Newbie - brief introduction and need some quick advise

[engrdad]

My story is that I have had migraines since the age of 12 (presently 45). I complained to my neurologist recently that I have had a dramatic loss of energy for the last 6+ months and I have not been sleeping very well. My family doctor has me on ambien nightly. The doctor asked if I snore and I explained that my wife wears ear plugs each night. Therefore, he had a man deliver a oximeter for me to use at home. After this, the doctor told me I had 93 episodes and ordered a sleep study. I completed the first sleep study last Wednesday night. If required (and the nurse stated it would be), my next sleep study will be this Thursday.

This is all new to me and I am presently pretty ignorant about all this. Your site is great and I am sure all my questions could be answered with research. However, due to my insurance, I am very time limited. I have UnitedHealthcare and am having the study at sleepworks (PPO for my insurance). The agreed amount is ~$1300 per study ($2600 total). The equipment is quoted to cost ~$1500 more. I have ~$1000 left on my yearly deductible this year and then insurance covers 90%. Next year the deductible goes back to $3000. Therefore, doctor & sleepworks have agreed to get all completed and any required equipment ordered before Christmas.

Since time is so short, I am assuming I will need a machine and will be researching as much as possible this week. My questiona are:

1> If money is not an object, what equipment is recommended? What would be the best APAP machine and what would be the best CPAP machine to start out with? From the few minutes I have researched, it appears that the Respironics M Series REMstar Auto with A-Flex seems popular for the APAP.

2> Will the test determine what type of mask is required (nasal, mouth, face, etc...)? I notice that I seem to breath through my mouth mostly when I sleep.

3> What type/ brand of mask is recommended? I typically sleep on my side.

I know that I am jumping the gun here but I have very little time. I want to take advantage of this small window to get the best machine, mask, other equipment?? that I can. Also, any ideas on getting the doctor to order what I want would be appreciated as well. Thanks in advance for any suggestions......

[Wulfman]

Welcome to the forum.

Part of the answers to your questions lie in what is found in your sleep studies.
The REMstar Auto with A-Flex is the "latest and greatest" in the way of APAP/CPAP machines (APAPs will run as CPAP machines).....if you have the "garden variety" of Apnea called OSA (Obstructive Sleep Apnea).

HOWEVER.....if they find in your sleep study that you require higher pressure than an APAP/CPAP can deliver (20 cm.), then you would need a Bi-PAP machine.
If you have a number of Central Apneas in your titration portion, then you may need a special type of machine. (S/T or ASV......much more money)

Have you gone to the yellow lightbulb (Our Collective Wisdom) and read those articles yet?

Get your ducks in a row by doing lots of reading.

Best wishes,

Den

[mindy]

Welcome!

I'm just going to try to give you a *brief* overview but am sure that more knowledgeable members of the forum will chime in with their suggestions.

The Respironics M-series APAP with A-Flex is a popular choice. I have it. If you get one of these, you don't need to make the APAP/CPAP decision ahead of time ... since the APAP machines can be set to straight CPAP at any time. It is also "data capable" which means that you can download the nightly data to your computer and use EncoreViewer to see how your therapy is working (if you are interested).

Masks are definitely patient-specific. No two faces are the same and there is no mask that works for everyone. Nasal pillow masks are less obstrusive and lighter; full face masks work better for others. I have a nasal pillow mask (or more than 1) and am now working on finding a workable full face mask for those times when I have a stuffy nose. If you have a helpful sleep center, it may be possible to get "loaner" masks from them to try. Your sleep doc may have suggestions also.

If you are a mouth breather, you may need "additions" to the nasal pillow mask (lots of creative ideas on this web site).

Also note that the machines are significantly cheaper through some on-line vendors (like our sponsoring web site) but then you don't have the potential help fo the Durable Medical Equipment (DME) provider -- which some don't get anyway.


I'll let others add to this.

Best of luck!
Mindy

[Slinky]

Most scripts for equipment are very generic and then you are stuck fighting w/the DME supplier for a better xpap. This is a suggested script to show a good specific equipment script.

1] Respironics REMstar M Series Auto w/A-Flex (w/heated humidifer if you prefer)
2] IP ---- cms (whatever your inhalaltion pressure is)
3] EP --- cms (whatever your exhalation pressure is)
4] A-Flex setting 3 (or whatever your doctor determines)
4] Ramp off (unless you prefer it on)
5] Show AHI/Leak feature On
6] Fisher & Paykel HC 150 heated humidifier (unless you prefer the integrated heated humidifer. If so just add "w/heated humidifier to the REMstar Auto w/A-Flex)
7] Nasal mask, Full Face mask, or nasal pillows mask of patient's choice.

The reasoning for this:

1] Exact brand and model of machine
2] Scripted pressure (the autoPAPs have a pressure range rather than a set pressure)
3] Scripted amount for lower pressure at exhalation
4] Starts w/4 cms of pressure and ramps up to your set pressure after you get to sleep
5] Allows you to access your nightly data via the LCD screen
6] While the integrated humidifiers are most convenient for travel and take up less space on your nightstand, in really dry situations sometimes they can't provide as much humidity as you might need or want. For many the integrated humidifiers are more than satisfactory.
7] This ensures that you can try several masks, including a full face mask (sometimes they insist on a script specifiying full face if the script just says mask, or will only provide the exact mask mentioned in the equipment order).

The above are compliments of RestedGal. I can't take credit for them.

[ozij]

Slight correction:
The IP and EP terminology is used for machines that give different pressure for inhalation and exhalation = bi level machines.

Bi-levels are more expensive - and crucial for some people, especially if they need high inhale pressure, and do not need (or even suffer from) high exhale pressure.

