Brand new to cpap (overloaded with information) Start where?

[verbatim]

Where do I start?

1. On Tuesday they gave me a wristwatch-fingercuff to wear overnight.
2. On Wednesday they told me my "Polysomnogram Report" had a "Apnea/Hypopnea Index" of 91.8/hour and a Minimum oxygen saturation of 76%.
3. On Thursday they gave me a loaner Philips Respironics "REMstar Auto A-Flex" set to, I think they told me, 10 to 20 cm of water (and a nasal mask F&P Eson).
4. On Friday I downloaded sleepyhead software for Windows and have a PDF of the results
5. In a week I'm supposed to go back to them with the loaner machine where they will read the results.

But I want to get an idea of where I stand now so that I have questions for them next week.
What do I do now?

What is the first thing that I look for in the results?

[palerider]

What is the first thing that I look for in the results?

please post your results like shown here, instead:

https://sleep.tnet.com/resources/sleepyhead/shorganize

[Janknitz]

Kaiser???

[verbatim]

Thank you for telling me how to post the pictures.
If I can remove the ones I posted (which turned out to be huge) that would be good so I will try to do that.

Yes it is Kaiser.
I am curious how you know that?

But I'm even more curious what to LOOK for.
I have only met ONE person at Kaiser, who is the tech.
I'm sure a doctor is involved, but I have not met her yet, whomever she may be.

Also I hear there is software from the Philips company that I can use that is better than sleepyhead (or gives different information?).

What specifically am I looking for?
Do I need the bipap for instance, or is the cpap doing me well?

[Janknitz]

Yes it is Kaiser.
I am curious how you know that?

But I'm even more curious what to LOOK for.
I have only met ONE person at Kaiser, who is the tech.
I'm sure a doctor is involved, but I have not met her yet, whomever she may be.

Also I hear there is software from the Philips company that I can use that is better than sleepyhead (or gives different information?).

What specifically am I looking for?
Do I need the bipap for instance, or is the cpap doing me well?

.

This is how Kaiser works.

There is a doctor you will never see. The sleep lab techs do it all under the "supervision" of the sleep doctor (who basically rubber stamps what they do after the fact). However, IMHO the techs are pretty good and unless you have some sort of complex issues there's really no need for the MD.

You do need to understand that Kaiser is your healthcare provider and your insurer and your DME. They contract with a supplier, Crapria, to provide your equipment and supplies, but the buck starts and stops with Kaiser. That means a total lack of choice on your part unless you want to pay 100% out of pocket--in which case you can get whatever you want from wherever you want at your own expense. Kaiser will NOT reimburse you for out of network or off prescription purchases.

Even mask choices are limited and prescribed (you can only get the mask prescribed for you from Crapria) but their formulary has most of the best and most popular masks.

So Kaiser will decide what type of machine you need and prescribe the exact make and model they decide you will get. You have no say or choice in the matter. That's not necessarily a bad thing. The machines they prescribe are all fully data capable because they will monitor you as needed to help you optimize your therapy. Although compliance is a concern, they also care about efficacy and optimization of treatment because they get that it's in Kaiser's best interest as your insurer.

They used to deal exclusively in Philips Respironics machines but this February I needed a replacement machine and it was the top of the line ResMed Airsense Auto. It may be that they are still using the PR's for home titration in your region, or you may be in a region still prescribing PR machines.

[Julie]

I have yet to hear of ANY machine who's data even comes close to Sleepyhead's. Not even a bit. And SH is free, easy to use and allows you to be in control of your own therapy, understand it much better and have the freedom to make changes - e.g. pressures - when you want.

[verbatim]

This is how Kaiser works.

Oh. OK. Whew!
I thought maybe sleepyhead printed something private in the sleepyhead reports that I showed above.

I wonder how the OTHER insurance companies do it then?

Anyway, here are my first two night's reports, so far:

Friday May 20th to Saturday May 21st 2016:
Page 1. http://i.share.pho.to/d5dce325_l.png
Page 2. http://i.share.pho.to/4b5d345b_l.png
Page 3. http://i.share.pho.to/89d1a9d9_l.pn

There is a doctor you will never see. The sleep lab techs do it all under the "supervision" of the sleep doctor (who basically rubber stamps what they do after the fact). However, IMHO the techs are pretty good and unless you have some sort of complex issues there's really no need for the MD.

You are 100% correct that there is a doctor's name on the paperwork, but I have never seen that doctor, even though I've been there three times now.
The tech told me she'd give me a machine in a week to keep, so the one I have now is just a 1-week loaner machine.

I just want to make sure I request the right stuff.
1. I don't know if cpap or bipap is appropriate (nor do I know how to tell).
2. I don't know if they will give me a machine that records data (but I want one)
3. I don't know if they give me an automatically adjusting machine - but that's probably what I want.

You do need to understand that Kaiser is your healthcare provider and your insurer and your DME. They contract with a supplier, Crapria, to provide your equipment and supplies, but the buck starts and stops with Kaiser. That means a total lack of choice on your part unless you want to pay 100% out of pocket--in which case you can get whatever you want from wherever you want at your own expense. Kaiser will NOT reimburse you for out of network or off prescription purchases.

Ouch. I didn't know that.
I've never had Kaiser before.

Does that mean I can't ASK for the three things above?
1. Bipap (if that's better)
2. Data recording
3. Automatic pressure

Even mask choices are limited and prescribed (you can only get the mask prescribed for you from Crapria) but their formulary has most of the best and most popular masks.

