new member looking for advice from Onatario,Canada

[tigertrout]

Hello all

In these covid times I opted to not go to the hospital for a sleep test. So I did a home test, results showed severe sleep apnea. Home sleep tests are not acceptable where I live.
Now I am trying to figure out what to do, if I want to get a new machine I would need a prescription, which I am assuming I will not get without a sleep test
from an accepted facility. (I am in Ontario Canada by the way) I know that my insurance will not cover costs without the sleep study and prescription, nevertheless,
I am only concerned with getting a machine and starting the process.

Questions are,

1. is it acceptable to purchase a good lightly used machine and buy new masks etc.
2. what would be a good start as far as machines go, any more recommended than others, what should be avoided.
3. how accurate are home sleep tests.
4. I am a mouth breather (big Time) should I go directly to a full face mask, or where should I start.
5. can i set up a machine (with yr help that is) on my own or do I need to go to a clinic of some kind.
6. are there any concerns about setting up a machine on yr own. (safety)

thx in advance Sean

[zonker]

welcome to the zoo!

Questions are,

1. is it acceptable to purchase a good lightly used machine and buy new masks etc.
2. what would be a good start as far as machines go, any more recommended than others, what should be avoided.
3. how accurate are home sleep tests.
4. I am a mouth breather (big Time) should I go directly to a full face mask, or where should I start.
5. can i set up a machine (with yr help that is) on my own or do I need to go to a clinic of some kind.
6. are there any concerns about setting up a machine on yr own. (safety)

1. oh, hell yes. many have done it before you. and i wish i had known i could've done it myself when i was first suspected of having apnea. buying a used machine generally requires a script, but bear in mind that ANY doctor or dentist can write one, if they are so inclined. or you could buy peer to peer. forum friend lsat has gently used machines quite often. pm him if you want to see what he has.

2. i'm prejudiced but i like the resmed line of machines. see my sig. in fact, lsat often has this very line.

3. dunno. i had one. it got me a script and got me to here on the forum where i found the good info.

4.thought i was a mouth breather too and couldn't go any other way. but i also wear a full beard and i could NOT get a good seal to save my soul. finally started using a nasal pillow mask.

now, this takes some jiggery pokery to make it work. basically, you have to cover your mouth to get it closed. but the effort is worth it for me. if you decide on a nasal pillow setup, then we can talk in detail.

5. no no clinical setup is needed. basically, what you will do is set it up with a wide open pressure setting of 7-20. then by looking at the results, you can tweak it to get it optimized. (with the help of forum members, natch.)

6. nope. nothing is going to explode or kill you or anything!

good luck!

[Pugsy]

3. how accurate are home sleep tests.

Fairly accurate assuming someone actually slept decently. False positives are rare and those usually happen only with the reported AHI barely meets diagnostic criteria and maybe the person didn't sleep so good.

False negatives are not common but they can happen depending on how much data the sleep study actually collected and if a person slept or not. If the sleep study is only measuring oxygen levels with the pulse oximeter on the finger thing. More chance of false negatives because not everyone will have a significant drop in O2 levels associated with apnea events. I have a friend whose in lab sleep study ended up with AHI of over 60 but her O2 levels never really dropped all that much...baseline was 97% and lowest it went to was just 94% which is actually normal for asleep O2 levels because it's normal for O2 levels to drop a little when we fall sleep.

More on the various types of sleep studies and the data each type collects can be found here.
http://freecpapadvice.com/home-sleep-tests

4. I am a mouth breather (big Time) should I go directly to a full face mask, or where should I start.

Actually it depends on why you are a mouth breather and is that issue fixable but in general if you can't breathe only through your nose comfortable and you just HAVE to mouth breathe....yes...start with a full face mask.

5. can i set up a machine (with yr help that is) on my own or do I need to go to a clinic of some kind.
6. are there any concerns about setting up a machine on yr own. (safety)

Unless you have some very serious chronic lung issues going the DIY route is totally safe and fairly easy to do.
We have a lot of forum members who not only self diagnosed (bypassed a sleep study entirely) but also went the DIY route for figuring out pressures needs. It's not rocket science. A little bit of education and time...you can easily get it figured out.

