Titration results

[bairdbeth]

Went to my pulmo today for test results from 2nd study. I only got a copy of my 2nd study report. My pulmo thought it had all results from both tests,but it didn't have all I want so I will get it when I go back to their CPAP clinic in 7 weeks. From my 1st study I had AHI of 21.4,PLM index of 51, sleep efficiency of 15%, O2 saturation- 91%-97%. From the titration study Sleep effieciency was 87%, latency to sleep onset was 43 minutes, total sleep time 412 minutes, supine time 85% ( not normal for me!), Stage I-9%, Stage II- 83%, STage III & IV- 0%, REM- 8%, AHI- 0.6 (Yeah!), PLM index 23,CPAP started at 7 and increased to 11, optimal pressure was 10 cm at which minimum saturation was 95%. He wrote me a prescription for a CPAP with heated humidifier and gave it to the person in his office designated to contact DME's. I asked about c-flex and he told me I needed to talk to the DME about it? Is that right or does it have to say it on the script? My report also says my sleep architecture is abnormal( even on CPAP) Will the numbers in my sleep stages change once I use CPAP for a while? What is a "normal" % for REM? I am now waiting impatiently for a DME to call me. My pulmo said to call his office if I hadn't heard from one by Tuesday and to call again if I don't have a machine by Friday. At least I know I have backup from his office! Does evryone have a CPAP clinic to go to? What do they do?

[Wulfman]

You NEED to get the prescription given to YOU! It's good for life. It should not be the doctor's office or the DME that selects the equipment. This is going to be YOUR therapy. It isn't going to be them that puts on the mask at night. You will be at the mercy of that DME......who will pick out the cheapest/low-end equipment to give you and then charge your insurance a small fortune.
You and your insurance provider are paying the doctor.....therefore he is working for YOU. If you want C-Flex, you should be able to insist on a Respironics machine (of your choice).

Have you read the information that Mile High Sleeper put on her website?

http://smart-sleep-apnea.blogspot.com

Best wishes,

Den

[kteague]

Hi. I just reviewed some of my old sleep study results, and if you were a 53 year old female your expected REM would be 21.8%. It would be interesting to compare your stages of sleep in the first study alongside the second, to see if the drop in PLMs corresponded with a drop in any particular stage of sleep. Just curious about that.
Kathy

[StillAnotherGuest]

From my 1st study I had AHI of 21.4,PLM index of 51, sleep efficiency of 15%

Sleep efficiency of 15%? I think you'd need X-ray vision to try to make a diagnosis with that amount of information. Is that number right? If so, I'd like to see the first study results, too.
SAG

[bairdbeth]

I didn't sleep much during the first study, so 15% is right. I wrote that done when we went over the first results. That can be a typical night for me at this point. I look at the clock many nights and see every hour or two change. I will get a copy of my first study as I really want to compare sleep stages. Also, I thought he gave me a copy of the prescription to put with my machine when I travel. Instead it just says patient uses CPAP at bedtime on a script. I will get a copy or original from DME when I hear from them.

[Snoredog]

From my 1st study I had AHI of 21.4,PLM index of 51, sleep efficiency of 15%

Sleep efficiency of 15%? I think you'd need X-ray vision to try to make a diagnosis with that amount of information. Is that number right? If so, I'd like to see the first study results, too.
SAG

I agree with SAG, if this is your second study they should have given you something for the RLS so it didn't blow the whole study. Would not have been too hard to see if those leg movements were the cause of the arousals during the first study (and given you something for the second).

You got No deep sleep at all, Normal sleep efficiency is >80%

You NEED to contact your doctor's office and:

1. Get a copy of the first sleep study report.
2. Get a hard copy of the prescription.

If they won't give you those items, I would complain to insurance company and find a NEW doctor.

Your DME is NOT going to give you a copy of the prescription. Prescriptions come from doctors not DME's.

[snoregirl]

I have to second Snoredog's advice to get the prescription and copy of sleep studies.

You may not like the DME your doc sends the prescription to, nor do you have to use them. To go to another B and M DME you need this paperwork. To use Bill my insurance you also need this paperwork. To buy online you need the prescription.

You also need to research machines. Use the CPAP.com site to understand the bells and whistles each has and decide how much you care about each (for example exhale relief, data collection, auto titration, size/weight, auto altitude adjustment, options for running off battery...).

Only then will you know if you are going to be happy with what the DME will "give" you. If not you will know what to ask for, or you will find out later that "you wish you had...".

If your Doc doesn't put CFLEX on the prescription they may not give you a machine with it. If you want it, you need it on. It is not the DME's call whether or not you get CFLEX it is the doc's.

