Talk with Doc?

MRH · Post by **MRH** » Thu Sep 06, 2007 2:11 pm

Here is the deal. Tomorrow I have set up a appt. to talk to my regular Doctor about my progress, and not quite getting there, since starting CPAP back in March. There has been no follow up really since the Sleep Study. I had the oxygen levels checked one night a few weeks into it but had to call the Doc to find out anything. He said they are better, but I bet not right, at that stage of the game! Anyway enough rambling, I am taking a bunch of data from the Encore software to show him. I have leaks pretty much under control other then some spikes here and there, and a fuzzy baseline when I need a shave There are still apneas that show up on the flat lines and some when leaks are there but not large leaks (Still AHI's between 8 to 15) So I am thinking of trying to talk him into a autopap machine, think that is a good plan? Any advice on what else I should tell him?

Thanks,
Mark

arthuranxious · Post by **arthuranxious** » Thu Sep 06, 2007 2:40 pm

I think those AHIs are way too high to be considered a successful treatment of OSA. Some doctors are not into talking, you don't indicate of he is a real sleep specialist or just an internist or pulmonologist. Requesting an APAP is easy, but some doctors really don;t believe in the relaibility of automated pressure control, he may resist for that reason. Do we know if a change of pressure would make a difference? have you tried having the pressure increased? Some of this kind of fiddling around is often done by the respiratory tech of the DME, you didn't mention if they are helpful or clueless. Good luck!

Goofproof · Post by **Goofproof** » Thu Sep 06, 2007 2:59 pm

You have the machine and the tools at hand. They are telling you your treatment isn't working, the Dr. is going to help based on a guess? There must be a reason it's not working, are you truly making all the changes you need to to be successful. The 431 mask caused my AHI to be pn the high side maybe you need a different FF Mask. Jim

MRH · Post by **MRH** » Thu Sep 06, 2007 3:14 pm

I am on my 3rd mask the first was a nasal, I do the mouth breathing thing! The second was a Comfortfull and it wouldn't seal without cinching it down way too tight (Bruised gums and wore off whiskers) The 431 has been the best so far and my numbers have been the best so far too, since getting it. So I am assuming (I know scary) that since I am getting better leak control and apneas are showing up when there are no leaks, that maybe the pressure is off some. Wouldn't a auto help with this? Maybe the study pressure of 11cm h20 is a bit off. It all happened in one night and the tech told me I slept 4.5 hours. Oh and by the way it is my regular Doc, I have never heard from the sleep Doc at all only seen his name on the bill!!

Only help I have had is myself and this forum. What do you mean by a guess Goofproof? I have been downloading data from the card.

Thanks,
Mark

JeffH · Post by **JeffH** » Thu Sep 06, 2007 3:30 pm

whiskers could be part of the problem. I had to shave off my life long full beard and just have a goatee to get my mouth breathing problem solved. Tape past the hair and you get a pretty good mouth seal.

JeffH

Snoredog · Post by **Snoredog** » Thu Sep 06, 2007 3:37 pm

AHI is too high.

Possible cause:

Pressure is currently too low OR

Pressure has been already increased too high so AHI is on an upward trend. You would have to use your EncorePro reports with James program to perform a AHI vs. Pressure report to spot where you are at.

First thing to try is increasing pressure by 1 cm and plotting your AHI progress over time. If AHI remains the same or increases you know you have gone the wrong direction. You want to be on the downward trend such as going from 8 to 9 cm as shown below as opposed to an upward trend going from 9 to 12 cm:

Land in the bottom where 9 cm is shown and you have found your "sweet" spot which should result in the lowest AHI.

Once you have found that and you remain tired you show that to your doctor and ask about them other items that may have shown up on your PSG. Because once you reach that sweet spot you are effectively being treated for OSA and it is not the cause of said fatigue.

MRH · Post by **MRH** » Thu Sep 06, 2007 4:28 pm

Thanks guys. No beard for whiskers but I do get a fuzzy looking line on the days where I don't shave on the leaks. Actually my AHI is running the lowest it ever has since starting this stuff (Had 244 events in 4.5 hours on study Oxygen down in the 70's). I have been running up and down on the AHi's One day it might be 7 or 8 then the next maybe 10 to 15 not real consistant. Never had a talk to the Docs since starting except my regular Doc when I told him I needed a full face mask because of the mouth breathing and he agreed. So now I figured I should talk to him and show him some of the charts. I thought about seeing if he would prescribe me a auto, that might be the quick and easy way to get the numbers down better. I never really felt bad before all this, the regular Doc suggested the study.

