Being My Own Doctor - Defining my own pressure and more

[lucas7bm]

Hello, everyone, I'm from Brazil and I hope my non-native english doesn't interfere with my interaction in this forum. It is my first post here and, like most of them, I'm looking for help - however, with all these searches that I've been doing lately, I hope to be helping other newbies very soon.

Here is the thing: I'm 21 and was diagnosed with severe sleep apnea on June/July of 2016. I'm tall, thin, not a woman, young, with basically nothing that I could do to reduce my AHI to a normal one without using a CPAP* - both me and my Doctor agree on this. Since then I've been through an initial phase of denial and wasn't really considering using a mask and a breathing machine every single day from that moment.

But recently - and as expected - I've come to the decision that I need to sleep well and wake up feeling better. That I need energy for my day, emotional stability to deal with the daily problems and - as a college student - the best combination of attention and memory that I could have. So, my decision was to, finally, look for a CPAP and search about the treatment. I've read hundreds of posts here, took a look on softwares like SleepyHead and - as a future computer scientist - even searched about the algorithms used on the automatic machines.

Considering all of this, I've come to the decision that the ResMed AutoSet is problably the best choice that I could take. It will give me an effective, modern and user-friendly treatment and will also provide me every information about my sleep that I could use.

HERE COMES THE QUESTION:
Knowing all of this, do I really need to make a new exam to define the right pressure for my treatment and things like the "right machine"? It seems to me that the AutoSet could never be a "bad option" without something that I need. And it also seems that I could find the right pressure just by myself.
The only thing that I think I could have some help or could try first is the oronasal mask that I will probably have to choose as a secondary (considering a nasal pillow would be the first option). I hope this wasn't too long or boring and, in advance: thank you. This forum has helped me a lot even before I was a member of it.


*I'm not considering that I could change anything if I was old, small or a woman, of course. I'm just saying that I don't have most of the risk factors - not even the ones I could change - and I'm still lucky enough to have it. yay!

[prodigyplace]

You would likely want the Airsense 10. It provides more useful data.
In this country you need a medical prescription before you can purchase a CPAP machine or complete mask.

Welcome to the forum.

[Pugsy]

Is this the ResMed AutoSet you were thinking about?
The AirSense 10 AutoSet.
https://www.cpap.com/productpage/resmed ... idair.html
There are several older models but you didn't say specifically which one.
This would be the machine that I would use if I were in your shoes and wanting to do what you are wanting to do.

Yes, you can do what you are thinking about doing. I wouldn't have another sleep study if it were me. As long as your diagnosis was obstructive sleep apnea and not central sleep apnea then it would be fairly simple to find optimal pressure settings with that machine.
Do you have a copy of that sleep study?

How easy or difficult is it in Brazil to get a machine and mask. Do you need a RX? Would your doctor be willing to supply a RX if you need one?
There is a place here in the US that will ship machines and masks internationally...you might check them out for pricing options.
http://www.secondwindcpap.com/

The ResMed S9 AutoSet would also be a decent choice. It was discontinued when the AirSense models were released.
I wouldn't go with anything older than the S9 model though. Not enough data to do a good job doing what you are wanting to do.

[lucas7bm]

You would likely want the Airsense 10. It provides more useful data.
In this country you need a medical prescription before you can purchase a CPAP machine or complete mask.

Welcome to the forum.

Oh, I'm sorry, I was referring to the AirSense 10 AutoSet.
And here in Brazil we don't have any need to have a medical prescription (although I do have one). We can simply buy it, considering it doesn't bring a enough risk (this is also true with most common use medicines - you don't need a medical prescription).

[lucas7bm]

Is this the ResMed AutoSet you were thinking about?
The AirSense 10 AutoSet.
https://www.cpap.com/productpage/resmed ... idair.html
There are several older models but you didn't say specifically which one.
This would be the machine that I would use if I were in your shoes and wanting to do what you are wanting to do.

