Another new user (Looking for Sandman Auto Comments)

[coreyg]

Hi, I've been lurking here for a while but I always have a few questions so I figured I need to introduce myself.

I'm 42 and over-weight with high blood pressure. My normal doc has been seeing me every 3 months since he put me on high blood pressure pills and about a year ago, I mentioned that I had to eat snacks all of the time to stay awake. He immediately scheduled me for a sleep study but he did this as we were walking out and I really wanted to talk to him before any sleep study. (I was in denial and I only knew you had to stay the night for a sleep study and I didn't want to do that). So, when the sleep study clinic called, I said I wanted to talk to my doctor before I set up an appointment. So, three months went by and I finally saw my doctor again. He convinced me that I need to go (and in retrospec, the OSA was getting worse), so he called the sleep study guys again but they must have had a note in my file that I refused the appointment and they never called. So, another three months went by (now the OSA was really bad, I was falling asleep driving, at work and even while I was talking sometimes) and I got the phone number of the sleep study people and I called them. I got in after a couple days and my AHI was 75 or so. But, I never talked to the sleep doc. I only talked to the technician who was extremely helpful but was not allowed to tell me certain things. I was able to guess since it was a split-study so once they put the mask/xPAP on me, I knew I had OSA. After a couple days, they sent the entire report to my normal doc who called me (he's never called me before!) to refer me to a DME provider to get me a CPAP.

At this point, I googled and found this group and realized I wanted a data capable system. I didn't know anything else (like Constant vs Auto) but I really wanted to be able to see how things were going. When the DME called, I asked for a data capable system and they asked me if I was a licensed sleep specialist and that the prescription didn't say data capable. I was mainly interested in getting feedback on whether I'd be able to decrease the pressure (at the sleep study when they increased above 10, I swallowed air and came very close to stopping the whole thing) as I hopefully lost weight. At that point they said they could send a titration system home with me to see.

I was annoyed with the "licensed sleep specialist" comment but at this point I didn't have a prescription, I was falling asleep everywhere and I just wanted something quickly, so I went in and they gave me a Sleep Easy CPAP and a copy of my prescription! It's interesting to me that my prescription said "with C-Flex" which I don't think the Sleep Easy has so they didn't even fill my prescription correctly.

The Sleep Easy was good enough, after about a week, I was feeling a lot better and no longer falling asleep during the day. When I left the DME, she said to call her the next day. So, after the first night, I called her and said I used it most of the night but took it off after about 6 hours. I think when the sun came up, I (half asleep) thought it was almost time to get up and just removed the mask. As I was hanging up on her, I think she said to call her tomorrow. I didn't think I had to call her every day so I didn't call her. That was the last time I talked to her. After about 3 months, I got a call from their head quarters asking me if I was still using the system and whether or not I wanted the supplies. I told them, yes and actually, I thought I had already signed up for the auto supplies (actually, I'm sure I signed the paperwork for it, I think it wasn't forwarded to the main office). So, they sent me the first shipment. It has a hose, a mask cusion (I use the Forma Full Face Mask) and another mask.

About this time, I was not liking the fact I had no feedback from the CPAP, so I ordered a Sandman Auto with card/software (paid for by me). I choose this one because of the mobility, I travel on business every couple months and I like to go to Europe for vacation in the summer each year and I thought it'd be easier to take with me than some of the other models. I received it and started using it before I changed masks or cusions so I'd know where I was. The one thing that surprised me was my HI number was generally 15 to 20. The AI was usually between 1 and 3. This is with a constant pressure of 16 cm (my prescription). The HI stayed this way for about 3 weeks (except one day when it went to 30, I had a cold/flu that day so I assume that's why).