As for what machine to look at...we don't know what pressures you might need. Might be a little bit and might be a lot...for this reason I strongly suggest the ResMed AirSense 10 AutoSet or the for Her Autoset. Exhale relief is superior on the ResMed machine than the Respironics machine and if you end up needing higher pressures you might need that slightly better exhale relief.
There are other reasons as well that I recommend that model/brand but I figured that exhale relief is more easily understood.

Check out secondwindcpap.com for a slightly used machine. They will ship to Canada and won't even require you to furnish a copy of your prescription. They are good people. They have both gently used and even new open box specials.

If you can afford it...the AirSense 10 for Her model is what I would suggest. It has 3 modes of operation available. The regular AutoSet has 2 modes. While we don't know if you would need or want that 3rd mode...better to have something and not need it than need it and not have it.

You can read about the features here
https://www.respshop.com/manuals/ResMed ... %20her.pdf

All this assuming you have plain jane run of the mill Obstructive Sleep Apnea... which odds are..you will have.

[Miss Emerita]

Before you go the DIY route, could you let us know more about the results of the test? In particular, what was the breakdown of the events you had? (Obstructive apneas, hypopneas, central apneas, respiratory-effort-related arousals [RERAs].)

[zonker]

Before you go the DIY route, could you let us know more about the results of the test? In particular, what was the breakdown of the events you had? (Obstructive apneas, hypopneas, central apneas, respiratory-effort-related arousals [RERAs].)

good point!

[Dog Slobber]

I'm in Ontario as well and some things specific to Ontarians you should know:

Ontario (OHIP) has an Assistive Device Program (ADP) that will pay for 75% of your eligible device.

This will get a brand new setup and is probably your best option.
https://www.ontario.ca/page/assistive-devices-program


Under the ADP, there is very strict guidelines that describe the criteria for getting a CPAP, APAP or BiLevel. Most people qualify for CPAP. Having said that, you really want an APAP. There is a loophole where the ResMed AirSense 10 AutoSet for Her qualifies as a CPAP device, even though it's actually an APAP device. Push for this device, and don't let them talk you out of it or try to push a different machine onto you.

http://www.health.gov.on.ca/en/pro/prog ... manual.pdf

Take a look on page 7 you will see the ResMed AirSense 10 AutoSet for Her listed amongst the CPAP devices.

Having said that if you still want to go the DIY route than second hand is still a pretty good option. I've bought and sold a few machines on Kijiji.ca and FaceBook marketplace.

You can get some good deals if you're patient, but there are some things to be careful of, many people have no concept of the value of the machines or even the type of machine. They don't know the model, run hours, nor how to find out.

Some considerations:

• Ask for the specific run hours, you will probably have to tell them how to get it.
• Ask for years old.
• Ask for specific model, only accept ResMed AirSense 10 AutoSet or ResMed AirSense 10 AutoSet for Her. They may not know the model, no not accept CPAP, Elite.
• Ask if it is a non-smoking household, depending on your sensitivities perhaps non-pet household
• Test it out specifically, smell the machine both running and non running
• Listen for loud noises while running
• Don't believe what they say, verify yourself
• Proper testing during COVID and the current stay-at-home order is problematic
• I do all my supplies through an online site here in Ontario, will share if you're interested

I'm ok with a second mask provided it's cleaned. But the odds of it being a good fit are problematic.

If you like you can PM me with your city and I'll keep an eye out on Kijiji for you.

[tigertrout]

Here is the print out, let me know if this is all that is needed.

