First Night, so far, so good...

[EDNurseAngel]

I have to say all and all that this has not been a horrible process. The things that lead me here might not have been the best.

I have pretty much snored most of my adult life. I had my tonsils taken out when I was 26. That pretty much made me a nose breather right then and there. I stopped snoring for several years after that. Life, kids, 50 pounds, and 11 years later, I was snoring like a freight train again. My blood pressure was out of control. The day after Christmas I got a nosebleed, not really anything new, I get them a lot in the winter. But this one would not stop. I toughed it out for about 3 hours before going to the ER. In total it bleed for about 7 hours before they finally got it stopped. I saw an ENT 2days later to pull the nasal packing. He recommended a sleep study. Luckily I work at the hospital, my office is actually just down the hall from our sleep lab, they got me in the next day. The sleep study was great fun, NOT. I did not have a split study because I didn't have the worst apnea until later in the night.

The ENT called me with my results about 10 days later, my AHI was 40, my SPO2 went down to 80%, and I had almost no REM sleep. He said the lab would call to schedule a titration study. They called and I set it up for Monday morning, I work nights and live about an hour away, so a day study was definitely the way to go for me. They recommended a local DME supplier that we work with through the hospital, most of our patients seem to like them, so I had no objections to using them. They called Tuesday morning to schedule a set-up appointment. I went in yesterday, and picked up the machine and mask.

Thanks to the advice from you guys, I went with the nasal pillows.

Well, I went to bed last night at 9pm, I woke up at midnight and had to go to the bathroom. My nose hurt a bit, so I loosened the straps and put the tubing over the top of the headboard, and that was perfect. I went back to sleep and slept for nearly 5 more hours. I got up, got the kids off to school. I actually went back to bed after they left for school and got a couple more hours of sleep.

I don't have any numbers, that mode was disabled, through the DME, but I only remember waking up twice, as opposed to the 7 or 8 times in a typical night. And I feel pretty good.

[Lee Lee]

Congrats on the first leg of your journey! Remember to stay flexible and open to new ways to sleep, etc. It takes awhile for things to settle.
I truly wish you well, and hope you feel better and better every day!

[avi123]

What were the rseults of your sleep study WITH a CPAP? What were the values of AHI and Oxygen desaturation at that time?

[Janknitz]

Sounds like you had a great first night! You may have some bad nights, too, but this shows you that you can absolutely do it and you will soon feel the benefits.

Let us know if you want help "cracking the code" to access your AHI on your machine. There's no reason the DME should have locked you out.

You can purchase Encore Viewer software so that you will have access to complete data, if you're interested in that sort of thing. You have a great machine, but its "on board" data is sorely lacking.

[EDNurseAngel]

I have a copy of the clinician manual, so I can get to the disabled features, but I decided that I would be a good girl and leave it alone until my follow up appointment in a month.

avi123,
My AHI on CPAP titration was 4.6, I ended up at a pressure of 15, but that was when I was sleeping on my back which I almost never due, the lowest my sat got was 93%, but I am a smoker so my usual sat is only 97-98% anyway.

I only real thing that bothers me so far is that is is harder to exhale while the pressure is ramping up. Which makes no sense at all. When I wake up at 15 it feels fine, but from 6-10, it bothers me, don't know why.

[scrapper]

I only real thing that bothers me so far is that is is harder to exhale while the pressure is ramping up. Which makes no sense at all. When I wake up at 15 it feels fine, but from 6-10, it bothers me, don't know why.

Move the starting pressure up to a higher number for the ramp, and you'll be much more comfortable.

[EDNurseAngel]

Okay. As my husband pointed out, "Well behaved women rarely make history." So I enable the AHI function on my REMstar. My AHI this morning was 2.5, which I pointed out to hubby was in the normal range.