I then decided to test the Auto feature and changed to AUTO from 10cm to 16cm (16cm is my prescrition). The first thing I noticed was the pressure went up to 16 very quickly and stayed at 16 most of the night. I didn't really want to increase the pressure above 16cm since I was hoping that 16cm was actually a little high (based on the sleep study info which was all I had until this experiment). After a few days, I decided to try out the new mask in an attempt to lower the leaks since I had been using the same cusion for 4 months now. I had some problems getting it to fit, but I thought it was the fittings and I kept trying to get it to work. After 4 or 5 days of really bad mask leaking and not fitting right, I finally pulled it out and compared the size to the original. It was smaller. I studied the box it came in and I noticed there was a "Medium" sticker as well as a "Large" sticker on the box. When I first got it, I noticed the "Large" size sticker but not the "Medium". It seems they sent me a medium size mask and a large size cusion. They knew that the Large fit me (they tested that in their office), I have no idea why they sent a medium other than stupidity or insurance fraud. When I was having problems with leaks (because the size was wrong), I ordered a Mirage Quattro since it got a lot of reviews about not leaking. I received that a couple days after I figured out the size problem but for same reason, I was still getting a lot of leaks even with the new Large cusion on the old mask. I think I just didn't have the straps adjusted right but I couldn't figure out anything that wouldn't leak. So, I switched to the Quattro and the leaks are now a lot better and what's really weird to me, my HI are now typically down to 4 to 6. I'm not sure if that's because of AUTO or because of the mask or because I finally got the mask leaks under control. Although, when I had the Sandman for the first 3 weeks set to constant 16cm, there were very few leaks with the first mask and HI was higher.

Sorry for the really long post. I meant to introduce myself back when this story was a lot shorter, but I kept putting it off.

Right now, I'm not really that happy with the Sandman's software. I have a lot more info than I had before, but that has lead me to more questions that it hasn't been able to show me. My main issue is seeing the difference between apneas and hypopneas on the graphs as well as I can't figure how the length of the apneas. The resscan graphs look more useful to me but I really didn't want to spend another $800 or more this soon after the sandman. And, on top of that, my HI has suddenly come down to near 5 recently so the need to see the hypopneas on the graph is reduced.

My biggest issue of all of the above is, I have NEVER talked to the sleep doctor! I've talked to my doc and to the DME but other than the report from the sleep doctor, I have no other info from them. I find this quite strange.

I'd like to thank everyone that has been posting while I've been lurking. The info on this forum has been extremely helpful to me.

Thanks,
Corey

[KatieW]

Welcome to the forum, and your 1st post, coreyg. I always find it interesting to read about someone else's journey.

I don't know if were asking any specific questions, but I will tell you that I had a 5 minute "talk" with my sleep doctor. He basically gave me a copy of the sleep study/titration (which I much appreciated) and my prescription. And said "see you next month". I said I'd be gone for 6 months, and he said "ok see you in 6 months". If it hadn't been for this forum, I wouldn't have had any information or support in my therapy. I am so grateful to this forum, and all its generous members.

Do get a copy of your sleep study/titration, if you haven't already got one. And a copy of your prescription.

[coreyg]

yes, I got a copy of my sleep study report and a copy of my prescription. The prescription allowed me to my the Sandman auto so I now have feedback on how things are going. I don't really understand the non-data systems specially after all of the leak problems I had last week. I didn't know how bad it was without looking at the data.

Thanks,
Corey

[roster]

yes, I got a copy of my sleep study report and a copy of my prescription. The prescription allowed me to my the Sandman auto so I now have feedback on how things are going. I don't really understand the non-data systems specially after all of the leak problems I had last week. I didn't know how bad it was without looking at the data.

Thanks,
Corey

Welcome Corey.

You did not ask any questions (that won't stop me from answering them anyway ), but maybe you would like to have some comments on the Sandman data. If so, go back to your original post and click on "Edit". Then change the title of the thread to something like "Sandman Auto User Wants Comments". That will help your post get attention from Sandman users.

[coreyg]

By the time I got to the bottow of the first post, I forgot the questions.

With the Sandman software, is there a way to tell the difference between Hypopneas and Apneas on the time-line graphs? And, is there a way to tell how long the apneas are?

And more generic,
Do snores really indicate a need to increase pressure when in auto mode?