Yes, you can do what you are thinking about doing. I wouldn't have another sleep study if it were me. As long as your diagnosis was obstructive sleep apnea and not central sleep apnea then it would be fairly simple to find optimal pressure settings with that machine.
Do you have a copy of that sleep study?

How easy or difficult is it in Brazil to get a machine and mask. Do you need a RX? Would your doctor be willing to supply a RX if you need one?
There is a place here in the US that will ship machines and masks internationally...you might check them out for pricing options.
http://www.secondwindcpap.com/

The ResMed S9 AutoSet would also be a decent choice. It was discontinued when the AirSense models were released.
I wouldn't go with anything older than the S9 model though. Not enough data to do a good job doing what you are wanting to do.

Exactly the response I was expecting, Pugsy.
Yes, I have a copy of the study and I "only" have obstructive sleep apnea. An AHI of 51, with just OAs and hypopneas.
And since it is really easy to buy machines and masks here, I didn't want to go to another sleep study just to find something that I will probably - or at least could - change analyzing the provided data along with SleepyHead or something similar (I could even code one, since I'm a programmer hahahaha).
I'm trying to avoid any more expense, since it is my father who will be paying all of those things. The only thing I'm considering is maybe rent a machine for some time, specially with oronasal masks and see how the treatment with each one goes for me.

Edit: Also, the prices of new machines in USA or Europe are basically the same price that I would pay buying CPAP on e-stores from here, but these "gently used" machines from this website have a good price. The only possible problem is delivery time or - maybe - importation taxes. :c

[TedVPAP]

Welcome to the forum.
In USA it is becoming common to prescribe an auto machine after determining OSA. Some doctors still want a titration study, others don't.
If it was me, I would self-titrate with the help of sleepyhead and this forum since self-management of treatment is often important.

[Pugsy]

You know since prices are pretty much the same I would suggest that you get a machine locally.
Either rent or purchase depending on what you want to do and cost.

I once sent a S9 humidifier to a guy in Brazil and he got hit big time for the import taxes and I didn't declare much value and it was just the humidifier and not the machine. Despite it being declare as medical equipment customs said they didn't care and he had to pay quite a bit in import tax despite it really not being valued all that much (I think I declared it at $20 and they stuck another $80 on it that he had to pay). I hate to think what they might want to add on to a machine.
If you can find out ahead of time and factor that cost in...might be doable and save a bit of money. 7 to 10 days to get it to you using US Postal service and I wouldn't use anything else because UPS or FedEx tack on additional "document" fees for filling out the customs paperwork.

Might just be simpler to get one locally.

Masks...they are always a crap shoot. If you can normally breathe through your nose just fine during the day an night then I suggest that you start with a minimal mask. It's just easier to get and keep sealed because there is so little area touching the skin. The more skin surface involved with the mask...the more work getting and keeping the seal.

[lucas7bm]

You know since prices are pretty much the same I would suggest that you get a machine locally.
Either rent or purchase depending on what you want to do and cost.

I once sent a S9 humidifier to a guy in Brazil and he got hit big time for the import taxes and I didn't declare much value and it was just the humidifier and not the machine. Despite it being declare as medical equipment customs said they didn't care and he had to pay quite a bit in import tax despite it really not being valued all that much (I think I declared it at $20 and they stuck another $80 on it that he had to pay). I hate to think what they might want to add on to a machine.
If you can find out ahead of time and factor that cost in...might be doable and save a bit of money. 7 to 10 days to get it to you using US Postal service and I wouldn't use anything else because UPS or FedEx tack on additional "document" fees for filling out the customs paperwork.

Might just be simpler to get one locally.

Masks...they are always a crap shoot. If you can normally breathe through your nose just fine during the day an night then I suggest that you start with a minimal mask. It's just easier to get and keep sealed because there is so little area touching the skin. The more skin surface involved with the mask...the more work getting and keeping the seal.

