First, let me say that I've read this forum til my eyes are bleeding. Of all forums I've been to, regardless of the topic, this FORUM IS THE BEST AND IS UNBELIEVABLY FRIENDLY AND HELPFUL!!!!!!!
My name is Rick, and I have sleep apnea.
I went to the sleep center this week for my initial exam & consultation. I'm scheduled for a split session on the 14th of this month. The doctor & I have little doubt about the outcome, since the evidence is there in spades.
I have some questions for you veterans, or even you newbies.
When talking to my Dr. I brought up the subject of APAP's. He quickly shot them down by saying they have too much lag, and can actually hinder therapy. I tried to convince him that was not what I had been reading. He said 99% of people do just fine with a CPAP.
Although he's a young, very personable doctor, I was a bit disappointed in his apparent lack of knowledge of the APAP. He works in a sleep clinic for crying out loud! He mentioned a new machine called VPAP, but said unless I wanted to spend $8000 on one, he wouldn't recommend it.
After my visit, I came back to this forum and read as much as I could from people using modern state-of-the-art APAP's. I can't find any reason to believe they're not superior to a good CPAP. Am I wrong?
If I'm not wrong, then how to I diplomatically go about telling my doc he's behind in his knowledge? I may never use the auto feature on the APAP, but I want the option.
Another question is about the night of my split session. They said not to drink any alcohol on that night. For the past 20 years I have had a couple of glasses of red wine after I come home from work. I rarely drink after dinner. My thinking is I should show up for the session in my "normal" condition, which is not, by any means intoxicated, but with the soothing effects the wine provides.
Shouldn't my tests be done in the state I'm going to be going to bed in most of the time?
I brought up my concern about falling asleep with forty-eleven gadgets pasted to me in a strange environment. They said the doc prescribed Ambien if I needed it. Is this normal?
Sorry for the long post, and thanks to all of you who have dedicated so much of your time and knowledge to this forum.
Rick
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CPAPopedia Keywords Contained In This Post (Click For Definition): CPAP, auto, APAP
Beginning My Journey: Friends wanted
Beginning My Journey: Friends wanted
Wake me up when this is over...
Re: Beginning My Journey: Friends wanted
Welcome to the hose head club Rick,Rabid1 wrote:First, let me say that I've read this forum til my eyes are bleeding. Of all forums I've been to, regardless of the topic, this FORUM IS THE BEST AND IS UNBELIEVABLY FRIENDLY AND HELPFUL!!!!!!!
Good to hear that your reading a lot of posts this place is a great place to learn.
For your question about the Auto read this thread.
viewtopic/t15492/Question--getting-the- ... -need.html
It is a good discussion of the topic.
For the part about the wine I wouldn't worry about having one glass of wine with or right after supper. Just my opinion but if you do that normally every night why not.
Life should NOT be a journey to the grave with the intention of arriving safely in a well preserved body, but rather to skid in sideways, chocolate in one hand, martini in the other, body totally worn out and screaming,WOO HOO what a ride!
I think if you have a couple of glasses of wine nightly and don't intend to stop then you should do the same for the sleep test, especially if they are doing a titration. I am sure others will disagree with me but what good does it do to titrate a pressure of let's say 9 when the wine makes you need 10? Of course we all shouldn't drink, shouldn't sleep on our backs, weigh an optimal number of pounds, but that is not reality. There, that is my non-medical opinion, do what you will.
On the APAP. If you truly want it and decide you can't convince your doc, you can always use your prescription for CPAP (provided you get it!!!!!) to order your own online without insurance. Up to you how much you want it and how hard you want to work on the doc.
Is he associated with a sleep lab that acts as a DME? If so might there be a conflict of initerest causing him to not want to prescribe APAP?
Whatever you do, get the original prescription and copy of your sleep study in case you choose to buy another machine later, or you don't like the DME they try to assign you to.
On the APAP. If you truly want it and decide you can't convince your doc, you can always use your prescription for CPAP (provided you get it!!!!!) to order your own online without insurance. Up to you how much you want it and how hard you want to work on the doc.
