No sleep study and I bought a CPAP!

[outrun]

Hell all I am new here. Please don't yell at me for not getting a sleep study. Here is the run down. I am self employed. Have been for the last 10 years and do not have insurance. First I have asthma that just got really bad this year that I had to go see the pulmonologist. We are still working on my asthma stuff but during some questioning she said I think you might have sleep apnea. After looking it up I about died. I have just about every symptom. I am 30yrs old 5 5 180 and I fall asleep every day. I just thought it was because I was driving a lot or it was because I was outside in the heat and it was making me tired. Not anymore.

Ok so she said I need to get insurance and do a sleep study. After looking into it I just can't grab some insurance somewhere and have a sleep study done. I don't have the money. Well I was talking to my aunt and found out that she has sleep apnea and she uses a machine called a cpap. I didn't even know what it was 3 days ago and now I own one.

Last night was my first night using it and I have a lot of questions. So far I love this forum and have been browsing it since I found it 2 days ago. Here are my questions.

I bought a Resmed Elite with humidifier, mask, carrying case. Is this a good unit?
I have know idea what to set the cpap at so not to use to much I set it at 4 when I went to bed and it felt like it was to little so I changed it to 6. But I woke up at one point feeling like I was gasping for air? Is this to little or to much? (I know hard to say since I didn't have a study but what is the average most people use)
During my first night using it my wife said I was snoring most of the night but she could not here it as much because of the mask. Does this mean I need to up the cpap? (usually my wife can't even sleep next to me and my own snoring is so loud I wake myself up.)

I am sure I have a lot more questions but that is it for now.


Thanks, Jason

[smurf]

There are soooo many things they look at when doing a sleep study. You need to know way too many things before starting therapy!!!! Please stop now and go get tested. Your life depends on it!!!!!!

[track]

Almost 2 years ago I also purchased a cpap machine..a resmed... without a sleep study or a doctors orders. I use my cpap religiously and have learned a great deal by just hanging around this site and reading. Jump in and you will be up and going in no time. It takes a while to get used to a mask and to self titrate yourself but if you have patience and you are motivated you can get it done. As far as insurance goes..I have insurance but I have to pay the first 2,500 dollars out my pocket so I would have had to pay for the sleep study too. Frankly based on what I have read the last two years on this site I am not all that impressed with the results a lot of people get from sleep studies and even less impressed by the treatment many get from their primary care doctors. I feel like I have my AHI under control and I don't snore anymore so it's all good.

[outrun]

Track,

Glad to see I am not the only one. I have been getting nothing but negative feed back from my family as expected. But they don't seem to understand unless you have like you said $2,500 laying around you won't even get anything done. All I did was spend $400 bucks and I am working on sleeping better. It's like I know I have sleep apnea so why spend 2,500 for a doctor to tell me that. But I would do it if I had the money.

I am still learning though. Still figuring out AHI and Titrate today. What do you have you cpap set out? Also what is the max ramp?

[Wulfman]

Shouldn't be a problem. Some insurance entities (like Kaiser) don't really do sleep studies, either. They just hand out Auto CPAPs (APAPs) for a week or two to see what shows up in the data and then go from there.

Did you get any manuals with the machine? Obviously, you know how to change pressures......do you know how to get the data from the LCD screen? Make sure you have the mask selector setting set for the correct mask setting.

I would advise you to watch that nightly data and adjust accordingly. Getting your numbers as low as you possibly can.
You didn't say what mask you have, but if it's a nasal mask (and not a full face mask), you'll need to make sure you're not leaking air out your mouth (tape or Polident adhesive denture strips are used by many here).

Your pressure is probably still too low at 6 cm. Something closer to 10 cm will probably work better. Too little pressure can give the feeling of suffocating and won't kill the snoring. Also, do some nasal cleansing/irrigating to clear out your nasal passages.......it'll be easier to breathe. Don't turn your humidifier up too high, either......that can have the effect of closing up your nasal passages. In many cases, LOWER or OFF works better with the humidifier.