If money is no object, then - according to Rested Gal - nothing beats the comfort of a Bi-pap Auto, and Respironics does have a Bi-pap Auto with cflex (that's 3 different features) Edit: though on the bi-pap the "flex" option is called bi-flex (Thanks, RG, for the correction). .

An APAP - auto - self adjusting machine - like the Respironics with A-Flex had a pressure range from high (top) to low (bottom). You may want to have that range on the script. It is not an IP EP thing, and I wouldn't use those terms on an APAP script.

A-flex is the more advanced c-flex. The flex comes from "flexible" and has to do with the way the machine attempts to make exhaling easier.

O.

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, C-FLEX, cflex, auto, APAP

[engrdad]

Thank you all for the quick replys. I just got a call from the sleep center and, as suspected, I failed the test. I asked her how bad it was and she said I had 70 events per hour and needed to come back for the second study this Thursday. I will do as much research as possible between now and then. Thanks again...

[mindy]

Try not to think of it as "failed" - rather think of it as catching a problem that can lead to a big improvement in your health and sense of well-being!

Yes, you do have a high number.... but that can be managed.

Mindy

[DreamStalker]

Thank you all for the quick replys. I just got a call from the sleep center and, as suspected, I failed the test. I asked her how bad it was and she said I had 70 events per hour and needed to come back for the second study this Thursday. I will do as much research as possible between now and then. Thanks again...

You didn't fail ... your in like Flynn man!

Welcome to the club!!



Sorry about the apnea Dx though

[gasp]

I was a member of this forum for two months before getting my machine : ) Best decision I could have made to learn about what would now become an almost ideal setup.

If money is no object, try the Respironics A-Flex on a rental/lease basis and if it doesn't work for you move on to another machine. I LOVE it!

So many masks I thought would work for me have not. My advice is to try as many as possible (if money is not object) and find the one fits, is comfortable and better yet, performs. I believe it's imperative to know your numbers - meaning how many events you still have, their duration, and more.

It took many tries to get the mask that would work for me. I'm a side sleeper and need a mask that will stay put. I ended up using the ResMed Mirage Vista (nasal mask) that doesn't work for many people, but works so well for me. It took many masks to go from a sleep study AHI of over 52 to consistently being under 1 now. That took paying close attention to the numbers and understanding what works and doesn't work for me.

Most masks have different characteristics such as quiet, noisy, and leak differently. You can go to your browser (I recommend Google) which works better to find info than this site's search feature, and key in " dreamstalker leak " and you'll see some handy info regarding different masks and their associated leak rates.

I have allergies so sometimes need a full face (FF) mask. I use the ResMed Mirage Quattro. It isn't an ideal fit, but does the job when I need it to. Advice of others here on the site led me to use a Neti Pot which cleanses my sinus cavities reducing nose stuffiness a great deal.

Best wishes!

[Slinky]

THANKS for catching that and correcting it, Ozij!!! I did make a mistake about the pressure range for autoPAP vs the IP and EP for the bi-levels. (Me bad, and then tried to blame it on RG, tsk, tsk!) 20 lashes w/a wet noodle for me!

That's what happens when you try to copy something in a hurry. I had a 2PM doctor appointment in town.

[mindy]

Hi Slinky,

When I do things like that, I call it "SCOB disease" (Swiss Cheese On the Brain")

Mindy

[differentdave]

Welcome to the forum, I have been on a m-series with a-flex for 6 days I think. I was able to go from second sleep study to having a machine in house in less than 2 weeks. Not sure if it will work for you but here it is
1: READ light bulb and question mark (I printed a lot out to read on commute, down time, etc)
2. You must get copy of both sleep studies (full reports not just the summary) from sleep clinic/doctor
3. As mention you MUST get script for specific machine you want (I highly recommend the a-fles)
4. Call insurance company find out benefits (how often do you get machine, mask, hose/filter/gel inserts/headgear/etc what’s your copay (you know deductible), etc
4. Tell sleep clinic/doctor NOT to fax script to dme, you might have choice and want to 'interview' the different ones.
5. Fax script/sleep study results to dme of choice, then follow up with confirmation call and to schedule appointment.
IN my case, sleep clinic, doctor and dme were all receptive to my research, knowledge, questions, etc.
Best of luck, you cant fail a sleep test. Educate and read the forums/faq/wisdom/etc and ask away!

[grandmma]

A tip with your mouth breathing which may help. I'm a dedicated mouth-breather (at least, was), and have just come off 8 weeks trial and purchased my first machine. Trouble is, due to the mouth-breathing, I initially trialled many masks and techniques without success.

I don't know if you've heard of the technique, but polident strips are wonderful. You place one between your lips - I bend it slightly first to shape, and it does take some trialling - and it sort of seals them shut all night. You can open your mouth, but it requires awareness and therefore when asleep they stay closed. It is only slightly gooey to remove, and far better than tape or a chin strap in my opinion. No marks too.

Good luck, whichever way you choose.

[differentdave]

oops when at 2nd sleep study have them try on different style masks at beginning (if need be tell them a while lie -its not comfortable, try full face, nasal pillow and nasal if possible)
Your DME should assist you in fittings and trying on different masks. This is a question to ask while 'interviewing them'. Also ask about return (under 30 is the case with my dme) and I am probably going to return my full face mask for a different model as the one I have sticks out to much and sleeping side causes breakage of seal unless mask is super tight.

Brand of mask is solely based on what fits you and what works for you.
Again best of luck/success

[gasp]

I forgot about the mouth breathing part of your post. I was a mouth breather and had to wear a chin strap when I first began therapy. I really didn't like wearing the chin strap so was determined to learn to keep my mouth closed during sleep. It didn't take too many times waking with discomfort after swallowing air in the night to keep my mouth closed while asleep.

Now I breath with my mouth closed during the day too - nice : )