A brand new one AirSense S10 AutoSet kit with an AirFit P10 mask here would cost approximately $890. So it would be really nice If I could, for example, buy this machine for just $550. However, taxes could hit me very hard and, in this case, it would certainly cost a lot more. About the mask, here is what I wanna do: take a pillow one, like the AirFit P10, and have a backup osonasal one, considering that I also have rhinitis and would need to breathe through my mouth when nasal congestion happens.

[Pugsy]

You know if you lived anywhere but Brazil I would say get the one from secondwind and maybe they won't hit you with extra taxes...but I just know what they did to a guy I sent just a humidifier to. It's been maybe 2 years ago that I did it.
You might check to make sure. I have no way of knowing if what the guy told me was true or not.

And yes...start with the P10 and investigate a full face mask for bad congestion times later once you are more used to the therapy itself.
You know in over 8 years of therapy I haven't had a time yet where I couldn't get my nose cleared up enough to start the night with my nasal pillow mask. Even with a bad cold or the flu.
I do have a full face mask just in case but I have never had a time where I just had to use it and in fact for my first 6 years of therapy I didn't even own one because I couldn't find one that I liked.
You may find that the added humidity helps the congestion...think how a hot steamy shower works in opening up the nose when we have a cold.
Hurts nothing to have a full face mask on hand just in case though but I would start with the nasal pillow mask. It's just less on the face and head to have to deal with both in terms of comfort and sealing.

[Goofproof]

Things to remember: Power Resmed requires 24 volt dc, special plug and special price.

Many others take 12 volt dc, simple cord cheaper. (Camping ect)

APAP best option, but 4 cm to 20 cm on auto is a failure setting, better a 3 or 4 cm pressure range, wide range takes too long to treat.

Say you need 10 cm for best treatment 8 cm to 12 cm works best or even 9 cm to 12 cm. Enjoy, use it every time you sleep... Jim

[lucas7bm]

It's really good to read this!
I was concerned about having to use the oronasal (FF, I believe) mask regularly because of my rhinitis. Again, thank you for your kindness, Pugsy. Cheers from Brazil!

[lucas7bm]

Things to remember: Power Resmed requires 24 volt dc, special plug and special price.

Many others take 12 volt dc, simple cord cheaper. (Camping ect)

APAP best option, but 4 cm to 20 cm on auto is a failure setting, better a 3 or 4 cm pressure range, wide range takes too long to treat.

Say you need 10 cm for best treatment 8 cm to 12 cm works best or even 9 cm to 12 cm. Enjoy, use it every time you sleep... Jim

Yes, I'm aware of the 24V required, but I don't believe in the last 12 months this could be a problem, so it's still a better choice than Dreamstation (which is very good, but it's not as good as ResMed's equivalent and is also more expensive here in Brazil).
About the range, I was thinking exactly 4, glad to read it's a good choice. Thank you very much, Jim!

[TedVPAP]

It's really good to read this!
I was concerned about having to use the oronasal (FF, I believe) mask regularly because of my rhinitis. Again, thank you for your kindness, Pugsy. Cheers from Brazil!

I breath better at night with my P10 then I do during the day. The PAP machine with pillows keeps my nasal passages open when I sleep.

[lucas7bm]

It's really good to read this!
I was concerned about having to use the oronasal (FF, I believe) mask regularly because of my rhinitis. Again, thank you for your kindness, Pugsy. Cheers from Brazil!

I breath better at night with my P10 then I do during the day. The PAP machine with pillows keeps my nasal passages open when I sleep.

This is really satisfying to read. Thank you very much, Ted.

[SouthSeaPirate]

My Dr was only useful enough to tell me how bad I was and answer the questions I had to fish for (questions I wouldnt hae known to even ask if it were not for me researching online).
Thanks to those on this forum, some even in this thread, and SleepyHead reports I am now sleeping like never before.
Really mean it when I say those here were much better help and more informative than any of my machine techs or my Dr.
I honestly think you can do the same.
Also I agree on the machine recommendation, literally the one I have.