Brand new to board... a few questions before I get my CPAP

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
hifiaudio
Posts: 79
Joined: Thu Apr 09, 2015 11:11 am

Brand new to board... a few questions before I get my CPAP

Post by hifiaudio » Thu Apr 09, 2015 11:20 am

I have had my sleep study, but not the follow up visit to discuss and get my machine, which will occur this coming Monday. The study technician was nice enough to answer a few of my questions and give me a little info. I have both central and OSA. I am 37, 185lbs, male. I am not sure how many events I had, but the central apneas kept me from breathing for up to 70 seconds at times. My O2 desaturations we into the high 50s.

When the lady called today she told me I will be getting a CPAP at a pressure of 13. During titration I did find it hard to exhale with the mask on.

My first real question is "Is there any reason NOT to get Apap now?" Aren't they pretty much state of the art for the technology? Why would I want something that cannot auto negotiate an appropriate pressure at all times? Are there disadvantages?

Or is this often a matter of what insurance will pay for? Am I free to ask for a more expensive or better machine and have insurance pay whatever they were going to for the cheaper machine? Or is that worth it or something I should even pursue?

I don't really know how much of this is my doctor or, worse, insurance company giving me what they want to vs what is truly best for my comfort and long term use of the device.

User avatar
Wulfman...
Posts: 6688
Joined: Mon Sep 01, 2014 6:41 pm
Location: Nearest fishing spot

Re: Brand new to board... a few questions before I get my CPAP

Post by Wulfman... » Thu Apr 09, 2015 11:33 am

hifiaudio wrote:I have had my sleep study, but not the follow up visit to discuss and get my machine, which will occur this coming Monday. The study technician was nice enough to answer a few of my questions and give me a little info. I have both central and OSA. I am 37, 185lbs, male. I am not sure how many events I had, but the central apneas kept me from breathing for up to 70 seconds at times. My O2 desaturations we into the high 50s.

When the lady called today she told me I will be getting a CPAP at a pressure of 13. During titration I did find it hard to exhale with the mask on.

My first real question is "Is there any reason NOT to get Apap now?" Aren't they pretty much state of the art for the technology? Why would I want something that cannot auto negotiate an appropriate pressure at all times? Are there disadvantages?

Or is this often a matter of what insurance will pay for? Am I free to ask for a more expensive or better machine and have insurance pay whatever they were going to for the cheaper machine? Or is that worth it or something I should even pursue?

I don't really know how much of this is my doctor or, worse, insurance company giving me what they want to vs what is truly best for my comfort and long term use of the device.
No. If you can swing it, get one. The primary importance is "full data-capability", but virtually all APAPs have that (except the Escape Auto by ResMed) including the fact that they have more options.
Now, that said, some people are disturbed by the changing pressures all night and some people don't have the breathing characteristics (flow limitations and snores) that cause the machines to increase pressures in anticipation of heading off apneas........BUT, you can always reconfigure the APAPs into single pressures or narrow pressure ranges and you can't get a single pressure machine to run in a range of pressures.

Go for the APAP if at all possible. And, the insurance code E0601 is the same for ALL CPAP machines (which includes the APAPs)


Den

.
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
User since 05/14/05

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Brand new to board... a few questions before I get my CPAP

Post by Pugsy » Thu Apr 09, 2015 11:37 am

You need to talk to your doctor before you get any machine.
Especially talk about those centrals and what he wants to do about them.
CPAP machines are fixed single pressure machines and an APAP is just an auto adjusting single pressure machine and depending on how many centrals and how much of a problem those centrals are you may need a totally different machine.
Now sometimes insurance companies won't pay for that totally different machine (it is quite pricey) until someone proves to them that regular cpap won't work and thus someone starts out on cpap and moves up the ladder when they "fail" the regular single pressure machines.

It all depends on how many centrals...did you have them before you even was put on the cpap machine for the titration or did they just show up at the titration study.
And it depends on how many and if they are still present at 70 seconds...cpap may not be the best choice of machines for you.

You need to have a good sit down discussion with your doctor about your options and the exact diagnosis and exactly what he wants to do about the centrals before you do anything about getting a machine.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

hifiaudio
Posts: 79
Joined: Thu Apr 09, 2015 11:11 am

Re: Brand new to board... a few questions before I get my CPAP

Post by hifiaudio » Thu Apr 09, 2015 11:43 am

Thanks!

