What to Do?? AHI 94 and O 76

[twb119]

When I had my sleep study done they said I had a AHI of 94 and oxygen down to 74 . When I when in for my trituration study the next week I felt better the next morning than I have in years. 3 days after the trituration study the sleep lab calls asked if I could come by that afternoon to get my cpap machine. So I when in and was given a Resmed (i looked all over the machine and it doesn't say what model) with a heated Hum with the pressure set to 19. When i asked about a Auto the tech said it wouldn't work well for my pressure also when i asked about a c-flex machine he said they don't work well.
The first night was ok on the cpap but woke up with a swollen face. But the nights 2-4 where hell waking up 5 to 8 times a night feeling like tire being aired up and having a hard time exhaling. I have a appointment with my sleep doc on monday 8/7/06.

What would be some good questions to ask and what machine to push for.

Thanks for any help.
Thomas B

[Ric]

When i asked about a Auto the tech said it wouldn't work well for my pressure also when i asked about a c-flex machine he said they don't work well.

IMHO, insist on an AUTO with C-Flex.

Your DME just recited two of the most common incorrect (i.e. false) lines heard by individuals new to this therapy. Truth is, you may not actually need that much pressure all of the time, and without a multi-night study, or an APAP, there is simply not enough data to establish that. You should INSIST! (throw a tantrum if necessary) to at least have the use of an AUTO for several weeks to find out what your variability in pressure requirements really is. And you would do well to KEEP the AUTO. It can be used as a straight CPAP if that's what you chose will best meet your needs. 19cm is a TERRIBLY high pressure to live with if in fact you don't really need that 100% of the time. And as for C-Flex, your DME is simply WRONG. Exhalation relief is all the more important at those higher pressures. You are expending far more energy breathing than you need to. Sadly, it appears your DME has put profit above your treatment, as the AUTO costs them a little more to deliver. If the therapy is a failure, they still have the money.

-Ric

[wolftracker]

With a pressure of 19 you dont want a apap.
you would probably need a bi-pap auto.

they have a higher pressure range I understand.

But the more experience ppl will confirm or not if this is true.

my .02

[GoofyUT]

Its difficult to to try to help you without knowing more of your condition and how is is currently treated. Your AHI and desats indicate SEVERE apnea. The pressure that you were titrated to would generally indicate the use of a bi-level PAP, and ResMed makes some fine bi-level PAPs which they call VPAPs. Somewhere on the machine is a label that will specify the model. If you can't find it, call your DME and demand that. Respironics makes a bi-level PAP that contains exhalation pressure relief (BiFlex) as well as auto-titration. Its called the BiPaP Auto w/Biflex and is certainly the current state of the art in Bi-level PAP therapy.

But, before I began worrying about C-flex or an auto-CPAP, I'd investigate whether I was on a bi-level, and then get the best one of those that I could, given your titrated pressure.

Hope this helps.

Chuck

[Wulfman]

twb119,

Well, they lied to you about most everything else.....maybe they didn't get your titration right, either.

In my own particular case, I was prescribed a pressure of 18. I tried that pressure for about an hour or less. Then I changed it to 10 and have been doing great on that pressure ever since. I've monitored my therapy since "Day One" with Encore Pro and (shortly after) MyEncore software to make sure I was on the right track. In fact, I've tried other pressures and ranges and keep coming back to 10.

My rationale for changing my pressure were:
I didn't have ANY faith in my sleep doctor.
Obviously, 10 was more pressure than I had been getting, before going on CPAP.
A pressure of 10 was a "comfortable" pressure for me.
As long as I'm monitoring my therapy, I can adjust upwards if need be.

If you've got a way of monitoring your therapy, you can tweak it for the optimal results.

Best wishes.

Den

[MandoJohnny]

The ResMed model you have will be indicated on the face of the unit. If you have the "Elite," you have an Expiratory Pressure Relief function which should help. If you need help setting it, PM me. I had a lot of the same problems you report when I was getting used to the machine. I had my EPR set at 3, which is the highest ERP setting, and it helped me adjust to CPAP the first few weeks. But pretty soon, I developed a preference for less EPR. My doc says this is not uncommon in a lot of patients and he had me reduce the EPR setting. BTW, when I did that, my AHI's went down also. Now I have the EPR off and my AHI's are the lowest they have every been.

[Issac]

Wolftracker is correct.
You absolutely need Bi-level with pressure that high. i found that out after suffering for over a year. Finally got someone who knew what he was doing having been in sleep for 5 years and insisted I use Bipap (bi-leval) instead of autopap. I will be getting the VPAP.

[Moogy]

I also recommend insisting on the Respironics Auto BIPAP. If your pressure is now at 19, you might need a higher pressure in a year or two, and the Respironics Auto BIPAP will go all the way to 25.

With such high pressure needs, the exhale relief from a bipap is very important.

My general practice doctor was happy to prescribe an auto bipap for me. If your sleep specialist won't agree to that prescription, ask your regular doctor to do it.

Many DMEs give you what THEY have available. Some suppliers are good, others are TERRIBLE in the amount of misinformation they give out.

If you have insurance, it is critical to get a good machine quickly, before your insurance buys the one you don't like. Some insurance plans purchase after only one month, so you don't have a lot of time. Explain that to your doctor, then call the DME in advance to see how they will fill the doctors auto bipap prescription. If they don't have the right machine, get a different supplier. If the local DMEs won't cooperate, try http://www.billmyinsurance.com

Good luck,

Moogy

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, bipap, DME, Prescription, auto

[Moogy]

So I when in and was given a Resmed (i looked all over the machine and it doesn't say what model) with a heated Hum with the pressure set to 19. When i asked about a Auto the tech said it wouldn't work well for my pressure also when i asked about a c-flex machine he said they don't work well.

My pressure goes as high as 19-20 MANY nights, and both the auto feature and the Biflex work FINE. I track my results with software, and the results prove these features are working. The tech doesn't know what he is talking about, in my opinon.

Moogy