Is he associated with a sleep lab that acts as a DME? If so might there be a conflict of initerest causing him to not want to prescribe APAP?
Whatever you do, get the original prescription and copy of your sleep study in case you choose to buy another machine later, or you don't like the DME they try to assign you to.
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Sleepless in St. Louis
- Posts: 254
- Joined: Sun Mar 19, 2006 11:12 am
- Location: St. Louis
Say to the doc "hey humor me on this. I want to at least give the apap a try. If it does not seem to work out for me, I'll just switch it over to the fixed mode." You can run the apap as a straight cpap. Some have found they do not do will on apap. I've tried both and the apap works better for me. I personally would not challenge him on his knowledge of xpap. He'll tune you out as soon as you do. It's hard to argue with the majority of people who come to this board that apap has some real advantages for many.
I agree with Tooly. I would go ahead and stick to your normal routine. I think they are just trying to say don't show up drunk with the hope of making yourself sleep easier in a strange environment.
I agree with Tooly. I would go ahead and stick to your normal routine. I think they are just trying to say don't show up drunk with the hope of making yourself sleep easier in a strange environment.
Sucking Wind since Feb '06.
Wine
The only risk that you'd run having your customary couple of glasses of wine before your titration study is that the pressure that you will wind up being prescribed wil be higher than you would normally require on nights when you don't have any alcohol. Alcohol tends to relax the musculature surrounding the upper-airway, which makes it easier to collapse on itself when you breath in while asleep. That's what OBSTRUCTIVE sleep apnea is all about. So, if you drink on the night of your titration study, what the lab will see is that you require a higher pressure to splint open your airway, and that's what they'll prescribe.
On the other hand, if you drink every night and don't drink the night of your titration study, you'll be prescribed a LOWER pressure than you require on the nights when you do drink.
A possible solution for this is to discuss your alcohol-consumption habits with your doc, and ask about the suitability of starting you on an auto-titrating CPAP (APAP) which will adjust its pressures from night to night and throughout the night to maintain patency of your airway, whether you've drank or not. However, APAPs are NOT for evryone, and you would need to carefully discuss with your doctor whether you have any conditions thatw ould contra-indicate the use of an APAP.
Cheers!!!
Chuck
BTW, Tooly is a VERY good friend to have throughout this journey, especially if you share your wine with him!
On the other hand, if you drink every night and don't drink the night of your titration study, you'll be prescribed a LOWER pressure than you require on the nights when you do drink.
A possible solution for this is to discuss your alcohol-consumption habits with your doc, and ask about the suitability of starting you on an auto-titrating CPAP (APAP) which will adjust its pressures from night to night and throughout the night to maintain patency of your airway, whether you've drank or not. However, APAPs are NOT for evryone, and you would need to carefully discuss with your doctor whether you have any conditions thatw ould contra-indicate the use of an APAP.
Cheers!!!
Chuck
BTW, Tooly is a VERY good friend to have throughout this journey, especially if you share your wine with him!
People are dying every day in Darfur simply for who they are!!! PLEASE HELP THEM!
http://www.savedarfur.org
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http://www.savedarfur.org
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The auto can be set to straight cpap. The ADVANTAGE is having options. Another advantage is that many auto machines have smart cards in them that allow you to SEE how well you're responding to the therapy. (Of course you need teh software and smart card reader for that part.... another investment NOT usually covered by insurance.)
Here's another little tidbit for you. The BILLING CODE for insurance is the same for a straight cpap or an Auto. The auto costs more. The equipment supplier makes a lot more money if you just get the straight cpap.
Here's an example:
The ALLOWABLE billing for a cpap (or apap) for my insurance company is $1,385.15.
That's right... almost fourteen hundred bucks. The equipment supplier can bill more than that, but that's what the insurance company pays and if the equipment supplier is a "participating DME" then they accept that payment. OF COURSE THEY DO! Who wouldn't, when they are giving you a $300-$400 machine! Now.... why should they give you a $700 machine? They'd LOSE 3 or 4 hundred easy dollars on the deal.