Snore dog, so you think it would be a waste to see if I could talk him into a auto?

Thanks again,
Mark

socknitster · Post by **socknitster** » Thu Sep 06, 2007 5:05 pm

An auto can't hurt, and it is worth a try if your insurance will pay.

But Snore is right, you can do some tweaking yourself too, 1 cm at a time and find out where you currently are on the upside-down bell curve he showed.

Try increasing 1 cm. See what happens. Maybe your sleep study wasn't perfect. I sure know mine wasn't.

jen

Goofproof · Post by **Goofproof** » Thu Sep 06, 2007 6:32 pm

It would be a shame to let a little hair, shave years off your life. Shaving right before bed removes the hairs and oils, and softens the skin so the mask will operate better. The dog will like you better too.

I was talking about the Doctor doing the guessing, it's what they do best because they don't really know us. Jim

MRH · Post by **MRH** » Thu Sep 06, 2007 7:13 pm

Thanks everybody for the advice. I guess I will have to shave everyday, I am not one to do it that way. I gave up the full beard so I suppose a everyday shave won't hurt. My leak averages are still pretty good even with the fuzzy looking line. I have been keeping my leak around 40 to 48 lpm with the masks leak rate at 41 lpm so I thought that is pretty good. I think my Doc will listen and help me out, we will see. I have a health care spending acct from work that I give money back every year so I could use that if he says ok and I can't get insurance to cover it.

I will let you all know how things go,
Mark

ozij · Post by **ozij** » Fri Sep 07, 2007 1:39 am

Mark,
Its like snoredog says: In order to discover your sweet spot for pressure, you have to change your pressure manually - and track it.

On a auto, you never know if the pressure is higher because you had more apneas, or if you had mor apneas because the pressure was higher.

Derek on tracking his results

You may be better off at discovering why your apnea are so high if you set you machine on a low range=high range for a while, and tracking your results for each pressure.

O.

Snoredog · Post by **Snoredog** » Fri Sep 07, 2007 3:03 am

[quote="MRH"]Thanks guys. No beard for whiskers but I do get a fuzzy looking line on the days where I don't shave on the leaks. Actually my AHI is running the lowest it ever has since starting this stuff (Had 244 events in 4.5 hours on study Oxygen down in the 70's). I have been running up and down on the AHi's One day it might be 7 or 8 then the next maybe 10 to 15 not real consistant. Never had a talk to the Docs since starting except my regular Doc when I told him I needed a full face mask because of the mouth breathing and he agreed. So now I figured I should talk to him and show him some of the charts. I thought about seeing if he would prescribe me a auto, that might be the quick and easy way to get the numbers down better. I never really felt bad before all this, the regular Doc suggested the study.

Snore dog, so you think it would be a waste to see if I could talk him into a auto?

Thanks again,
Mark

MRH · Post by **MRH** » Fri Sep 07, 2007 7:57 am

Thanks for all the advice. I will see what the Doc says this afternoon after I show him the charts. I might have to start playing with the pressure settings some we will see

Mark

MRH · Post by **MRH** » Fri Sep 07, 2007 9:37 pm

The Doc comes in, and I start showing him charts and telling what I think might be going on. He is grinning and says that I probably know more then he does about this stuff and looks at the daily charts and says "What kind of machine do you want?" I had wrote it down on a piece of paper and he started to copy it onto one of his prescription papers and tells me that he will be talking to the DME. I called the DME and told them that the Doc would be calling and she said they had the M Series Auto with A-Flex in stock and after trying to get things squared away with insurance etc I could take my old machine back to the other DME (Who is too far away, I didn't know this when I started) I am still renting to own then they would set me up with the new one. It sounds like I am lucky to have a Regular Doc who will listen and a DME that is somewhat helpful.

Mark

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Talk with Doc?

Talk with Doc?

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