Is a new sleep study really necessary?

Hi,

I have had my CPAP machine for 3.5 years. When I first got the machine it was the most wonderful thing, I had no problems adjusting and slept through the night from the very first night. Since then I have moved several times and am not in contact with my original ENT Doctor. In the first year I shed about 40 lbs using just the machine which I though was good as the Dr had said that 40 - 60 lbs was due to my sleep apnea.

My current problem is that I am again falling asleep during the day. If I sit still for more than a few min I am asleep in the chair. Also, from reading stuff on the net I have acquired the excessive gas problem. My machine is a Remstar Plus and it is set at 19. I dropped the pressure setting down to 18 last night and that alleviated the gas a bit but I still took the little chair nap again today and tired all day.

My insurance will not cover a new sleep study or a new machine but since I really want to feel better again and don't want to get to the point where I was 4 years ago (not allowed to drive) should I drop the machine another point or two and see what happens? Should I suck it up and do the sleep study again? Would one of the machines that have software and adjust do the job?

Thanks
Terry Ann

Absolutely a machine with software would make a very big difference, as you could see where the problems are and address them specifically. You are at quite a high pressure, but having lost a lot of weight may no longer need that pressure, may no longer be subject to the mask leaks that the pressure may be creating (though if you're unknowingly breathing with your mouth open overnight, you're losing all the Cpap air that way - and a higher pressure will make that worse, a full face mask a lot better). An adjusting (Apap) machine is usually a very good thing to have, but it's the software that will help you diagnose what's what, not the machine. Look on Cpap.com for the Respironics M series Pro, then at the software bundles that can come with it (card, reader, s-ware, etc) and consider getting one. However, you maybe should also get a new study because having lost so much weight, you really may need a very different mask (fullface or otherwise) now and different pressures.

I do have the open mouth problem which I had when I got the machine I used the chin strap for about the first six months then found I didn't need it ... however in the last six months or so I have had to use that again. I do have a full face mask in addition to the nasal pillows and have tried both of them.

Terry Ann,

Listen to Julie......her advice is spot on.

If you're waking with a dry mouth, that's a sign that you're mouth-leaking during the night and losing your therapy air.

Most insurance providers won't replace a machine until about 5 years, so you're looking at an out-of-pocket expense......but getting a data-capable machine and software will be much less expensive than having another sleep study. AND, you'll be able to take control of YOUR therapy.

Do you have your prescription for your present machine?

After reading your response to Julie, which (specific) masks do you have?


Den

I should be able to get the machine from the insurance company but I found that in the long run they are cheaper to buy here than to go through them. My insurance rents the machine with the price to me being more than they are to buy it directly.

Yes I have a prescription and it is on file here but it says to set the machine to 19.

I have a full face Fisher Paykel mask and a Breeze nasal pillow one. I prefer the breeze and use an ace bandage to keep the mouth closed as it works better than the chin strap.

TerryAnn wrote:I should be able to get the machine from the insurance company but I found that in the long run they are cheaper to buy here than to go through them. My insurance rents the machine with the price to me being more than they are to buy it directly.

Yes I have a prescription and it is on file here but it says to set the machine to 19.

I have a full face Fisher Paykel mask and a Breeze nasal pillow one. I prefer the breeze and use an ace bandage to keep the mouth closed as it works better than the chin strap.

I had problems with my pressure and insurance co, so I purchased an M series Auto pap from cpapauction.com with very few hours on it for less than half the price of a new one. Resetting the pressure isn't that hard and the instructions to do so are readily available. My prescription was for 14 pressure on a cpap. I now have my min of 9.5 and max of 15 on an auto pap and it rarely has to go above 12.5 to correct my apneas. my AHI is .3. The software and card reader are easy to obtain also.

Often what happens when you lose weight is that your face changes along with everything else, and you may well need either a new mask, or to tighten (slightly, not a lot!) the one you're using. It's amazing how much of a difference even a slight loss can make. If your FF mask is not really a good fit, consider others such as the Quattro, Liberty or UltraMirage. Have you tried a lower pressure recently, e.g. 15?

TerryAnn wrote: Yes I have a prescription and it is on file here but it says to set the machine to 19.

I have a full face Fisher Paykel mask and a Breeze nasal pillow one. I prefer the breeze and use an ace bandage to keep the mouth closed as it works better than the chin strap.

If you get a new machine that is data capable from cpap.com you also get the complete instruction manual - then adjusting the pressure is up to you.

Chin straps don't always help - they make no difference for me - it depends on your face shape. My jaw just drops back and my lips open. They are about as good as the withdrawal method of birth control.

If you need a new prescription for an auto adjusting machine - any dr or dentist can write one at your direction. There are samples of prescriptions on the board here if you search for them.

TerryAnn, The guys are giving you good advice about getting a machine with software and taking care of the mouthbreathing. On another point, in what position(s) do you sleep?

I too would appreciate some advice about a new sleep study, but under far different circumstances.

I had my one and only sleep study almost ten years ago, and until a month ago, used the same CPAP at the initially prescribed pressure. I adapted easily to CPAP therapy and noticed positive results within a few days of finding the right mask. My sleeping has been quite "normal", although not perfect. It is affected by my arthritic shoulders and some other minor afflictions, but apneas seem to be a thing of long ago, as my wife can testify. I wake rested, as a rule.

A month ago I purchased a new, data capable APAP on my own. I initially set it to a range of 8 - 12 cm and ultimately settled for 9 - 13 cm, with my 90% high pressure averaging 11.6. This is higher than the 10 cm my old machine was providing, but easy for me to deal with given the more than 50% reduction in noise with the new machine. My leak rate is consistently zero. AI average is below 0.1. HI averages 1.4, which I think is exaggerated by removing my mask to wipe my continuously running nose.

From what I understand, my numbers are pretty close to optimal, and probably the envy of many of you.

My primary care physician took control of my treatment immediately, scheduling the sleep study, reviewing the results with me, and forwarding the equipment prescription to the DME. I had my sleep test on a Thursday and got my equipment on the following Monday. My PCP questioned my CPAP compliance and results at my regular quarterly appointments for the first year, and I don't think we've discussed it since. My close friend, who shares the same physician, has been sent to two follow-up sleep tests in the past 5 years, but I haven't given him any reason to re-test me. We have a very close personal relationship, and I believe that I am trusted to inform him of any important changes in my health. He also knows that I am pretty diligent about researching my medical conditions and asking him questions when I'm not 100% certain of my understandings.

At my next appointment, I will provide my doctor with a monthly printout from my new machine, but I'm inclined to use it to argue that I don't need the expense of a new sleep study, if he's thinking that it may be due after ten years. The new calendar year will undoubtedly bring yet another reduction in insurance coverage, and I just don't need the expense of a new study.

Any thoughts?

sronsen wrote:At my next appointment, I will provide my doctor with a monthly printout from my new machine, but I'm inclined to use it to argue that I don't need the expense of a new sleep study, if he's thinking that it may be due after ten years. The new calendar year will undoubtedly bring yet another reduction in insurance coverage, and I just don't need the expense of a new study.

Any thoughts?

I think you're exactly right.

Since you're doing an excellent job monitoring your own treatment and have the tools and intelligence to do that well for yourself, you don't need a new study simply because X number of years have gone by.

Just my non-medical opinion.