Now the only other thing that bothers me is that BCBS, my insurance, requires compliance data in order to pay for the machine. I work tonight and won't sleep again until tomorrow morning. I may or may not sleep on Mondays, it depends on what I have to do. I will sleep Monday night, but excluding Saturday night means at best I can only use the CPAP 85% of my nights. Insurance requires 70% of my "nights" for at least 4 hours. I shouldn't get penalized for going to work to pay for the insurance that covers the machine. I think I will keep a log in addition to the machines data to document my compliance. What if I was in EMS and working 2-3 24 hour shifts a week? Most people I know that work EMS and FD work 2 24 hours shifts a week minimum, they are immediately down to 71% of the week if you take out those two days. One night with a sick kid or parent, and the numbers are blown. Or for that matter picking up an extra shift at the hospital.

I slept an hour and a half longer than normal last night, with my CPAP on the entire time. Didn't even get up to go to the bathroom. My six year old daughter is in a beauty pageant today, so I can't take my usual Saturday afternoon nap, but I am going back to sleep while Daddy takes her to get her hair done.

Any other night shifters out there with this kind of problem?

[avi123]

Hi, about lowering the expiration pressure you need to adjust it with the Flex option. I am not a Respironics Mevin. But there a lot of posters who are.

Flex Family Technology

Flex Technology is designed to enhance traditional CPAP therapy; maintaining effective therapy at minimal pressures. Users new to CPAP equipment find the Flex feature provides airflow at just the right pressure relief for every breath and makes adapting to CPAP therapy easier. The PR Auto comes with both C-Flex and A-Flex modes as well as the new C-Flex Plus technology.

C-Flex offers a comfortable way to deliver sleep therapy by giving pressure relief at exhalation. Pressure is lowered based on a breath-per-breath analysis and provides up to 3 levels of relief based on the patient's expiratory flow.

C-Flex Plus is a new enhancement added to PR Pro and Auto CPAP machines. Similar to C-Flex, the technology provides pressure relief during exhalation based on expiratory flow. C-Flex+ minimizes the pressure transition and provides additional comfort when in fixed-CPAP mode. In addition, C-Flex+ softens the breathing cycle between inhalation to exhalation.

A-Flex is a comfort feature built on top of the REMstar Auto algorithm. If breathing events occur, the algorithm raises the A-Flex pressure profile to eliminate breathing events, while simultaneously making sure that pressure never rises to a level that's unnecessarily or uncomfortably high.


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About your insurance at BCBS, if it is like my (I am under Medicare plus BCBS as supplementary) then my DME had to report to BCBS within 31 days to 91 days, after I got the CPAP, and deliver the signed info given by my Doc (to the DME) that I am doing OK on compliance and benefit.

IMO, your Doc needs to arrange it with your employer and the insurer, to change the language in the insurance contract b/c you're a night shift worker

[robysue]

Now the only other thing that bothers me is that BCBS, my insurance, requires compliance data in order to pay for the machine. I work tonight and won't sleep again until tomorrow morning. I may or may not sleep on Mondays, it depends on what I have to do. I will sleep Monday night, but excluding Saturday night means at best I can only use the CPAP 85% of my nights. Insurance requires 70% of my "nights" for at least 4 hours. I shouldn't get penalized for going to work to pay for the insurance that covers the machine. I think I will keep a log in addition to the machines data to document my compliance. What if I was in EMS and working 2-3 24 hour shifts a week? Most people I know that work EMS and FD work 2 24 hours shifts a week minimum, they are immediately down to 71% of the week if you take out those two days. One night with a sick kid or parent, and the numbers are blown. Or for that matter picking up an extra shift at the hospital.

Notes from your sleep doctor's office and your supervisor at work concerning your work/sleep schedule should be enough to persuade the insurance company of what 100% compliance for you ---given your work and sleep schedule--- are in terms of calendar days.

Be upfront with your sleep doctor's office NOW about your concerns about this issue and see what they say about it. I bet they will be willing to write a letter explaining your shift work and when you can/cannot sleep more than 4 hours in a noon--to--noon time frame.

Best of luck on your adjustment to CPAP.

And good for you for unlocking that data capability and the ability for you---the patient whom the data is about---to see it.