Help with first appointment post CPAP

[schnarchen]

I will have my first appointment after getting my CPAP with my ENT (prescribing physician) in two days. I have a few questions for him and would appreciate any advice on these or additional questions to ask.

1) I am still seeing AHIs of 4-8 most nights that are clustered together. This is consistent with my sleep study that showed my apneas occur during attempts to enter REM sleep. Early on I thought I was feeling much better, but now I'm not so sure. My pressure was prescribed at 7cm. Should we try increasing pressure?

2) Would I benefit from APAP? Is it too late to prescribe it now that I have my machine? (I wish I had read more on this forum sooner and I would have insisted on a different machine)

3) I am struggling with stuffy nose and sinuses. I already take flonase (along with advair and singulair for asthma) once per morning. Should I take it at night or double my dose? Any other suggestions? (I've tried generic afrin, but that doesn't help after the first few days)

Anything else?

[Bodhi]

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[Pugsy]

1) I am still seeing AHIs of 4-8 most nights that are clustered together. This is consistent with my sleep study that showed my apneas occur during attempts to enter REM sleep. Early on I thought I was feeling much better, but now I'm not so sure. My pressure was prescribed at 7cm. Should we try increasing pressure?

If leak was not a factor, then maybe an increase in pressure might be warranted. Something to talk to doctor about.

2) Would I benefit from APAP? Is it too late to prescribe it now that I have my machine? (I wish I had read more on this forum sooner and I would have insisted on a different machine)

Never to late if the doctor will come on board.. Depends on the doctor. If he will change the order to APAP, DME will have to honor it no matter how long it has been.

My situation was very similar to yours. Titrated pressure of 8 cm gave me about the same AHI of yours, with mainly clusters on the reports and also a history of events being worse in REM sleep. Gave a good case for the doctor to advise APAP which I already had but now had doctors blessing to have the minimum at 10 and left the max open (changes in pressure never bugged me).

I used the reports to present my case. It was agreed that for my needs the minimum of 10 took care of the majority of the night and I do see some increases during the time that appears to correlate with REM sleep time in the reports. Much nicer to use 10 as minimum and not have it straight cpap of 12 or 13 or 14 which is sometimes needed.
Side note. Last week I decided to lower the minimum to 9 just to see what happened. Clusters showed up...
So sometimes just a little change can make a huge difference.

[KatieW]

Do you have a copy of your sleep/titration study? Did they actually titrate you during REM, because if they didn't, and you have having REM at home now, then the titrated pressure may not be high enough.

Also, if you are using EPR on your Elite II, that is lowering the pressure on exhale, and I would raise your pressure by that same amount.

for example, during my sleep study, I was titrated at 7 cm H2O, no REM, no EPR.

After a year and a half, using both the S8 AutoSet II and the S9 Autoset, I have self-titrated and find my best pressure is fixed cpap 12, with EPR of 2.

Which is a good reason to have an AutoSet, even though I run it on cpap most of the time.

[schnarchen]

You guys are so helpful. Thanks.

Do you have a copy of your sleep/titration study? Did they actually titrate you during REM, because if they didn't, and you have having REM at home now, then the titrated pressure may not be high enough.

Also, if you are using EPR on your Elite II, that is lowering the pressure on exhale, and I would raise your pressure by that same amount.

I do have full copies of my initial sleep study and later titration study. Yes, the technician titrated me during REM. They started at 4cm, and in the first REM raised it to 5. They went to 6 during some non-REM apneas, and then I went through my second REM period without any events. They then raised to 7cm during my last REM stage just before I woke up. I'm obviously far from an expert, but I wonder if I had another study starting at 7cm if I would be titrated higher.

It certainly helped, because my initial sleep study only showed 9.4% REM, but my titration went up to 18.2% REM. I remember feeling great the next day after the titration study.

And yes, I am using EPR, but only during the 20 minute ramp at the beginning.

[schnarchen]

My situation was very similar to yours. Titrated pressure of 8 cm gave me about the same AHI of yours, with mainly clusters on the reports and also a history of events being worse in REM sleep. Gave a good case for the doctor to advise APAP which I already had but now had doctors blessing to have the minimum at 10 and left the max open (changes in pressure never bugged me).

I used the reports to present my case. It was agreed that for my needs the minimum of 10 took care of the majority of the night and I do see some increases during the time that appears to correlate with REM sleep time in the reports. Much nicer to use 10 as minimum and not have it straight cpap of 12 or 13 or 14 which is sometimes needed.
Side note. Last week I decided to lower the minimum to 9 just to see what happened. Clusters showed up...
So sometimes just a little change can make a huge difference.

I will try to talk him into changing my Rx to an APAP, but if not, I will certainly discuss raising the pressure until I see this go away...



The good news is that I'm tolerating it pretty well. I haven't missed a night yet, and after several weeks I have only woken twice to find the mask on the floor.