If an auto CPAP is set to range about 2 below and 3 above your titrated pressure setting, it's not "running wild" from 4 to 20. It has been narrowed down. The BIG thing is the card and software in my opinion.
Tell your doctor you want to be INVOLVED IN YOUR TREATMENT and that you want to see results so that you can ask intelligent questions. You want a machine that records MORE THAN COMPLIANCE data. Being compliant simply means you're wearing the device. It says NOTHING ABOUT HOW EFFECTIVE the therapy is.
The capital letters are good "buzz phrases" for you.
The fact that some people do better on straight cpap is exactly that.... a fact. But the 99% number was smoke and mirrors. DO NOT BE AFRAID to ask for data to substantiate claims that you don't need anything better than the bottom of the barrel equipment. Don't settle.
This may sound like I am being harsh but this is YOUR THERAPY and you WILL BE DOING THIS FOR THE REST OF YOUR LIFE. You want the best information ... the most COMPLETE information you can get. Don't settle.
My sleep doctor wouldn't write the script for an APAP. I went to my regular doctor, spoke to her intelligently about what I wanted and why... and she wrote me the script right there. Don't settle.
I felt so strongly about this that I paid $700 out of my own pocket to get the machine I wanted (Remstar auto with heated humidifier) and the mask I wanted (Resmed Swift nasal pillow). BE COMMITTED to this. It's important.
Don't settle.
I then went to my sleep doc with DATA IN HAND and talked to him. I swear I knew more about the therapy and how the machine works than anyone working in his office (and why I chose this one over another one) and... he offered me a JOB in his office! (I am not kidding, I swear).
Don't settle
This is YOUR health and YOUR life.
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CPAPopedia Keywords Contained In This Post (Click For Definition): auto cpap, humidifier, nasal pillow, swift, CPAP, DME, auto, APAP, Smart Card
Here's another little tidbit for you. The BILLING CODE for insurance is the same for a straight cpap or an Auto. The auto costs more. The equipment supplier makes a lot more money if you just get the straight cpap.
Here's an example:
The ALLOWABLE billing for a cpap (or apap) for my insurance company is $1,385.15.
That's right... almost fourteen hundred bucks. The equipment supplier can bill more than that, but that's what the insurance company pays and if the equipment supplier is a "participating DME" then they accept that payment. OF COURSE THEY DO! Who wouldn't, when they are giving you a $300-$400 machine! Now.... why should they give you a $700 machine? They'd LOSE 3 or 4 hundred easy dollars on the deal.
If an auto CPAP is set to range about 2 below and 3 above your titrated pressure setting, it's not "running wild" from 4 to 20. It has been narrowed down. The BIG thing is the card and software in my opinion.
Tell your doctor you want to be INVOLVED IN YOUR TREATMENT and that you want to see results so that you can ask intelligent questions. You want a machine that records MORE THAN COMPLIANCE data. Being compliant simply means you're wearing the device. It says NOTHING ABOUT HOW EFFECTIVE the therapy is.
The capital letters are good "buzz phrases" for you.
The fact that some people do better on straight cpap is exactly that.... a fact. But the 99% number was smoke and mirrors. DO NOT BE AFRAID to ask for data to substantiate claims that you don't need anything better than the bottom of the barrel equipment. Don't settle.
This may sound like I am being harsh but this is YOUR THERAPY and you WILL BE DOING THIS FOR THE REST OF YOUR LIFE. You want the best information ... the most COMPLETE information you can get. Don't settle.
My sleep doctor wouldn't write the script for an APAP. I went to my regular doctor, spoke to her intelligently about what I wanted and why... and she wrote me the script right there. Don't settle.
I felt so strongly about this that I paid $700 out of my own pocket to get the machine I wanted (Remstar auto with heated humidifier) and the mask I wanted (Resmed Swift nasal pillow). BE COMMITTED to this. It's important.
