Possible that I would need a different pressure every night?

[2girlsmom]

OK, I have given my background a few times with regards to apnea but basically I wasn't feeling as good @ 10cm so I was retitrated to a 14. I still felt crappy there so I decided since sleep doc has my d/l from my time at 14 I would experiment for a few weeks.

Sun night @ 11 I had an AI of 0.2 and felt GREAT!! Also dreamt a ton!
Mon night @ 11 I had an AI of 1.8 and woke with a headache. Dreamt very little.

From seeing how much of a difference there was each night, and then seeing I would have the occasional night @14 below 5 AHI, I really think I should trial and autopap. Or would most doctors just poo poo that notion?

I'm just amazed at how different my nights were so far. I'll keep tracking things.

[MichelleFL]

I think you should go for it! I am trying to do the very same thing even though I don't have a machine to back me up yet on my own theory. I don't believe that my level of pressure which my sleep doc has set at 6 is going to be what I need everynight as some of my nights are worse than others.. Good luck with this!

[goose]

Hey 2.....
You sound like a textbook case for an Auto machine. Adjusting to your needs is precisely what the Auto machine will do.....
Example -- I had mine at 10cm in CPAP mode for almost a year. Numbers were good but still felt crappy most days -- better than before treatment, but still not real good. I changed to the APAP mode, played with a few ranges and now have it set at a range of 10-15....There's a big difference in the way I feel each day, and the numbers are still pretty much the same. It rarely ever hits the top numbers and my 90% number is generally about in the middle, so that's where I'm leaving it for now.

In your shoes, I'd talk with the doc about what's going on and tell him/her that you want an Auto machine so that you can self titrate and use the range facility to let the machine adjust to your needs each night. Study up on all the arguments (our collective wisdom -- above) and be prepared to have the doc disagree with you. If he/she does agree, ask for a make/model specific prescription (again study on which manufacturer's machine you would like) with the appropriate range. It sounds like a 10-15 range would work for you. But make sure it's a data capable machine and get the software and card reader so you can view your reports and take active control of your therapy!!!! Be prepared to have the DME fight having to provide an Auto machine (hence the make/model specific prescription) because the billing codes for a straight CPAP and an Auto CPAP are the same -- they make more $$$ if you don't get an APAP!!!!!
Hopefully your doctor will embrace that action!!!! (Mine sure did)....

Good luck -- let us know how you're doing
cheers
goose

[2girlsmom]

I plan to go into my appt in 2 weeks VERY prepared. I am tired of feeling bad. I am thankful the sleep doc Rx'd an Elite so I can see the data but after seeing it, and still feeling bad some of the time, an APAP would most likely improve things. I've had a headache ever since I woke up this morning. Ugh. I know it's my higher AI, and who knows how long they were, as well. Ugh.

The funny thing is, yesterday I felt GREAT and today it's just AWFUL.

[Babette]

Yup. Been there, done that. I don't have a great answer for you. In my case, I remember one incredibly euphoric day after the first night with the Hybrid mask, straight CPAP of 10, and then never being able to replicate it. It mystified me.

Now, I don't usually have EUPHORIC days, but I'm slowly and steadily better than I was before. I've gotten into a fairly comfortable groove. I've recently decided to go with the Auto again, and as of last night, changed to 10-20 cm. Looking at my numbers, they do appear to be going down over the past month, since I switched back to Auto. And since I started taping more. I'm still not 100% compliant with taping, but I'm working at about 85% now.

Don't put one bad night out there as your final word on this particular combo. Give it a few more tries. If you don't bounce back, then tweak something else.

Might be that you're like me, and you require constant tweaking. Some people do seem to need that. Some people can just "set it and forget it" and get Zero AHI and feel great. I hate those people, but then, I hate blondes, skinny people, and rich people too. Fat lot of good that gets me.

Good luck!
B.

[2girlsmom]

Babette, I'm with you on the skinny and rich people but I did marry a blonde and he's pretty great so I'll disagree with that one only on that count. I'll try the rest of the week and then see where I'm at. Then I'll try 12 for a week. My sleep doc might not like it, but this should prove my case for an APAP I would think.

[RAINSUX]

I also recommend an Auto machine so that you're better able to keep up with things.

I was titrated at 7 and was still getting used to the mask when I found this group. I bought the software and reader and found that my AHI was in the teens. I would have never known, and the VA was not going to help me fnd out. I gradually increased my pressure and saw a gradual decrease in AHI. My AHI bottomed out at 10.5 and it stays around 1.5. Thanks, Group! My AHI will increase if I change the pressure to 11. I couldn't get past the idea of an Auto machine, though, and the VA wouldn't get me one, so I bought it myself. It pretty much confirmed what I had already found out, that 10.5 is my sweet spot, but that was a good thing. I think I'm one of those people who does better on straight CPAP, and I usually sleep with the old Pro2 Tank. But I switch to the APAP for a few nights now and then just to make sure nothing has changed. Or just to try something different.

If I had to have just one machine it would definitely be an APAP (mine is a Respironics AFLEX) even though I would probably leave it on straight CPAP most of the time. The more options you have, the better.

Sam

[2girlsmom]

Thanks Sam, for your reply. I wish I had realized how nice an APAP would be to have before I got this Elite. Oh well. I'm sure my insurance will just looove having to buy another machine if dr rx's it. Sleep studies ain't cheap so I just think EVERYONE should get an auto, for crying out loud. They should just always prescribe them. Sigh. Oh well. I just hope I sleep half decent tonight.

[NooneInParticular]

Sun night @ 11 I had an AI of 0.2 and felt GREAT!! Also dreamt a ton!
Mon night @ 11 I had an AI of 1.8 and woke with a headache. Dreamt very little.

From seeing how much of a difference there was each night, and then seeing I would have the occasional night @14 below 5 AHI, I really think I should trial and autopap. Or would most doctors just poo poo that notion?

I'm just amazed at how different my nights were so far. I'll keep tracking things.

It is amazing. Most docs wouldn't think AHI of 1.5 could make ANY difference. How are you tracking all this? Did your doctor give you a software and reader or did you buy them?

[2girlsmom]

My AI is the only thing I listed there, AHI was higher, but Resmeds read the HI portion a bit high. I know that my apnea is severe in REM (33.5 events, desat to 76%) so for me, an AI of 1.8 probably means I had way more apnea events than 1.8 an hour because mine all practically come in REM.

I am just looking at the LCD screen right now and recording that. My software and reader are on the way today, so I'll be able to really look at things then.

[NooneInParticular]

My AI is the only thing I listed there, AHI was higher, but Resmeds read the HI portion a bit high. I know that my apnea is severe in REM (33.5 events, desat to 76%) so for me, an AI of 1.8 probably means I had way more apnea events than 1.8 an hour because mine all practically come in REM.

I am just looking at the LCD screen right now and recording that. My software and reader are on the way today, so I'll be able to really look at things then.

What were your AHIs on good and bad nights, anyway?

As for REM-specific apneas, it is a contentious issue. Look at this study where REM specific OSA was not associated with any daytime sleepiness http://www.ncbi.nlm.nih.gov/pubmed/1200 ... d_RVDocSum. A huge analysis may soon be published showing no adverse daytime or cardiovascular outcomes a/w REM-OSA, even if it is severe (in contrast to NREM OSA). Some smaller studies, however, do show sxs a/w REM OSA.