Den

[Goofproof]

It really helps to get the software and reader so you can make better sense of what's going on. Jim Without it you are flying blind so to speak.

[rested gal]

Please don't yell at me for not getting a sleep study.

Heheh, don't worry...I'd be the last person in the world to yell at anyone about that. LOL!!
http://www.apneasupport.org/viewtopic.php?p=2332

Here are my questions.

I bought a Resmed Elite with humidifier, mask, carrying case. Is this a good unit?

Yes, it's a very good machine.

I have know idea what to set the cpap at so not to use to much I set it at 4 when I went to bed and it felt like it was to little so I changed it to 6. But I woke up at one point feeling like I was gasping for air? Is this to little or to much? (I know hard to say since I didn't have a study but what is the average most people use)

Even 6 cm is probably still too little. Statistically, most people's airway is held open nicely with a pressure of 10 cmH2O. If I were just making a wild guess at what pressure to set a cpap machine at in your situation, I'd set it at 10.

During my first night using it my wife said I was snoring most of the night but she could not here it as much because of the mask. Does this mean I need to up the cpap? (usually my wife can't even sleep next to me and my own snoring is so loud I wake myself up.)

Continued snoring while using cpap usually is an indication the pressure needs to be raised. Unless you were opening your mouth and breathing through your mouth in your sleep while wearing a "regular" nasal mask (covering just the nose...not wearing a FF mask (Full Face, covering nose and mouth together.)

I am sure I have a lot more questions but that is it for now.

Good questions, Jason. And this is a good thing you're doing for yourself...using a machine and using this message board to learn how to treat yourself.

Here are some links that should encourage you about the decision you've made:

"Can Patients with Obstructive Sleep Apnea Titrate Their Own Continuous Positive Airway Pressure?"
Link to a study that concluded, "yes."
http://ajrccm.atsjournals.org/cgi/reprint/167/5/716

By the way, the people in that study were using plain cpap machines with no software and without even the benefit of getting to see anything about last night's AHI and leak data which you can see the next morning in the LCD window of your Elite. How they felt, and feedback from their bed partner (like the way your wife said you were still snoring at the pressure of 6) was apparently the way those people worked on getting their pressure up to an effective level.

"Not Every Patient Needs to Go to the Sleep Lab" Link to a Powerpoint presentation by Dr. Barbara Phillips at a meeting of the American Lung Association of the Central Coast - November 2004
http://www.alaccoast.org/pdf/Phillips_0830.pdf

Good luck, Jason. Keep reading, reading, reading. You're doing a VERY good thing for yourself, imho.

A side benefit of doing what you're doing is that you don't have "OSA" (Obstructive Sleep Apnea) on any of your medical records. Not a small consideration when you read about how some people are denied life insurance coverage or have to pay larger premiums for medical insurance due to a pre-existing condition of "sleep apnea" in their medical records. The day may come when you can afford health insurance...might be good that you haven't been "diagnosed" with "sleep apnea." You're just using a cpap machine to stop snoring because your snoring disturbed your wife...right?

[rested gal]

I am still learning though. Still figuring out AHI and Titrate today.

"Learning lexicon of cpap terms" Link to topic listing common abbreviations and definitions.
viewtopic.php?t=14902

Here are some more links you might want to tuck away and dig into as the days go by:

LINK to Mile High Sleeper's great information resource for cpap users.
http://www.smart-sleep-apnea.blogspot.com

A masterlist of a compilation of my favorite links:
viewtopic/t17435/ALL-LINKS-by-rested-gal.html

Oct 30, 2006 subject: Please Share Misc Helpful Hints
viewtopic.php?t=14746 Great thread started by Moogy

[ozij]

A Resmed Elite is a good machine for you to do your self titration on, since it can report your nightly Apnea and Hypopnea results as well as leaks on the LCD

They call it "titration" because it's a process off adding a little pressure or subtracting a little, till you find out what is right for you. You use the AHI report on the screen and the way you feel to figure out what is the right pressure. Sure, a sleep study may give you more info about what's happening when you sleep. But between doing nothing, and using a good machine to find out you own pressure, you're much better off doing what you started to do. Do not stop.