Analysis (Flow evaluation period: 9 h 11 min / SpO2 evaluation period: 9 h 22 min)
Indices Normal Result
AHI*: < 5 / h Average breaths per minute [bpm]: 8.21
RI*: < 5 Breaths: 4525
Apnea index: 51.6 < 5 / h Apneas: 474
UAI: 0 Unclassified apneas: 0 (0%)
OAI: 27.7 Obstructive apneas: 255 (54%)
CAI: 20.7 Central apneas: 190 (40%)
MAI: 3.2 Mixed apneas: 29 (6%)
Hypopnea index: 2 < 5 / h Hypopneas: 18
% Flow lim. Br. without Sn (FL): 12 < Approx. 60 Flow lim. Br. without Sn (FL): 551
% Flow lim. Br. with Sn (FS): 16 < Approx. 40 Flow lim. Br. with Sn (FS): 723
Snoring events: 3640
ODI Oxygen Desaturation Index*: < 5 / h No. of desaturations: 477
Average saturation: 92 94% - 98% Saturation <= 90% : 148 min (26%)
Lowest desaturation: 69 - Saturation <= 85% : 43 min (8%)
Lowest saturation: 69 90% - 98% Saturation <= 80% : 8 min (1%)
Baseline Saturation: 96 % Saturation <= 89% : 123 min (22%)
Saturation <= 88% : 99 min (18%)
Minimum pulse: 43 > 40 bpm
Maximum pulse: 102 < 90 bpm
Average pulse: 65 bpm
Proportion of probable CS epochs: 0 0%
Analysis status: Analyzed automatically
Analysis parameters used (Default)
Apnea [20%; 10s; 80s; 1.0s; 20%; 60%; 8%]; Hypopnea [70%; 10s; 100s; 1.0s]; Snoring [6.0%; 0.3s; 3.5s; 0.5s]; Desaturation [4.0%]; CSR [0.50]

[tigertrout]

I put the results of the sleep test up for review.......

[Miss Emerita]

Thanks for providing the summary report. There are several measures I don't understand, but I believe I understand these:

Apnea index: 51.6 < 5 / h Apneas: 474
UAI: 0 Unclassified apneas: 0 (0%)
OAI: 27.7 Obstructive apneas: 255 (54%)
CAI: 20.7 Central apneas: 190 (40%)
MAI: 3.2 Mixed apneas: 29 (6%)
Saturation <= 88% : 99 min (18%)

These results strongly suggest that you have mixed apnea, with a significant proportion of your events central in nature. Central apneas are pauses in breathing of 10 seconds or longer in which no obstruction is detected. CAs are usually treated with a specialized machine, an ASV machine (adaptive servo-ventilation). More here:

https://www.aastweb.org/blog/what-is-asv

You are having significant oxygen desats during the night, so it is important to treat your apnea. It's *possible* you could be successfully treated with an ordinary PAP machine, but honestly I am skeptical.

Bottom line, can you share the results of this study with your doctor to discuss the best next steps? Perhaps the first step will be to try an ordinary PAP machine to demonstrate that it doesn't work, then move on to an ASV. That is often what happens. But the sooner you get going on this, the better.

I would happily defer to the experts on the site with all of this.

[Miss Emerita]

One additional thought. Ideally your doctor would accept the results of the sleep report as sufficient for ordering a titration study. And ideally, the titration study (a sleep study in which you're trialed during the night on machines and settings) would start you on regular PAP, and then if that didn't control your AHI, shift you to ASV. That way you could demonstrate "failure" with regular PAP and success with ASV in one night -- IF indeed you need an ASV machine.

[michaeldwilson]

Before you go the DIY route, could you let us know more about the results of the test? In particular, what was the breakdown of the events you had? (Obstructive apneas, hypopneas, central apneas, respiratory-effort-related arousals [RERAs].)

good point!

A word about the DIY route and full face masks.

I tried and tried to get the full face mask to work but I had leaks and a nice red mark on the bridge of my nose. I decided to try a "hybrid" AirFit F30i mask on the cheap, so I frankensteined one by purchasing the four parts from ebay. I bought everything for around $60. I've had much success with it.

Best of luck!

Mike