If he does put CFLEX you will get a Respironics machine as they are the only ones who make "CFLEX" If he puts something else that indicates exhale relief the DME could give you ResMed or another machine that has some form of exhale relief.

Prescription needs to say "Heated Humidifier" or you may not get that.

You need to question your insurance company yourself (not through the DME) to see what is covered and your copay. You need to ask the DME about the total price so you can determine if your out of pocket expense is greater buying through the local dme using insurance than buying online cash. Some have had success getting reimbursed by insurance for cash purchases, but not all. If your insurance requires rent to purchase, the chances of cash reimbursement I think are lower.

Do not walk out the DME's door with equipment you do not really want. You may not be able to go elsewhere and use your insurance after they start paying a particular DME.

Don't patiently sit by the phone waiting for a call. Do your homework, get your paperwork, call the DME that the doc sent stuff to and ask questions $$ and machine make and model.... You may find you get answers that you don't like, and can quickly move on to other options. You may also find you like them and will be happy dealing with them. But you don't need to sit and wait for the call. These are questions the DME can answer now. They probably won't call you until they call to say "We have your machine, we need to schedule a time for you to come get it". That is nice but what if it is the wrong machine (wasted time while they order another or you figure out that they are unwilling to order another).


Most of all get that paperwork from the doctor. It is yours and you can choose whom you want to do business with. It is your choice, not the doctor's.

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CPAPopedia Keywords Contained In This Post (Click For Definition): respironics, resmed, humidifier, cpap.com, cflex, Titration, DME, Altitude, Prescription, auto

[bairdbeth]

Thanks! I will call pulmo office on Monday. They had not assigned a DME when I left. They were going to look at who my insurance worked with best. I already looked into Bill my insurance. They cannot cover an initial setup with my insurance, so I have to use a local DME. The pulmo said I needed CPAP. not APAP so I have it down to 2 machines-Remstar Pro 2 C-flex or Resmed S8 Elite. I also want to try several masks, Activa,Swift, Hybrid and Ultra Mirage FF. I hope those are good choices. If I can't get those then I will deal with another DME or just pay out of pocket. My health comes first and it is my say as to how it is treated. I will stop by the office and get a copy of the 1st study and true script. Any input on machines I have selected or masks(which is more individual, I know) would be appreciated.
Thanks!

[snoregirl]

You don't "need" apap says your doc. It is not a matter of "need" for some of us, but choice and comfort.

Just to be clear, APAP allows you to run at a lower pressure much of the time for some of us who have higher pressures (mine is 13 and while not high it is higher than a lot). For me that is comfort running much of the night at 10 and only getting 13 when I need it.

It also solves my problem of what I believe is a questionable sleep study (titration), potential weight changes, positional sleeping etc.


There are many here who are happier with straight CPAP and even say that changes in pressure disturb their sleep. But if you have an APAP you can use it as a straight CPAP by setting both pressures to the same thing.

So if your insurance will only give you a cpap and you are fine with that (I think your pressure was 10 (not too awfully high) then fine. BUT if there is a choice, or you are buying out of pocket APAP is a real option (can get from CPAP.com with Cpap script). I personally hope never to see the inside of a sleep lab again, and with APAP that is more of a reality. Of course you could do that with CPAP and software, but it is more time comsuming.

My insurance could not work with billmyinsurance either but good you checked.

Either of those machines sound good (Elite or Pro2). The key is getting the DME not to try to give you a Plus or Escape if you want data capability. Maybe not now but in the future. If you are are not worried about APAP, then either machine you picked has exhale relief. They were what I was considering before I decided I really wanted the APAP.

I have two of the masks you mention. I love my swift, and the Ultra Mirage FF is nice too (but I prefer less on my face so the swift wins for me). I am also planning on trying the Hybrid soon. Activa has a large following although I have never tried it.

Good luck with the DME.

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CPAPopedia Keywords Contained In This Post (Click For Definition): mirage, activa, cpap.com, swift, CPAP, DME, APAP

[GoofyUT]

When it comes to constant pressure (CPAP), xx cmh20 from a Resprionics machine is exactly the same as xx cmh20 from a ResMed. Both the S8 Elite and the REMstar Pro2 are FINE machines.

