Thinking about starting CPAP therapy on my own - Thoughts?

Home screening revealed that I have "mild" OSAS. The determined AHI is 6.7, but I have sleep position based apnea, hitting me when trying to sleep on my back, with hypopnea accompanied by considerable snoring in all other positions. The summary of that screening tells AHI slight / Snoring medium heavy / SpO2 slight.

I simply can not sleep on my back (though I want to), sleeping on either side results in me rolling around all the time and occasional shoulder pain, and my preferred sleeping position on my stomach also does not lead to restful uninterrupted sleep accompanied by neck tension and sometimes headache in the morning. I'm clearly feeling the effect it has on me, I'm exhausted when I wake up, tired and unmotivated throughout the day, always ready for an after-lunch nap.

The problem is now, that my full diagnoses in a local sleep clinic is still 3 months away (it's simply impossible to get an earlier appointment). If the diagnoses in the sleep clinic results in me needing a CPAP machine, my health insurance will cover the costs for a rental machine, but requires 80% use (which shouldn't be a problem, because once I have it, I wanna use it).

Right now I'm tempted to start CPAP therapy on my own right away by ordering a new ResMed AutoSense 10 AutoSet with humidifier + heated hose + ResMed AirFit P10 from an online retailer in the USA (which seems to make the most sense, as it's simply impossible to get a machine at a reasonable price here in Europe), with the idea of selling it again once I get a rental machine from a local DME provider paid by my health insurance (I think there is no point in keeping it as a backup, because if there is something wrong with the rental machine, they are going to replace it anyway). I just don't want to wait any longer.

Any thoughts on that?

When getting a new ResMed AutoSense 10 AutoSet that is not pre-configured (so everything at factory default), which settings are to be adjusted to get started? What are the default minimum and maximum pressure settings and how to determine the best starting values on my own?

How long before the clinical sleep study should I stop using the machine to not influence the examination?

bonum.noctem wrote: ↑

Sat Jul 28, 2018 4:51 am

How long before the clinical sleep study should I stop using the machine to not influence the examination?

If it were me and in your situation...a week..just to be on the safe side.

bonum.noctem wrote: ↑

Sat Jul 28, 2018 4:51 am

When getting a new ResMed AutoSense 10 AutoSet that is not pre-configured (so everything at factory default), which settings are to be adjusted to get started? What are the default minimum and maximum pressure settings and how to determine the best starting values on my own?

In auto mode the default settings are 4 minimum and 20 maximum. They are easily changed. See the manual
https://sleep.tnet.com/home/files/resme ... -guide.pdf

Most people find that 4 cm starting point a bit uncomfortable. Feel like they are suffocating..they aren't but it sure feels that way.
I suggest a minimum of 6 and EPR set to 3 as a starting point.
As for figuring out pressure needs..use the software available.
https://sleep.tnet.com/equipment
and we can help you with learning how to evaluate pressure needs.
Heck...for all we know the minimum of 6 might work out if the machine never goes over 10 cm.

This guy is going the DIY route...he is doing quite well.
viewtopic/t172310/How-Important-is-the- ... nions.html

While I cannot advise you on the overall path, I will comment on some of your conclusions:
1) do you have or can you easily get a prescription? Virtually all online dealers will require one - it can be from any practitioner legally authorized to prescribe. You will need to research the exact specifications for the prescription - make and model of not only the machine but any mask you want, as well. One well-regarded dealer that does not ask for a prescription is SecondWindCPAP.com - they specialize in used, open-box, and some brand new machines, but no masks as I recall. Our host on this forum, CPAP.com, can provide you with everything you might need but will need prescriptions for machines, masks, and some other components. Their prices are fairly standard, but they do offer free return insurance on some masks.
2) the standard operating pressure for most auto PAP machines is 4-20 CM H2O - while I doubt most would not advise any specific range at this point, you could probably feel safe in starting with the full range until you get other information or guidance. Given the machine will use only the pressure it needs to do its job, you should feel comfortable in the expectation that you will not be having gale force winds being stuffed down your nose. Even at 20 CM it is not very high pressure (others have alluded to it not being enough to even inflate a balloon).
3) personally, I think a BU is adviseable - if you attempt to sell the machine you buy initially, you will loose most of its initial cost; if you travel much, it can function as a familiar travel machine that leaves your primary to be left home without having to take it apart, possibly loosing parts. This also leave the travel machine already packed and fully outfitted for a trip.

