Disappointing results.

Hello All!

I just got a condensed version of my sleep study last week. I had about the same about of apneas but my pressure went up from 12 to 18. I'm not happy about it. Right now I'm upset and want to got to the root of the cause. I'd like to get that pressured lowered.

Wow, that is a big pressure jump. I'd be dissapointed too. I hope you can get to the bottom of what made the difference.

Hi AdmiralRoss,

I went back in some of your older posts to see what your sleep study in 2006 turned up:

viewtopic.php?p=210834

One of the things they mentioned about the titration was:

During the recording, nasal CPAP was applied from 7 to 14 cm. During nearly 1.5 of primarily supine sleep at 12 cm, which included 25 mins of REM sleep, the respiratory disturbance index was 0 events per hr. Basal oxygen saturation was 98%, with minimal desaturations to a low of 94% observed when titrated.

That was one and a half hours on your back, and almost half an hour of REM included while on your back. That sleep position (on one's back) and stage of sleep (in REM) is when you'd expect most apneas and hypopneas to hit. The fact that 12 cm pressure was taking care of you fine during "worst case scenario" would make me really, really wonder why...just one year later...another titration had you at 18 cm.

I'd sure want to use an autopap set for a range, rather than a straight cpap at 18. With a autopap range setting of, say 10 - 20 and the software, it would be interesting to see if you ever get up anywhere close to 18 cm at home.

Unless you've gained a great deal of weight in the past year, I'm betting the titration last year nailed a good pressure for you. That 12 cm pressure.

I'm not a doctor. I'd sure go auto.

rested gal wrote:Hi AdmiralRoss,

I went back in some of your older posts to see what your sleep study in 2006 turned up:

viewtopic.php?p=210834

Thanks for analyzing that. I'll surely bring it up.

Hello All!

A secretary called me today stating that a Man would be at the sleep center where I went to. There he will have all of the equipment that I would need. Well, I go there at 15:00hrs. The gentleman comes to great me. First impressions. He looked unprofessional. This guy travels from place to place with all of his gear. But he does have a main center of operation. Which is about 50 + mins away. To see how smart he was I asked a few questions. Why did my pressure change? He says that I've changed in those 19 months time and that's why pressure changed. He was gonna give me a straight cpap. He started to display the S8 Escape CPAP Machine. I told him since my pressures are changing it wouldn't be smart to get a straight then would it????? I told him that I want a autopap with the aflex + data capable. He looked at me and said what will you do with the data and why you need it? I told him that I want to monitor my health.

So he told me that the prescription would have to be modified. It will take another week to get that done. Once done I'll be back next week on Friday. He told me that I don't need the reader and any of the info on the card. Because the menus on the machine will collect the data and display it on the tiny screen. This wasn't good enough for me. I told him I'm responsible for my health. He states that it's illegal for me to possess the reader because the card in the machine can change the settings and that was dangerous. I can't give you a reader it's against FDA regulations. I told him that I don't want a reader from him and that I can get one on my own. Oh I wouldn't recommend that. So We'll see how it goes with this guy. I wanted to let him know that I'm not an idiot. So from DAY 1, this guy wants to jerk me around. I hope that I showed him I won't tolerate that.

I really wonder what he's going to say when it's time to pay. What kind of mambo jumbo about maintenance contracts and leasing out the machine. Wish me the best of luck guys/gals.....

Praise to this forum for giving me the knowledge I needed today. If not I would came home with the S8 Escape CPAP Machine. Which is not what I want. When I know that there is better.

Thanks again to ALL!

My guess is that he doesn't know diddly about the software, he's just giving you the party line fed to him by his boss. They all say the same things, so there must be a script they are reading it from.

There are a few good ones, to be sure. But I've spoken to every one in this town and they all give this same line. But they don't seem to be able to tell you much about what's on there beyond compliance data. Besides, the new respironics software doesn't have the feature that enables you to change your pressure.

RosemaryB wrote:Besides, the new respironics software doesn't have the feature that enables you to change your pressure.

Right.

My guess is that the guy probably pushes mostly resmed machines. Not that there's anything wrong with his doing that. Most machine vendors probably have a favorite manufacturer they do most of their business with so that they can buy in bulk quantities (lower prices) from one supplier and make more profit. That's ok.

If the guy handles mostly resmed stuff, he's probably totally unaware of the new software Respironics introduced this month (Oct) called Encore Viewer...specifically developed FOR patients to use.

admiralross wrote:He states that it's illegal for me to possess the reader because the card in the machine can change the settings

Even IF...even IF a person were using Encore Pro (which does have a feature that allows making pressure setting changes on the Smart Card) instead of Encore Viewer (which doesn't)...even IF a person were using Encore Pro, there is nothing "illegal" about "possessing" the card reader, for goodness sakes.

For that matter there's nothing illegal as far as I know (might be unwise...depends on the person) about changing one's OWN pressure settings.

All the talk that keeps cropping up from DMEs about the illegality of changing pressure settings without a doctor prescribing, "change it to this and that" applies (I think) to the therapists who handle the machines for SOMEONE ELSE (for the patients.) I have yet to see that there's a law or FDA regulation governing what a patient himself/herself chooses to do about making changes in his/her own therapy.

Whether making changes oneself to one's own therapy without consulting with their doctor is a good idea, smart idea, bad idea, dangerous idea... is beside the point of whether it's "illegal" for the person to do that. DMEs probably say it mostly because from their side of the fence it would be illegal for THEM to make changes in ANOTHER person's therapy settings without a doctor's orders.

They sure aren't used to "patients" deciding to take up the reins of their own treatment. Probably strikes most of them with astonishment. Like hearing a cow start talking.

As a side note, I agree with what KansasRT and other RTs have said on this board many times....that the vast, vast majority of cpap patients out there in this big old world are not the least bit interested (and many not even capable of) monitoring themselves via even the LCD's limited info, much less with software. Most probably don't want to be involved with their machines any farther than knowing where the on/off switch is. Most also probably don't use the ON switch much...if at all.

Good for you, admiralross, for taking more interest in your health and wellbeing than that!

Hi Amiralross,

One has to take care of ownself. If everything has to wait until the doctor or sleep tech comes to you, it might be to late? Your common sense prevail. Soon I think there will be a smart/intelligent-pap that give everything that you need including (remote monitoring/configure/self tuning and many more features...mp3, mp4, wireless, moisture control....and event advice you what to do next....etc.). I found that this forum is inevitable for all of us that need self-therapy. Take good care of yourself and the pressure will go down.

Mckooi

On another thread I commented that it worked for me to have my doctor write a prescription for an autopap machine. That was the only way my DME would give it to me.

I wanted to add, that the same thing will work with the mask in my experience. The doctor wrote a script for my mask, too. I recently helped another person get started and that was the only way her DME would give her the mask she used very successfully during her sleep study (hybrid). It worked. They only carry Respironics and Resmed masks in stock, and mostly Respironics.

The final tip is to have the doctor write the mask script that says "full kit." If you are getting a mask that has different sizes of gaskets or pillows that way they will have to include them all. If one size isn't working for you, you can try the others. For your replacement masks this is less important, since you will have found the one that fits for you. A very good sleep lab tech in my community suggested this to me. He says that whenever he works with a person where this is appropriate for a sleep study, he always suggests the "full kit" idea.

Proving that there are some excellent techs out there! Too bad they are in the minority, though.