Don't settle.
I then went to my sleep doc with DATA IN HAND and talked to him. I swear I knew more about the therapy and how the machine works than anyone working in his office (and why I chose this one over another one) and... he offered me a JOB in his office! (I am not kidding, I swear).
Don't settle
This is YOUR health and YOUR life.
_________________
CPAPopedia Keywords Contained In This Post (Click For Definition): auto cpap, humidifier, nasal pillow, swift, CPAP, DME, auto, APAP, Smart Card
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| Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear |
| Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control |
| Additional Comments: original pressure 8cm - auto 8-12 |
Rabid1,
Is that a male Eclectus with the dog?
Is that a male Eclectus with the dog?
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| Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear |
| Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control |
| Additional Comments: original pressure 8cm - auto 8-12 |
Yardbird,
Thanks for a great reply. I feel exactly the way you do. I'm fully prepared to spend my own money on the correct (read best) machine for me. I will let the doc know where I stand.
I own a computer consulting firm, so I'm a full-blown nerd. I want ALL the data when it comes to my health.
Thanks for a great reply. I feel exactly the way you do. I'm fully prepared to spend my own money on the correct (read best) machine for me. I will let the doc know where I stand.
I own a computer consulting firm, so I'm a full-blown nerd. I want ALL the data when it comes to my health.
Wake me up when this is over...
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curtcurt46
- Posts: 262
- Joined: Wed Sep 27, 2006 12:35 pm
- Location: Retired US Army
Rick,
I want to tell you a couple of the only down sides to an auto cpap that I have read or experienced. I use an auto bipap and think that an auto can be of a great benefit when used correctly.
The auto pressures must be set to a very narrow range for most people to be effective. Many times the patient is given a wide range say 5cm to 20cm and the machine as the doctor says lags behind the problem. With this wide range the patient is getting therapy, but not the best therapy. Many doctors and RT's feel that if a patient is compliant without regard to best pressure then they still get a great benefit when compared to no therapy. The truth is they look at compliance first then your performance last if at all. Doctors and RT's generally don't have the time to help you struggle with achieving the best AHI's and lowest leaks.
The minimum pressure should be set at your titration PSG pressure provided you have confidence that the tech did a good job in finding the sweet spot. The max pressure should be a few cm greater (3-5cm). Now the down side. A good number of people do their best on a single pressure, whereas when using the auto operating within a range may cause some folks to not sleep as soundly. They wake up several times throughout the night. I think you would want to try both and then make a decision what's best for you. The sleep lab may try you on a bipap to see if you get any benefit from a lower exhalation pressure. This may give you a hint at your tolerance of up and down pressures.
One other thought. If you have any trouble breathing through you nose you should ask the sleep lab to give you a full face mask for the titration portion of the study. Mouth breathing/leaking can skew the results.
With your current doctor your only argument might be that the auto can be set to a single pressure as he prescribes, but you and he still have the flexibility to go to auto to refine the best pressure should this be necessary in the future.
Good Luck and I hope this helps.
I want to tell you a couple of the only down sides to an auto cpap that I have read or experienced. I use an auto bipap and think that an auto can be of a great benefit when used correctly.
The auto pressures must be set to a very narrow range for most people to be effective. Many times the patient is given a wide range say 5cm to 20cm and the machine as the doctor says lags behind the problem. With this wide range the patient is getting therapy, but not the best therapy. Many doctors and RT's feel that if a patient is compliant without regard to best pressure then they still get a great benefit when compared to no therapy. The truth is they look at compliance first then your performance last if at all. Doctors and RT's generally don't have the time to help you struggle with achieving the best AHI's and lowest leaks.
The minimum pressure should be set at your titration PSG pressure provided you have confidence that the tech did a good job in finding the sweet spot. The max pressure should be a few cm greater (3-5cm). Now the down side. A good number of people do their best on a single pressure, whereas when using the auto operating within a range may cause some folks to not sleep as soundly. They wake up several times throughout the night. I think you would want to try both and then make a decision what's best for you. The sleep lab may try you on a bipap to see if you get any benefit from a lower exhalation pressure. This may give you a hint at your tolerance of up and down pressures.