Unrealted to your process, I would suggest early on you download SleepyHead software and use it, it is free and will help you in understanding your sleep patterns; also making note in your profile of equipment as well as pressure settings will help others in responding to questions. (you can get SH from https://sleep.tnet.com it is under the equip & software tab - the current version is V1.0.0. beta 2)

EDIT ADDENDUM: I just noted you state you are in Europe - for the most part that removes most advise about US based dealers and any specific prescription requirements. Some dealers my ship outside the US, but I cannot state which ones will. The comment about SleepyHead remains, though as well as a backup.

Pugsy wrote: ↑

Sat Jul 28, 2018 5:12 am

bonum.noctem wrote: ↑

Sat Jul 28, 2018 4:51 am

How long before the clinical sleep study should I stop using the machine to not influence the examination?

If it were me and in your situation...a week..just to be on the safe side.

OK, looks reasonable.

Pugsy wrote: ↑

Sat Jul 28, 2018 5:12 am

bonum.noctem wrote: ↑

Sat Jul 28, 2018 4:51 am

When getting a new ResMed AutoSense 10 AutoSet that is not pre-configured (so everything at factory default), which settings are to be adjusted to get started? What are the default minimum and maximum pressure settings and how to determine the best starting values on my own?

In auto mode the default settings are 4 minimum and 20 maximum. They are easily changed. See the manual https://sleep.tnet.com/home/files/resme ... -guide.pdf

Most people find that 4 cm starting point a bit uncomfortable. Feel like they are suffocating..they aren't but it sure feels that way. I suggest a minimum of 6 and EPR set to 3 as a starting point. As for figuring out pressure needs..use the software available. https://sleep.tnet.com/equipment and we can help you with learning how to evaluate pressure needs. Heck...for all we know the minimum of 6 might work out if the machine never goes over 10 cm.

This guy is going the DIY route...he is doing quite well. viewtopic/t172310/How-Important-is-the- ... nions.html

Very well, I have just downloaded the clinical guide and will work through it later. So pressure 6 to 20 with EPR 3 as a starting point, then use SleepHead analyses for adjusting accordingly. I'm already following the other DIY thread, but thought it's better not to piggyback.

I have just taken a look at the Organize your SleepyHead Charts page.

What's not clear: When you start therapy, is the data from the first night already usable or does it require a few nights before the data gets more representative?

Just sent you a PM re stomach sleeping.

You don't WANT to back sleep - it provokes more apneas.

Also Google 'Falcon Position Sleeping".

One night's worth of data is sufficient for a good starting point evaluation assuming you sleep.

JimW159 wrote: ↑

Sat Jul 28, 2018 5:45 am

1) do you have or can you easily get a prescription? Virtually all online dealers will require one - it can be from any practitioner legally authorized to prescribe. You will need to research the exact specifications for the prescription - make and model of not only the machine but any mask you want, as well. One well-regarded dealer that does not ask for a prescription is SecondWindCPAP.com

I think if I remember correctly OP is in the UK or Europe somewhere. So he doesn't have to play by the same rules that those of us in the US play by.

Using CPAP.com is going to limit him to non ResMed and non Respironics products because neither will allow cpap.com to ship outside the USA.

Secondwindcpap.com is my usual recommendation for international buyer who aren't in the USA.
There are some countries that don't require a RX to buy on line or even at local brick and mortar storefronts.
He mentions online and Europe prices being awfully high so I assume he has researched whatever requirements he might have where he lives.

JimW159 wrote: ↑

Sat Jul 28, 2018 5:45 am

1) do you have or can you easily get a prescription? Virtually all online dealers will require one - it can be from any practitioner legally authorized to prescribe. You will need to research the exact specifications for the prescription - make and model of not only the machine but any mask you want, as well. One well-regarded dealer that does not ask for a prescription is SecondWindCPAP.com - they specialize in used, open-box, and some brand new machines, but no masks as I recall. Our host on this forum, CPAP.com, can provide you with everything you might need but will need prescriptions for machines, masks, and some other components. Their prices are fairly standard, but they do offer free return insurance on some masks.

I will not get a prescription before the clinical sleep study has come to the conclusion that I need a CPAP machine, but if I go that path, I'm going to order from an online retailer in the USA, that does not require a prescription for international orders.