Here are the diffeernces that you ought to consider for yourself:

1. Both have a form of expiratory relief. Resprionics has C-flex which is a MOMENTARY decrease in pressure at the start of your exhalation, with a user selectable (but non-speecific) depth of relief. ResMed has EPR which last for the ENTIRETY of the exhalation, in the same way that a bi-level PAP does. The amount of expiratory pressure relief is specific and is user-selectable at 1, 2 or 3 cms. For this reason, many refer to the S8 Elite and Vantage as "mini-biPAPs." I have NOT used ResMed's EPR though I have considerable experience with the S8 AutoSet Vantage. I currently use a REMstar Auto w/ C-flex, and I find the C-flex feature to be remarkably effective;

2. Respironics machines (other than the new M series Pro and Auto) do not report any efficacy data on its LCD display. To view and use the data, you are required to purchase the Respironics EncorePro software, a SmartCard reader,a nd have a Windows computer that you can use it with. The new M series Pro and Auto DO report limited efficacy data on their LCD screens, but only AHI and pressure in 7 and 30 day averages.

The ResMed S8 Elite will report Pressure, leak, AHI, AI, HI as well as usage data directly on its LCD screen with simply a few keystrokes, therefy obviating the need to purchase any software, reader of even a computer. It reports this data in nightly, weekly, monthly, six-monthly and yearly averages.

However, if you do choose to purchase and use software, which IS useful since it will give you detailed data about events in the time domain, Respironics' EncorePro is FAR more useful than ResMed's AutoScan v5.7 in my opinion, and I've used both. Hwoever, many here have reported considerable difficulty installing and using EncorePro. And, neither Resprionics nor CPAP.com will provide end-users ANY support since teh software is intended for professional use only. I experienced NO difficulties installing and using EncorePro v1.5.77, though;and, finally

3. The human factors design of the ResMed S8 Ellite is consderably better, in my opinion, than on the Resprionics REMstar Pro2. The reservoir on the ResMed fills with the flip of a lid, and it has a clear, sharp, easy to read dot-matrix LCD display with a timed back-light. The REMstar on the other hand has a more difficult to fill and clean reservoir, and has a small, confusing and hard to read LCD display that is NOT back-lit at all. I also like the form factor and colors of the ResMed much better, but that's just my opinion.

Hope this helps.

Chuck

[bairdbeth]

Great info! Thanks! So if I can get an APAP, I had it down to #1 choice of Remstar Auto with cflex or #2 S8 Vantage. I tink I might like the option of APAP as I do plan to lose weight once I can get some daytime energy.

[rested gal]

Great info! Thanks! So if I can get an APAP, I had it down to #1 choice of Remstar Auto with cflex or #2 S8 Vantage. I tink I might like the option of APAP as I do plan to lose weight once I can get some daytime energy.

I think you're smart to strongly consider getting an autopap rather than a straight cpap machine, regardless of what the doctor says you "don't need". The autopap can always be run as a straight cpap machine, if that is more effective for you.

goofyUT gave a very good description of the difference between C-Flex and EPR. Bear in mind that he was describing how those two things would be in the two straight cpap machines you had mentioned: REMstar Pro2 and ResMed S8 Elite.

Now that you're thinking about getting an autopap instead of a straight cpap, it's important to know that IF you want any kind of pressure relief when you exhale, the only autopap that can give you that is the Respironics REMstar Auto with C-flex. The ResMed S8 Autoset Vantage with EPR cannot use its EPR if you operate the Vantage in "auto" mode. The Vantage's EPR feature can be used only when the Vantage is operating in "cpap" mode, not in "autopap" mode.

I'm sure Goofyut would have mentioned that, had you been considering an autopap earlier. What he said is correct for the two cpap machines you were thinking about getting.

[bbeck4x4]

this is a lot of information to digest for a person who had had many nights of good sleep, especially for those of us that didn't get a good nights sleep last night, let alone in the last month,.

so everything in the above posts is correct, take your time, weigh your options, and try every mask that you can, until you find the ONE that works best for you,

I read here once, that these masks are like bra's, they don't all fit the same(having never wore one, myself , I have no personal experience with them ) the greatest one for me is most likely not going to be the best for you, so all you can do is try out all of them(with the least amount of $ spent) until you find one that works best for you, one that has the LEAST number of issues, they also fit better when broken in, kinda like a new pair of leather boots,

also know that all of the masks need to be tried out, while you are laying there in bed trying to figure out how on earth you are going to sleep with this thing on your face, but it can be done. and you will start to feel better, but only when you get past this last hurdle.

[snoregirl]

I love the bra reference. I can say that I have worn one and I totally agree.

[GoofyUT]

Wait. So you mean that you're supposed to wear bras on your feet?? Or boots on your chest???

I'm SO CONFUSED!!!!

I got it!!! How 'bout a pair o' Hybrids under your blouse!!!!

Thanks for clearing this up for me!

C