That is good to know.
MY insurance runs out in two months, so, I won't get a chance to get a second mask from them, so whatever they give me as the first mask needs to be durable as the tech said they only last six months (and I won't have any insurance in six months unless I find a new job by then).

So Kaiser will decide what type of machine you need and prescribe the exact make and model they decide you will get. You have no say or choice in the matter. That's not necessarily a bad thing. The machines they prescribe are all fully data capable because they will monitor you as needed to help you optimize your therapy. Although compliance is a concern, they also care about efficacy and optimization of treatment because they get that it's in Kaiser's best interest as your insurer.

If they give me an automatic machine with data monitoring then I should be fine, right?

They used to deal exclusively in Philips Respironics machines but this February I needed a replacement machine and it was the top of the line ResMed Airsense Auto. It may be that they are still using the PR's for home titration in your region, or you may be in a region still prescribing PR machines.

The tech only said that the machine that I get will be "better" than the one I have as a loaner, so, I'm not sure what brand it will be yet.

[verbatim]

I have yet to hear of ANY machine who's data even comes close to Sleepyhead's. Not even a bit. And SH is free, easy to use and allows you to be in control of your own therapy, understand it much better and have the freedom to make changes - e.g. pressures - when you want.

I'm not sure how to make those changes in pressures, but certainly sleepyhead gives a lot of data.

For example, here are my leaks last night:


Here is a zoomed in graph of the leaks around midnight:


Here is the pressure & flow overnight last night where I see a problem in the middle:


And here it is zoomed in at midnight showing some sort of problem:


PS: These images are STILL too big. I don't know why exactly. I'll tray again later to shrink them.

[palerider]

Also I hear there is software from the Philips company that I can use that is better than sleepyhead (or gives different information?).

philips has software called "encore" or "encore pro" that is the "official" data reading software.

it's old, and clunky (looks like it'd be state of the art for the early 90s) it's not interactive, it just makes reports... basically, it's designed to make printouts that the doctor can look at.... it's hideous. it's also complicated and hard to use. it's for professional masochists only.

that said, sleepyhead does have bugs in it, but they're generally fairly nitpicky things... the important bits are all solid, and provide more info than the official software does.

[palerider]

PS: These images are STILL too big. I don't know why exactly. I'll tray again later to shrink them.

DO NOT SHRINK YOUR IMAGES it makes them too small to read the data.

look at page 2 and page 3 of the webpage I gave you above, it shows the right way to take a screenshot, and how to post the images so they look great and provide good, readable detail.

[palerider]

I'm not sure how to make those changes in pressures, but certainly sleepyhead gives a lot of data.

For example, here are my leaks last night:

go to apneaboard.com, there's a link at the top that shows you how to request, by mail, a clinician manual for your machine.

your leaks are nice and low, very good.

[Julie]

It's important to get the right machine (or at least not the wrong ones) because a couple are 'bricks', don't allow you to get any useful data beyond compliance for the insurance co... e.g. anything with "Escape" or 'Plus" in the name - stay away from those.

[Janknitz]

Like I said, AFAIK, Kaiser only prescribes data capable machines because they actually care whether or not your machine is working effectively for you. As far as Bipap or auto, it totally depends on what THEY decide.

While waiting you should call Kaiser's DME unit and find out what your coverage for CPAP is. Even if you have little or no coverage you'll get Kaiser's deeply discounted price from Crapria, and in most cases it's a great discount.

Kaiser will fit you for a mask and generally lets you keep the samples. Then you only have to replace the cushion or headgear on your own which is cheaper than buying a whole new mask.

[verbatim]

Everything you said was spot on!
Thank you for the wonderful advice!

Kaiser let me keep the sample mask and headgear and hose.
They gave me a "ResMed" "AirSense 10 Audoset" machine.
I'm confused if it's bipap or just cpap because they told me it's cpap but it has a different exhale pressure.
I picked up the encore software but it did not work with this new ResMed (but it worked with the loaner Respironics).
Sleepyhead works with both the ResMed and the Respironics.

Here are details gleaned by pressing both the round power button and the square home button for three seconds to get into "unlock" mode on the "AirSense 10 Autoset" machine.
THERAPY:
- Mode = Autoset
- Max Pressure = 20.0
- Min Pressure = 10.0
- Mask = Nasal

COMFORT:
- Ramp Time = Off
- EPR = On
- EPR Type = Full Time
- EPR Level = 2
- Humidity Level = Off

Accessories:
- Tube = SlimLine
- AB Filter = No

Options:
- Essentials = Plus
- SmartStart = On

Reminders:
- Mask = Off
- Water Tub = Off
- Tube = Off
- Filter = Off

Things I like:
- Very quiet
- Seems to work just fine without any water in the humidifier
- It figures out my pressure (average after 16 hours is 14.2 cm of water with an AHI of 1.1)

Things I don't like:
- 24VCD means it won't work from a car battery
- Airplane mode constantly nags me to turn it off
- Humidifier is required (or a $20 plate has to be ordered)

Things I don't understand:
- Why does it have both WiFi and CDMA?
- Does it spy on me via Verizon cellular somehow?
- They called it CPAP but it has a different exhale pressure (so isn't that bipap?)

[chunkyfrog]

It is cpap because the maximum pressure drop for exhalation is 3 cm. (EPR on Resmed machines)
Bilevel/ bipap can have a greater pressure drop, making exhalation even easier.
Sometimes this helps with higher pressures, and/or aerophagia. (Swallowed air).
Both ways can be an awesome comfort feature.