Semi-newbie - need some help

[Sasquatch75]

Hi all. I have been lurking around here for a while now. I have gotten some great info to help make my CPAP therapy more successfull. Here is some of my background.......

I had a split sleep study done at the end of January. On the first of February I met with the ENT who sent me for the sleep study. He didn't give me a lot of info other then I have around 42 events an hour and my titraited pressure was at 9 cm H2O. The doctor was going to send my script to a DME that works with my insurance to get a CPAP. I requested a fully data capable machine and was denied. I stated that I did not sleep well ant the sleep study. I didn't think I slept at all, but they told me I did. This is the start of not caring for my doctor treating my sleep apnea.

On Feb 4, i received a Resmed S8 escape II with heated humidifier and a respironics nasal mask. Within a week I was calling the DME to get another mask. I got a Resmed Swift LT. Now this is getting better. I really like the the Swift Lt. Now I can't wait to start feeling better.

After two weeks of 100% compliance, I call my doc and tell him I do not feel any differant. Doctor's response......Give it a couple more weeks then come in. Doc, I know my body, I know how I feel and there is no change. Didn't help. Really starting to not like him.

Then finally on March 8 I go to see the doctor. Tell him I still don't feel any poositve effects from the CPAP. Doctors response.....Well, obviously you don't respond to CPAP we should do surgery. I tell hin NO!!! I say they are CPAP machine out there that are fully data capable and can help to fine tune the pressure. I am sure I did not sleep well at the sleep study, so maybe now I am getting into REm sleep a little more than before which could be causing more events.

So we discuss this for one minute. I give him the name of the machine I would like to get. A Resmed S9 Elite II. He said he will send the script to the DME. I think, alright I will now have a full data machine.

Two weeks later DME shows up at my house. Here is the two week auto-PAP trial your doctor ordered. I am a little frustrated, but thought OK I'll try it. They gave me to use a DeVilbiss Intellipap autopap.

The doctor wrote the script for pressure range between 5 and 15 cm. (Doctor thinks 15 is the max pressure for treating sleep apnea). The first thing I did was increase the minimum pressure to 7 cause it felt like I was sufficating. I have been monitoring the results with the codes the machine gives you then going to website and seeing the pressures and AHI. The AHI reading were around 17 avg per hour.Two weeks go by and I had given the DME the codes to give to the doctor. Still no response from the doctor.

I decide I am going to raise the minimum pressure to just below the 90% from the 7 day report. I change the pressure to 11. Now the pressure range is between 11 and 15. for the next week AHI is around 9.5. I think I making progress. I bump the upper limit to 16 as my pressure had been staying around 15 quite a bit. still the same results.

Last night I put the upper pressure at 20. I figured it is an auto-pap so if I don't need it, it won't go there. Well, it went to 20 a couple of time throughout the night. I check my results this morning and my AHI is 11.5. I feel much better, but I don't like the AHI number. I am guessing I am starting to get pressure induced Hypotneas.

Sorry for the long winded story, but I wanted to give you some background. I have requested a full report from my sleep study and I looking for a new doctor. I need help in trying to figure out the best pressure range to lower my AHI number.

Thank you all in advance for listening and helping.

Jeff

[DreamStalker]

At those high pressures with the mask type you are using (nasal) ... I can bet you are leaking your treatment out of your mouth.

Leaks make your AHI data and pressure data (on APAP mode) pretty useless.

What does your data show on leaks?

Are you experiencing dry mouth during the night or upon waking?

Fill out your profile and make it easier for the more experienced folks to help you.

[Sasquatch75]

Sorry for the lack of information. What would anyone like to know?

I have not had a dry mouth nor have I noticed much for mouth leaks. The graphs for leak data show zero.

[Hawthorne]

I'm thinking you might need a Bipap machine if your pressure is going that high.

Not sure what you need to do to get one but, if you do, still push for an auto or at least data capable.

Who will be interpreting your auto trial with the Intellipap?

I think the auto "at home" trail is a good thing. It looks like, by the way your numbers are going and the pressure you need to feel better, that you MAY need a Bipap.

[snnnark]

Did they give you a machine with the smartlink module? It fits on the back of the machine and has an SD card slot.

The Intellipap does respond to hypopneas. If those hypopneas are central in nature it will continue to increase pressure till it hits max. That will not be helping you.

Do you have the smartlink module and software?

Much as I like my machine it's not the one I would recommend for home titration.

[Sasquatch75]

first of all, thank you for the replies.

I believe the my ENT doctor will be "interpreting" the results. I am not convinced he is a good doctor to treat sleep apnea.

No, i do not have the Smartlink software. I can only use the codes the machine gives then go on the internet to have them decoded. It is not the best, but it is better than nothing. I am hoping I can at least convince the doctor to prescribe me the same machine with the Smartlink software.

I wonder if by adjusting the levels the Intellipap uses to determine an apnea or hypotnea would help. Any ideas?

[hose head]

If the doctor wrote script for S9 AutoSet, that is what you should have got. From what I understand the S9 can sense centrals. When you ask for a script get one in your hand. You can buy a machine with it online, or use it to make the DME give you the machine the Doctor ordered. It sounds like you are taking control of your therapy. Good for you. I got my script from my family doctor. She wrote exactly what I told her I wanted. I have never seen my sleep doctor. My family doctor and myself keep track of my therapy.
Read the posts about the S9. If you think it will help you, don't let them give you another. If you have copy of script in your hand you can go shopping for new DME.

Good luck

[OCSleeper]

Last night I put the upper pressure at 20...I check my results this morning and my AHI is 11.5. I feel much better, but I don't like the AHI number...I need help in trying to figure out the best pressure range to lower my AHI number.

1. Are you still tired? If you feel better, the therapy is working is starting to work. Don't focus on AHI so much right now.

2. You should be raising the LOWER pressure, not the upper. If I understand your post, you are now at 11-20? I'd go to 12-15 next, then 13-15, etc... if you don't have better results at 15-15, see the doctor about a bi-level trial.

[Sasquatch75]

Last night I put the upper pressure at 20...I check my results this morning and my AHI is 11.5. I feel much better, but I don't like the AHI number...I need help in trying to figure out the best pressure range to lower my AHI number.

1. Are you still tired? If you feel better, the therapy is working is starting to work. Don't focus on AHI so much right now.

2. You should be raising the LOWER pressure, not the upper. If I understand your post, you are now at 11-20? I'd go to 12-15 next, then 13-15, etc... if you don't have better results at 15-15, see the doctor about a bi-level trial.

Yes, I still feel tired. I can tell a big differance though between nights that the AHI is around 17 and the ones that are around 9.

I'm not sure how a bi-level will help. Doesn't a bi-level just decrease the pressure when you exhale to make breathing easier? If I am wrong, please let me know what and how a bi-level works.

Thank you