Yeah I had the centrals while on no machine.

By the end of the study apparently I slept for 2.5 or 3.5 hours (cant remember which) with no real events of any kind.

The technician said I was his hardest titration in 2 years.

User avatar
Wulfman...
Posts: 6688
Joined: Mon Sep 01, 2014 6:41 pm
Location: Nearest fishing spot

Re: Brand new to board... a few questions before I get my CPAP

Post by Wulfman... » Thu Apr 09, 2015 11:45 am

I also agree with Pugsy. My focus happened to be on the question I highlighted and somehow I missed the part about the Centrals. Those could be the reason for a different type of machine.


Den

.
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
User since 05/14/05

hifiaudio
Posts: 79
Joined: Thu Apr 09, 2015 11:11 am

Re: Brand new to board... a few questions before I get my CPAP

Post by hifiaudio » Fri Apr 10, 2015 11:46 am

Thanks again for the help so far. I called the office back today just to find out the machine they plan to give me. It is the Respironics Remstar auto 560. Any reason that is not a great choice? (not necessarily a reason specific to my situation, more meaning is it known to not be as good in general as xxx machine, etc?)

User avatar
Wulfman...
Posts: 6688
Joined: Mon Sep 01, 2014 6:41 pm
Location: Nearest fishing spot

Re: Brand new to board... a few questions before I get my CPAP

Post by Wulfman... » Fri Apr 10, 2015 11:50 am

hifiaudio wrote:Thanks again for the help so far. I called the office back today just to find out the machine they plan to give me. It is the Respironics Remstar auto 560. Any reason that is not a great choice? (not necessarily a reason specific to my situation, more meaning is it known to not be as good in general as xxx machine, etc?)
That's a good machine. It's their top-of-the-line APAP.


Den

.
(5) REMstar Autos w/C-Flex & (6) REMstar Pro 2 CPAPs w/C-Flex - Pressure Setting = 14 cm.
"Passover" Humidification - ResMed Ultra Mirage FF - Encore Pro w/Card Reader & MyEncore software - Chiroflow pillow
User since 05/14/05

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Brand new to board... a few questions before I get my CPAP

Post by Pugsy » Fri Apr 10, 2015 11:55 am

The PR S1 560 machine is a great machine in all regards except one...it can't treat centrals at all and in fact it ignores them.

I don't know how many centrals you had during that diagnostic sleep study...having a few of them is actually normal.
So it very well might be that you don't have enough centrals for the doctor to worry about treating them and he is happy just treating the obstructive sleep apnea stuff.

You still need to discuss all this with the doctor and while you are there get a copy of the full sleep study reports (diagnostic and titration) and not just the one page summary.

Then 560 model is an APAP machine meaning it has both cpap mode (single fixed pressure) and apap (auto adjusting single pressure) mode available so it's like 2 machines in one. It is also a full data machine with software that is easy to obtain and use. So as long as your centrals aren't the problem...it is a great machine but if your centrals are a problem (your doctor's decision) then it isn't going to do anything for the centrals.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

hifiaudio
Posts: 79
Joined: Thu Apr 09, 2015 11:11 am

Re: Brand new to board... a few questions before I get my CPAP

Post by hifiaudio » Fri Apr 10, 2015 12:20 pm

Ok. That is weird to hear on the centrals, because I think the technician indicated that centrals were a big part of my problem. But perhaps I misunderstood. Guess I will know much more Monday.

User avatar
Pugsy
Posts: 63941
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

Re: Brand new to board... a few questions before I get my CPAP

Post by Pugsy » Fri Apr 10, 2015 12:34 pm

It's possible that the centrals are indeed a big part of the problem and it is also possible that your insurance will require you to use the cpap/apap before it will consider covering a machine that is designed to treat the centrals.
There are a lot of ifs and maybes and buts....so the best thing is to have that thorough discussion with your doctor and maybe with insurance.

There's too much that is unknown at this point to really form an opinion on which machine needs to be used and what for. Sometimes people go directly to the ASV type of machines (designed specifically for troublesome centrals) and sometimes they have some hoops to jump through and this is only if the centrals are really the problem.
Your doctor may not think yours are a problem. All we can do is speculate at this point because we don't have enough information and we also don't have a clue what special requirements your insurance might have IF (big IF) you do need that high end machine.