When I'm in auto (10 to 16cm), the pressure goes up to 16 very quickly and stays there most of the night and when I look at the graphs, it's the snores that are generally raising the pressure. I didn't really want to increase beyond 16 although I'm now thinking about it to see what the pressure does (and whether snores decrease with higher pressure).

Thanks,
Corey

[roster]

When I'm in auto (10 to 16cm), the pressure goes up to 16 very quickly and stays there most of the night and when I look at the graphs, it's the snores that are generally raising the pressure. I didn't really want to increase beyond 16 although I'm now thinking about it to see what the pressure does (and whether snores decrease with higher pressure).

Thanks,
Corey

Most experienced users of APAPs in general, say a pressure range of no more than two to three cms works best. I recommend changing the pressure range to 14 to 16 cm and monitoring the data and how you feel.

Do you know the answers to all these questions?

Questions to ask about your PSG and Titration Study
by CPAPtalk member rooster

1. Did I have any central apneas? How many?

2. Were there any comorbidities? What were they?

3. Did I breathe or leak through my mouth? How often? What do you recommend to prevent it?

3. Did I exhibit Positional Sleep Apnea (PSA)? Was my apnea more severe in one sleeping position as compared to others? Is my pressure requirement higher in one position as compared to others? (Often sleep apnea is more severe when sleeping on the back.)

4. Is there anything else unusual about the results?

5. How will I know my therapy is preventing apneas?

6. I am determined to own a data-capable machine and software to monitor apneas, hypopneas and mask leak. This will allow me to call your office with specific questions if I have problems with the therapy. Will you help me with the appropriate prescription?

In addition to the questions:

1. Get a copy of your PSG. It is your legal right to have one.

2. Get a copy of your CPAP prescription.

3. Make sure the prescription calls for a humidifier with the machine.

[rested gal]

Welcome to the forum, Corey. That was a very good introductory post you wrote.

If you have leaks well under control, and since you have the software to see how things go, I'd try a range of 14 - 20.

But I'm not a doctor or anything in the health care field. I'm only an autopap user with about 6 years of using different brands of autopaps. No experience with the Sandman Auto, however -- just several years with its predecessor (the PB 420E auto.)

[coreyg]

1. Did I have any central apneas? How many?

Yes, but less than 0.5 (per hour) at 16cm.

2. Were there any comorbidities? What were they?

I don't know what a "comorbidities" is.

3. Did I breathe or leak through my mouth? How often? What do you recommend to prevent it?

Yes, they switched me to a full face mask and I've been using that since.

3. Did I exhibit Positional Sleep Apnea (PSA)? Was my apnea more severe in one sleeping position as compared to others? Is my pressure requirement higher in one position as compared to others? (Often sleep apnea is more severe when sleeping on the back.)

I'm not sure on this. I'll have to look at my sleep study report again to see if it says anything about this.

4. Is there anything else unusual about the results?

I thought so. Looking at the sleep study result, I noticed that at 10cm, I had very few apneas but when I got one, they increased me to 16cm where I started having a few central apneas. At home and at 16cm, I have very few central apneas (according to sandman). This result (before the sandman data) led me to believe that 10cm may be enough pressure to treat my apneas. With the sandman data, I'm starting to think that 16cm is not high enough.

5. How will I know my therapy is preventing apneas?

Ha, I tried this with the DME. It didn't help getting a data-capable system. I got a VERY condescending response. But, that's why I bought the Sandman with software.

6. I am determined to own a data-capable machine and software to monitor apneas, hypopneas and mask leak. This will allow me to call your office with specific questions if I have problems with the therapy. Will you help me with the appropriate prescription?

I should have done this with my doctor. I think he might have done it, but he really just forwarded the sleep doctor's report and I never talked to the sleep doctor.

In addition to the questions:

1. Get a copy of your PSG. It is your legal right to have one.

PSG? Are you referring to the sleep study report?

2. Get a copy of your CPAP prescription.

Yup, got it!

3. Make sure the prescription calls for a humidifier with the machine.

Yes, it does.


