Newbie with some questions..

Hi everyone,

First of all, Merry Christmas and a happy new year to all.

I’m a 36 years old male who’s been diagnosed with OSA. After a couple of months of my first sleep study just had my titration sleep last week. However, around these parts of the world, getting the report and prescription will take around 1.5-2 months.

In the meanwhile, I wanted to start to educate myself on the issue so that when my report and prescription is ready, would like to have an idea on which machine to buy and what to look for.

But of course, as a newbie, I have so many questions that I’m trying to figure out. Would love to have some expert advice.

I’ll try to be as thorough as possible.

1st Sleep (PSG):

• AHI: 35
• O2 Saturation: Awake 97, Lowest 83
• Weight: 115 kg (254 lbs)
• BMI 31.2

2nd Sleep (Titration):

• Supine Pressure 7 (according to the sleep tech when asked in the morning)
• Non-supine Pressure: 5 (according to the sleep tech when asked in the morning)
• Weight: 106 kg (234 lbs) (My wife says after losing 20 pounds my apnea episodes have decreased a lot.)
• BMI 28.8

Medical Conditions:

• Non-Alcoholic Fatty Liver Disease - Grade 2
• Long-term elevated liver enzymes. (a liver biopsy is scheduled to check for possible underlying factors and determine damage to the liver)
• Have slight deviation in the right nostril and thus gets easily half or fully congested.
• Having a nasal deviation operation is out of the equation for the moment due to the liver condition.
• Quit smoking 1.5 years ago and only drink occasionally, 1-2 glasses of wine. However, for the last year almost didn’t drink anything at all.

With above information in mind, I’d very much appreciate your answers to the following:

• Is there a situation where a person won’t really benefit from an APAP, like low-pressure needs, or is APAP a must for everyone in the long run?
• If a person has nasal deviation and the nose is prone to congestion, limiting air flow through the nose, does this mean that this person will need higher pressures during such times?
• If the answer to the above question is yes and that person has a normal CPAP, is it logical to increase the prescribed pressure setting to let’s say +2 pressure to compensate for any extra pressure needs that may arise? This’ll mean the person will get higher pressures during normal times of course.
• If you already live in an area where humidity is high, like in Istanbul, does it still help to use a standard or heated humidifier?
• Are there any forum members with fatty liver disease and/or elevated liver enzymes that got better in time with CPAP use?

Those are the questions I have so far. Would very much appreciate your help and advice.

BTW, after extensive reading, I think I have decided on buying the S9 AutoSet. I just couldn’t justify paying the extra for AirSense 10.

Also, I can’t express how grateful I am to all of you who spend hours answering questions and providing more value to the wealth of information here. Thank you all.

With love from Istanbul..

Hi, and merry christmas!

I work as a sleep physiologist in the UK, so based on my knowledge and experience I will answer these questions as best as I can:

1) We issue all of our patients now with Auto CPAP, so I would recommend that. We give out the S10, but like you said, if you're paying for it yourself, the S9 does the same job but cheaper, it just has less gimmicks. Simply because it doesn't matter what position you lie, if you gain weight, drink alcohol, change medications (the list goes on...), it will detect airway closure and apply the appropriate pressure. Its generally a safer bet, but you really need to get the mask fit right, because if it detects leaks, the pressures will shoot up thinking you're having apnoeas, unlike a fixed pressure.

2) potentially a higher pressure, but again, if you go for the auto CPAP it will cover you. Also be sure to get a full face mask, because a nasal will not be effective if your nose is congested.

3) you will not know whether an extra 2cmH2O will be beneficial or not unless you get the help of your sleep lab. If you are concerned just go for the auto CPAP.

4) I would always recommend humidification. It's a lot more comfortable. If you live in a very humid environment you will just won't need it set as high. But don't worry, you'll find the setting you'll like in time.

5) sleep apnoea has been linked with NAFLD. Whilst I don't think there is yet conclusive evidence of how CPAP impacts NAFLD, its highly likely it will have a positive impact.

Good luck

Jade

Hi and welcome...

Raising pressure in response to nasal problems is not the way to go, but a well fitted (when lying down, as face changes a lot then) full face mask would do the trick, letting your mouth be open without losing Cpap air that way. In fact, raising pressure would only open your mouth wider, not helping a thing.

Heating humidifier water is strictly personal, so where you live isn't as crucial, but depending on the time of year, potential allergies, elevation, central heat vs otherwise, etc. etc. will dictate if you use humidity at all or not - completely personal. Some people feel congested using it almost any time, others can't be without it.

And Cpap vs Apap - your idea is really apples and oranges because pressure settings relate to the size of your personal airway and how much pressure is needed to keep it open - nothing to do with severity of apnea on testing. Apap is used to give you a broader range of pressures over a night time, to allow the machine to deal with apneas at different levels, whereas Cpap delivers just one pressure (a minority of us prefer it - not me - because the changing pressures tend to waken light sleepers at times), but having an auto machine is a better idea because it can be set in Cpap mode, where the reverse is not true.

Just saw that other note - but have no idea what NAFLD means at all.

What's hugely important is to get a machine that you can use with e.g. Sleepyhead software (free to DL from here) so you can track what's happening every night and tweak things if necessary - something you can't do with a 'brick' machine that gives no data (or only 'compliance' data - needed by US insurance co's to see if you're using their money for a good purpose . Don't get a machine with Plus or Escape in the name! I also think Sefam may be a local (Turkish) name stuck on the Dreamware machine for sale there, but not sure who sells it here (someone else will tell you).

Julie wrote:Hi and welcome...

Raising pressure in response to nasal problems is not the way to go, but a well fitted (when lying down, as face changes a lot then) full face mask would do the trick, letting your mouth be open without losing Cpap air that way. In fact, raising pressure would only open your mouth wider, not helping a thing.

Heating humidifier water is strictly personal, so where you live isn't as crucial, but depending on the time of year, potential allergies, elevation, central heat vs otherwise, etc. etc. will dictate if you use humidity at all or not - completely personal. Some people feel congested using it almost any time, others can't be without it.

And Cpap vs Apap - your idea is really apples and oranges because pressure settings relate to the size of your personal airway and how much pressure is needed to keep it open - nothing to do with severity of apnea on testing. Apap is used to give you a broader range of pressures over a night time, to allow the machine to deal with apneas at different levels, whereas Cpap delivers just one pressure (a minority of us prefer it - not me - because the changing pressures tend to waken light sleepers at times), but having an auto machine is a better idea because it can be set in Cpap mode, where the reverse is not true.

Just saw that other note - but have no idea what NAFLD means at all.

What's hugely important is to get a machine that you can use with e.g. Sleepyhead software (free to DL from here) so you can track what's happening every night and tweak things if necessary - something you can't do with a 'brick' machine that gives no data (or only 'compliance' data - needed by US insurance co's to see if you're using their money for a good purpose . Don't get a machine with Plus or Escape in the name! I also think Sefam may be a local (Turkish) name stuck on the Dreamware machine for sale there, but not sure who sells it here (someone else will tell you).

Non-alcoholic fatty liver disease (NAFLD)


Den

.

Thanks - I might have gotten there... sometime tomorrow a.m.