One other thought. If you have any trouble breathing through you nose you should ask the sleep lab to give you a full face mask for the titration portion of the study. Mouth breathing/leaking can skew the results.
With your current doctor your only argument might be that the auto can be set to a single pressure as he prescribes, but you and he still have the flexibility to go to auto to refine the best pressure should this be necessary in the future.
Good Luck and I hope this helps.
Curtis
curtcurt46
curtcurt46
I used to breed Amazons (blue fronts and yellow napes) and Rosellas. At one point I had 8 breeding pairs of amazons, 1 amazon for my personal pet, and 3 pairs of rosellas. I was also VP of a club that sponsored the Midwest Avian Research Expo in Buffalo, NY. So.... I've been around birds.
Oh... and bless you for keeping conures. I couldn't do it. They were too noisey for me.
Oh... and bless you for keeping conures. I couldn't do it. They were too noisey for me.
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| Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear |
| Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control |
| Additional Comments: original pressure 8cm - auto 8-12 |
Sorry, In my non-medical opinion I have to disagree with this statment
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"The minimum pressure should be set at your titration PSG pressure provided you have confidence that the tech did a good job in finding the sweet spot. The max pressure should be a few cm greater (3-5cm).
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I believe the range should encompass your titrated pressure but go a bit lower.
For example I was titrated at 13. I rarely go above 13 but I sure as heck go below. I set mine at 10 - 15 and I spend much of the night at 10. Range seems to be narrow enough that I get good data as the machine responds quickly enough.
13, while not a really high pressure, is not trivial when sealing a mask or exhalilng even with c-flex.
The major benefit I get from APAP is the LOWER pressure when I don't need my titrated pressure.
Now that said, I think it is difficult to determine how much benefit the original poster might get from an APAP until he knows his titrated pressure.
For example if he is titrated at 8 or so, there is not much room below that to go, and assuming the titration is good, he shouldn't go too much above it. Then it is debatable how much the APAP is worth, other than an easy way to check his titration level now and in the future without visiting the expensive, uncomfortable sleep lab.
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CPAPopedia Keywords Contained In This Post (Click For Definition): C-FLEX, Titration, APAP
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"The minimum pressure should be set at your titration PSG pressure provided you have confidence that the tech did a good job in finding the sweet spot. The max pressure should be a few cm greater (3-5cm).
_________________________________________________________________________
I believe the range should encompass your titrated pressure but go a bit lower.
For example I was titrated at 13. I rarely go above 13 but I sure as heck go below. I set mine at 10 - 15 and I spend much of the night at 10. Range seems to be narrow enough that I get good data as the machine responds quickly enough.
13, while not a really high pressure, is not trivial when sealing a mask or exhalilng even with c-flex.
The major benefit I get from APAP is the LOWER pressure when I don't need my titrated pressure.
Now that said, I think it is difficult to determine how much benefit the original poster might get from an APAP until he knows his titrated pressure.
For example if he is titrated at 8 or so, there is not much room below that to go, and assuming the titration is good, he shouldn't go too much above it. Then it is debatable how much the APAP is worth, other than an easy way to check his titration level now and in the future without visiting the expensive, uncomfortable sleep lab.
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CPAPopedia Keywords Contained In This Post (Click For Definition): C-FLEX, Titration, APAP
Hi fellas. Nice to meet some fellow bird lovers and hoseheads too!! This is my first official posting! Im only 2 weeks along rabid1 so i cant offer much. so far my transition has been pretty uneventful. Yardbird has offered me some GREAT tips!Rabid1 wrote:Dude, they're too noisey for EVERYBODYyardbird wrote:Oh... and bless you for keeping conures. I couldn't do it. They were too noisey for me.
I agree with you too rabid1..this forum by far is the most welcoming and so full of knowledge!!
Goodluck to another fellow newbie!