Now, I sort of wish I had walked out on the DME after their reply to the data-capable system request but at the time, I seriously needed a CPAP and I did not have a copy of the prescription at that time. I could not drive more than 10 minutes before I started getting extremely sleepy and I was very worried I would get into an accident. I'm amazed now that I did not. I actually had issues just staying within the lane and that was when I was "awake".

-Corey

[Thunder Road]

If your range is 10-16 I would set the command on apnea setting to 14 or 15. I would also set the comfort pressure to 12. This will stabilize the pressure to remain at 12 should there not be any events and allow it to go up to correct an event within a tighter range if the need arises.

I would also consult the waveform analysis report. This has all the data and the time it occurred.

Make sure the humidifier chamber is sealed. If it is not snapped together (lid and base) this will result in a massive leak and your data will be invalid. This happened to me.

Good luck! It is a great machine and the software is comprehensive.

[coreyg]

Hi Thunder Road,

Thanks for the settings suggestions. I wasn't sure about the comfort pressure and I just recently found out what the "command on apnea" setting meant.

So, the sandman (in auto mode) will increase from the comfort pressure if there is an event that triggers it? I was never sure of that, so I'd
always hit the on button to kick it out of the comfort pressure (which I've left at 4cm) if I needed to.

Thanks,
Corey

[Thunder Road]

The comfort pressure should be set somewhere between your minimun and maximimum setting. This will keep a tighter range to prevent a pressure spike should you have an event the machine will not have to 'chase' it to correct it. The comfort pressure should never be lower than the minimum. The command on apnea setting will allow the machine to correct and apnea above 10cm. I would set that close to your max pressure setting.

[roster]

The comfort pressure should be set somewhere between your minimun and maximimum setting. This will keep a tighter range to prevent a pressure spike should you have an event the machine will not have to 'chase' it to correct it. The comfort pressure should never be lower than the minimum. The command on apnea setting will allow the machine to correct and apnea above 10cm. I would set that close to your max pressure setting.

Thanks for chiming in and making good suggestions. What do you think about keeping the max setting at 16 for a few nights, monitoring the data and then making a decision about whether the max needs raising? She seems to have very little tendency to centrals, but I would prefer caution at this point.

[Thunder Road]

I agree wth your assesment. Tighten things up. See how the data looks and then make changes. Good idea!

[rested gal]

Corey's already hitting, and staying at, 16 regularly. And, 16 was the prescribed single pressure from the sleep study.

I then decided to test the Auto feature and changed to AUTO from 10cm to 16cm (16cm is my prescrition). The first thing I noticed was the pressure went up to 16 very quickly and stayed at 16 most of the night.

That's why I'd raise the max pressure to 20... if leaks are under control. With more ceiling up above, it will be easier to see if the machine does think corey needs to have more pressure at times than 16.

Good suggestions, Thunder Road, about the other settings available on the Sandman auto.

[mars]

Hi coreyq

Post by Thunder Road on 23 Feb 2010, 20:25
If your range is 10-16 I would set the command on apnea setting to 14 or 15. I would also set the comfort pressure to 12. This will stabilize the pressure to remain at 12 should there not be any events and allow it to go up to correct an event within a tighter range if the need arises.

Post by Thunder Road on 23 Feb 2010, 20:43
The comfort pressure should be set somewhere between your minimun and maximimum setting. This will keep a tighter range to prevent a pressure spike should you have an event the machine will not have to 'chase' it to correct it. The comfort pressure should never be lower than the minimum. The command on apnea setting will allow the machine to correct and apnea above 10cm. I would set that close to your max pressure setting.

There appears to be some confusion about the "Comfort Setting".

It is not as described above.

The manual says - page 16 - Using The Ramp Feature -

The ramp feature allows for a gradual rise in pressure to help you go to sleep. Therefore, treatment begins at a low pressure, called the comfort pressure, and rises from there to the pressure prescribed by the physician.

This to allow the user to start with a pressure lower than the minimum, to possibly help the user to go to sleep.

On page 40 of the manual you will find a description of Command on IFL. I suggest you check out your understanding of this feature.

And remember the old computer wisdom, first - read the manual

cheers

Mars