather but that changed.
I do have and have had a full beard etc.. I use a nasal mask, have always used one and have good success. I lose very little from the seal, this can be taken into account when you do the final study, be sure to tell them everything.
Again, welcome and good luck.

[snorzalot]

Welcome aboard Rosenkavalier!

I think you are definitely on the right track joining this forum and reading what material you can to better understand your condition. In the area I live, most OSA-related staff from the doctor, sleep lab and DME all seemed so shocked that I'm interested not only in my therapy but in learning everything I can about OSA. They still claim most patients they deal with just want to know how to turn this "thing" on and off.

I'm certainly not a doctor, but based on a few of the AHI/RDI scales I've seen 16.4 AHI from your study would be listed as mild to moderate. My untreated AHI on my pre-titration study was 50.5 (severe on all scales I've seen). I'm sure some of the members of this forum are triple digit as I've noted the polysomnography therapist both studies comment on that in my area.

Your oxygen looks like it's in the "good" range and your time sleeping in various stages is a lot like mine. I spent a TON of sleep in stage 2 (over 80%) and then like 18.x in REM and the rest was literally 1% or less in stage 1, 3 and 4. I'm not sure of the relavency in the various stages as again I'm not a doctor, but we are similar so that has to be some kind of warm fuzzy

I suspect you will see considerable more REM sleep (stage 5) once your titration study is underway and they are close to your required cm H2O. Remember to get a copy of your titration study when that concludes.

The mask question you asked is complex. I started in 1999 with a nasal mask, but since I'm a nose breather, I quickly went for a full face mask. I seemed to have skipped nasal pillows in the past. I CAN NOT use a chin strap (personal feeling of claustrophobia), so a full face works best for me. I have used ResMed Full Face S2 (no longer manufacturered) as it was upgraded by my 2nd mask, Resmed Ultra Mirage Full Face (a nice one) and finally, I'm on a Fisher & Paykel Flexifit431 Full Face (my personal favorite). I like this mask since it is a little longer and tends to encompass just enough of the chin that it's sort of like using a chin strap, yet you can still open your mouth for mouth breathing. I've read of others on here with leak issues on the mask, but it's been good to me. This leads to my next point. If everyone here was allowed to use every mask for one week and then at the end of the year pick their favorite, we'd have a LOT of selections. So much of this is trial and error and finding what works for you.

WARNING: Don't be like me though and give up like I did in 1999. Stick with it. I'm on a new machine now with a new mask, new settings, new everything and I'm averaging 7 hours of sleep per night and LOVING my new configuration. A large part of this is attitude and desire to be compliant with help from the experts getting you there through therapy modifications. Stick with it!

I also have a set of ResMed Swift Nasal Pillows. During My DME's visit, she claimed I was going to be billed for a new mask, so I might as well pick one .. lol, so I decided to try nasal pillows. I've read they are difficult for people to use with high cm H2O settings (I'm 16 atm). I like the feeling of having literally nothing on my face as compared to a full face, but it's taking a little bit to get used too and I love my FF so much now, I've only used the pillows a few nights, but I like them. I will probably mix them up to alleviate pressure (like many others here) on different nights of the week as full face masks often leave a tender spot on the bridge of the nose.

The APAP question you asked is a tough one. Hopefully, your titration study will get you very close to the required mark for you personally. If so and you don't have problems tolerating the pressure on CPAP, the APAP might not be required.

Of course, companies like Respironics make a single machine that runs in both CPAP and Automated CPAP (APAP) mode, so getting one of those could work out really well.

Good luck!