The majority of people do fine at about 10. Some need more, some need less, and you won't really know what you need till you've kept track of you data for a while. It takes time and patience - but it can be done - a fact supported by research as well.

While you're at it, keep in mind that pressure can be too high, as well as too low - make the changes gradually, watch the nightly data, but unless things feel really wrong - like they did at 4 - don't make your adjustments based on one night's data.

Your machine may have EPR, Exhale Pressure Relief, which drops the pressure for exhaling (obviously... ). Use it if you find yourself struggling against the incoming pressure. We usually need higher pressure when inhaling, and sometimes that (needed) inhale pressure feels bothersome on exhale.

If you belong to the majority of people, you have garden variety OSA and you're on your way to being well treated. If you belong to the smaller group, you may have other sleep disturbances that need to be diagnosed in a sleep study - you will find that out after trying your CPAP for a while.

Good luck and welcome to the board.
O.

[Snoredog]

My suggestion:

1. Try and maintain leak control, keep your mouth closed, tongue planted into your hard palate.
2. Start at 6.0 pressure and observe the AI on the machine, that an leak is the only 2 things you need to look at in the beginning. HI may go up/down but just ignore it.
3. If you setup and use Ramp, set it for 6.0 cm and 30 minutes once you increase the CPAP pressure above 6.0. Your goal is to get AI down to about 1 (or anything below 5 is good, but if you can get it down to 1 that is good).
4. Once AI=1, then work on getting HI down to below 5 in smaller .5 pressure increments. Very difficult to main a AHI=0, so I wouldn't bother with trying that at this point. Increasing the amount of time you sleep also helps.

Getting dry mouth is normal when you start, put a bottle of water on your night stand.

AHI =Apnea + Hypopnea indice averaged over 60 minutes. Your overall goal is to get that below 5. So if you have 1 apnea per hour and 4 Hypopnea per hour on average that is AHI=5.

But step 1 is getting AI down to 1, control leaks, then work on getting HI down after that.

That is all there is to it.

[track]

What do you have you cpap set out? Also what is the max ramp?

I have my cpap set at 9....but I restrict my sleeping to side sleeping by wearing a waterpak on my back at night....I have most of my apneas when I get on my back so I try to stay off it.

The maximum ramp on my machine is 45 minutes. My machine does not register AHI while on ramp.

[outrun]

Thanks for all the great info guys. Still looking over it all.

[Mikosiko]

....without even the benefit of getting to see anything about last night's AHI and leak data which you can see the next morning in the LCD window of your Elite.

Resgal: I do have a S8 Elite II... and the only thing that I can see in the screen is a basic menu... could you tell me how I can access the rest of the information?....

thank you
Miko

[rested gal]

Here you go, Miko...

Holding down the right and left arrow buttons together, then releasing them should bring up the "Efficacy" Data menu. If it doesn't, then a feature called "Smart Data" might not be turned on. To turn on that feature, follow the instructions you'll find in these topics for accessing the "Clinical" menu:

viewtopic.php?t=22776

viewtopic.php?p=226375#226375

[Bert_Mathews]

I am self employed. Have been for the last 10 years and do not have insurance. ------------
I bought a Resmed Elite with humidifier, mask, carrying case. Is this a good unit?
-------------------------- I am sure I have a lot more questions but that is it for now.
Thanks, Jason

SORRY to whack our quote so much.............. -BUT- I was self employed most of my life & only insurance I had was covered by my wife that was a nurse ... < More than needed?>
I have talked with a few friends that are self employed --- One has been looking at getting insurance but had a sleep study done after his first quote from a company, then when he called the insurance rep back in he was told the COST would double because he had the study NOT a SCRIPT or even a titration test? NOT RIGHT......

His plan is like your get a system and do it himself.................. !!! & I'll be glad to help him!!


BERT
GOOD LUCK and keep using this forum and ask QUESTIONS -- It's your HEALTH & you need to take care of it!