JimW159 wrote: ↑

Sat Jul 28, 2018 5:45 am

2) the standard operating pressure for most auto PAP machines is 4-20 CM H2O - while I doubt most would not advise any specific range at this point, you could probably feel safe in starting with the full range until you get other information or guidance. Given the machine will use only the pressure it needs to do its job, you should feel comfortable in the expectation that you will not be having gale force winds being stuffed down your nose. Even at 20 CM it is not very high pressure (others have alluded to it not being enough to even inflate a balloon).

Yes, thanks to Auto CPAP it should be easy to get started, though as mentioned before by Pugsy a minimum pressure of 4 may be too low to be comfortable, but I'll see for myself how this is going to turn out.

JimW159 wrote: ↑

Sat Jul 28, 2018 5:45 am

3) personally, I think a BU is adviseable - if you attempt to sell the machine you buy initially, you will loose most of its initial cost; if you travel much, it can function as a familiar travel machine that leaves your primary to be left home without having to take it apart, possibly loosing parts. This also leave the travel machine already packed and fully outfitted for a trip.

Indeed something to think about as well. I do travel several times a year, maybe not enough to justify an additional travel machine, but if the bought machine can not be sold at a reasonable price I may just keep it.

JimW159 wrote: ↑

Sat Jul 28, 2018 5:45 am

Unrealted to your process, I would suggest early on you download SleepyHead software and use it, it is free and will help you in understanding your sleep patterns; also making note in your profile of equipment as well as pressure settings will help others in responding to questions. (you can get SH from https://sleep.tnet.com it is under the equip & software tab - the current version is V1.0.0. beta 2)

Yes, already noted, nothing goes without SleepyHead.

Julie wrote: ↑

Sat Jul 28, 2018 5:56 am

Just sent you a PM re stomach sleeping. You don't WANT to back sleep - it provokes more apneas. Also Google 'Falcon Position Sleeping".

Just looked it up, I'm pretty much sleeping in that position but I need to use a flat pillow to lift my head slightly and I use a bolster to lift the shoulder at the side. Overall my most comfortable sleep position but not good enough to give me a restful night of uninterrupted sleep, as it still makes me move around and swap sides (head and arms position) often, besides the heaving snoring and hypopnea.

Modifying our mattress would definitely not be an option. Have you taken a look at something like a Contour CPAP Pillow 2.0?

I really would like to be able to sleep on my back, which a CPAP machine should be able to make happen. This is also a huge problem for me when trying to sleep on long distance flights, as I always only travel economy class, means quite upright position on my back.

Pugsy wrote: ↑

Sat Jul 28, 2018 6:04 am

One night's worth of data is sufficient for a good starting point evaluation assuming you sleep.

Good to know, thanks.

Pugsy wrote: ↑

Sat Jul 28, 2018 6:05 am

I think if I remember correctly OP is in the UK or Europe somewhere. So he doesn't have to play by the same rules that those of us in the US play by. Using CPAP.com is going to limit him to non ResMed and non Respironics products because neither will allow cpap.com to ship outside the USA. Secondwindcpap.com is my usual recommendation for international buyer who aren't in the USA.
There are some countries that don't require a RX to buy on line or even at local brick and mortar storefronts.He mentions online and Europe prices being awfully high so I assume he has researched whatever requirements he might have where he lives.

Yes, I'm from Europe (not UK though) and I already have made up my mind where to buy from, so that's not a problem. I've done my research, buying from the USA is the only viable option.

bonum.noctem wrote: ↑

Sat Jul 28, 2018 6:10 am

Yes, thanks to Auto CPAP it should be easy to get started, though as mentioned before by Pugsy a minimum pressure of 4 may be too low to be comfortable, but I'll see for myself how this is going to turn out.

In my initial response to your first post I made reference to "further information or guidance," I later noted you got more specific information about pressure from Pugsy - she is one source of guidance and information you can fully trust, her responses are always well reasoned and on target without any bias or agenda. She is a welcome and valuable voice in this forum. We are lucky she is with us.

bonum.noctem wrote: ↑

Sat Jul 28, 2018 4:51 am

Right now I'm tempted to start CPAP therapy on my own right away by ordering a new ResMed AutoSense 10 AutoSet with humidifier + heated hose + ResMed AirFit P10 from an online retailer in the USA (which seems to make the most sense, as it's simply impossible to get a machine at a reasonable price here in Europe), with the idea of selling it again once I get a rental machine from a local DME provider paid by my health insurance (I think there is no point in keeping it as a backup, because if there is something wrong with the rental machine, they are going to replace it anyway). I just don't want to wait any longer.

Any thoughts on that?

Yes. Do it!