_________________
Machine: AirCurve™ 10 VAuto BiLevel Machine with HumidAir™ Heated Humidifier
Additional Comments: Mask Bleep Eclipse https://bleepsleep.com/the-eclipse/
I may have to RISE but I refuse to SHINE.

If you want to try the Eclipse mask and want a special promo code to get a little off the price...send me a private message.

User avatar
Julie
Posts: 19898
Joined: Tue Feb 28, 2006 12:58 pm

Re: Brand new to board... a few questions before I get my CPAP

Post by Julie » Fri Apr 10, 2015 12:36 pm

Don't pay attention to techs' opinions on your therapy - they love to sound off but half have no idea what they're talking about with regard to you personally as they don't know your history or anything else meaningful... and sometimes they're just bored and like to hear themselves talk. A lot of us, if not most, have some centrals when falling asleep and just before waking... those are normal (which it's just possible that even your MD does not realize), but you need to differentiate about their timing vs e.g. a lot of them throughout the night. And a sleep study alone is not always the time to make hard and fast judgments on that... which is why a good machine plus software matter, to see how things go over time.

hifiaudio
Posts: 79
Joined: Thu Apr 09, 2015 11:11 am

Re: Brand new to board... a few questions before I get my CPAP

Post by hifiaudio » Fri Apr 10, 2015 12:54 pm

OK cool. thanks for all the great points. You all have been a big help already. I am sure I will be leaning on you for lots of questions as my therapy starts and I try to get used to it all!

hifiaudio
Posts: 79
Joined: Thu Apr 09, 2015 11:11 am

Re: Brand new to board... a few questions before I get my CPAP

Post by hifiaudio » Mon Apr 13, 2015 3:15 pm

OK just got back from my appt with the machine. I am going to be trying the Resmed Swift FX first. My AHI score was 39.2. Gotta go figure out how to get the software to read that card, etc.

User avatar
SleepDisturbed
Posts: 276
Joined: Thu Apr 25, 2013 1:52 pm
Location: East Texas

Re: Brand new to board... a few questions before I get my CPAP

Post by SleepDisturbed » Mon Apr 13, 2015 5:23 pm

Welcome to hose-head land!

Getting the software set up and checking data is VERY important when you are just getting started, but installing Sleepyhead and importing the data is dead simple if you have used a computer for more than fifteen minutes!

Once you get a few nights under your belt, post some data here and let some of the smart people around here take a look. See if centrals are a problem or not.


BTW, the Swift FX is a very good mask. If your nares get raw, get some Lansinoh cream and use it on them until you get acclimated. If your mouth opens and you have mouth leaks, try a chin strap (I like the Halo or Ruby Red). You need to eventually train yourself to keep it closed and to keep the tip of your tounge touching the roof of your mouth right behind your teeth. Once you do, you can ditch the chin strap -- took me about six months.

_________________
Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear
Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control
Additional Comments: 9.6 - 15 Pressure on APAP. EPR 2 / Sleepyhead software
What I lack in verbosity, I make up in brevity.

User avatar
robysue
Posts: 7520
Joined: Sat Sep 18, 2010 2:30 pm
Location: Buffalo, NY
Contact:

Re: Brand new to board... a few questions before I get my CPAP

Post by robysue » Mon Apr 13, 2015 7:03 pm

hifiaudio wrote:I have had my sleep study, but not the follow up visit to discuss and get my machine, which will occur this coming Monday.
My standard advice to folks who are just starting out is at http://adventures-in-hosehead-land.blog ... -with.html.

In a later post you say that the equipment they intend to set you up with is a PR System One model 560. That's a top of the line APAP which records full efficacy data. You also say that the tech who ran the study said that centrals were part of your problem. You should get a copy of your sleep test report and you should discuss the whole report with your sleep doctor. As pugsy has pointed out, CPAP/APAP machines are not really designed to treat clinically significant problems with central sleep apnea, but many insurance companies do insist that the patient "fail" at CPAP/APAP before being switched to a machine that is designed to treat centrals. It's worth asking the doctor how closely he intends to follow your data and what he intends to do if the number of centrals remains high once you start PAPing.

Good luck with the beginnings of your adventure in hosehead land.

_________________
Machine: DreamStation BiPAP® Auto Machine
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Additional Comments: PR System DreamStation and Humidifier. Max IPAP = 9, Min EPAP=4, Rise time setting = 3, minPS = 3, maxPS=5