Edit again- Sleep doctor visit

[Pugsy]

The only information your insurance company will ever get about your usage of your machine is how many hours you use it.
Did you meet the minimum compliance hours of use requirement....if they have one (some insurance plans won't have any set requirement and you probably need to check with your insurance company yourself to be sure. Don't ever accept what a DME tells you that your insurance "requires" unless you confirm it with your insurance company yourself. DMEs have been known to lie when the truth would fit better.)

The only reason they would ever refuse to pay for a machine is if you don't use it the number of hours they might have as a minimum compliance requirement.

Insurance companies won't get any of your detailed reports...they don't care. They won't know what pressure you started with or ended with. They won't know your AHI. They won't know if you change anything because the only information that is forwarded to the insurance company is that compliance hours of use.

[Attagirl70]

I unlocked the clinician menu last night on my machine. I didn’t adjust anything yet, just had a look around. My settings are currently 24/20. When titrating how slow do you go with the settings? Do I go down by tenths? Start somewhere completely different?

I am still having major issues with leaks. The only way I get a good seal is by having the straps so tight I wake up with sore spots all over my head, eyes swollen and my cheeks feel like I have been doing 100 mph with my head stuck out of the window.

I did receive my padacheek chin strap and bottom liners for the straps (where the magnets are). The liners do help with red marks so that’s a good thing. At least I don’t have the big indentations on my lower cheeks! lol

I will keep reading this forum and pray I can figure out the right mask for me so I can get a decent nights sleep. Thank you to everyone that has given me ideas and advice.

[Pugsy]

What was your AHI last night?
What was the event category breakdown?
Can you see it in the sleep report? If you can't see it you need to go back into the clinical menu setup area and change a setting called Essentials from On to Plus.
With settings of 20/24 you don't have much room to do any changes since the machine can only go to 25 unless you want to try auto mode with a range of pressures. We really need to see the OSCAR/SleepyHead detailed data to be able to get any sort of idea what your options might be. Maybe you don't need these high of pressures all night...maybe just part of the night.

[Attagirl70]

I am attaching my OSCAR data below for last night. Hopefully I did this correctly!

[Pugsy]

As I suspected...they have you in fixed bilevel mode.
Did you have an in lab sleep study using a machine where they came up with these settings?

If the leaks didn't wake you up...I wouldn't worry about them but any leak no matter how big or small that wakes us up is unwanted because it is disturbing our sleep.

You have lots of breaks in therapy where you turn the machine off and back on again.
Any special reason why the wake ups that you know of?

[raisedfist]

Curious...can you check what the rise time is set to? I believe in S mode it's set by default to Min which is very fast. Sometimes when you're getting wacked in the face with air it can make the mask difficult to seal. I suspect the setting to be the case, since even with a modest PS of 4, your tidal volumes and minute ventilation are very high for a female, let alone any adult that isn't an NBA player.

[Attagirl70]

Yes, I was told they started out with a CPAP couldn’t get the apnea under control so they switched to biPAP for the rest of the night.

The mask will start leaking and that usually wakes me up. Last night I was trying to adjust the mask for almost two hours before I got a semi decent seal and could fall back to sleep. I don’t know how anyone gets a seal with that high pressure.

I can handle small leaks unless it’s blowing into my eyes.

I tried the Simplus mask, couldn’t get a seal and I felt like all the air was going out the expiration holes of the mask and I wasn’t getting good results from it, not including all the farting noises driving me nuts.

I will go check the setting and let you know what it’s set on.

Thank you for the help!

[Attagirl70]

You were correct! The rise is set at min and grayed out.

[raisedfist]

Once in the clinical menu you should be able to modify the setting. Does "easybreathe" show as disabled? I thought by default easybreathe was not enabled in the S mode, but it's been a while. If easybreathe is enabled, then my hunch was wrong, since that's an automatic rise time basically and is typically very gentle. And usually rise time is greyed out when easybreathe is enabled.

Maybe snap a pic and post it here of your clinical menu settings so we can all see.

[Pugsy]

A mask liner might help with the leaks. Seems to at least tone down things just a bit. Reduces noise along with those teeny annoying leaks.
I would rather see you try to use a nasal interface mask if you can.
Simply because there's less surface area of the mask touching your skin and needing to maintain the seal.
The more real estate on the skin the greater the difficulty especially at your pressures.

Until you can get a nasal mask you might consider a mask liner and you can do a DIY mask liner made out of an old T shirt.

I assume that you are doing your preliminary mask fit at the beginning of the night at your full pressures and not at the starting ramp pressure????

[Attagirl70]

I have a mask liner ordered from padacheek that should be here Tuesday or Wednesday.

I am attaching my machine settings below.

[Attagirl70]

Couple more. I couldn’t get them to upload in one post. Sorry!

[Jas_williams]

In S mode there is no easy breath


It would be good to see your detailed sleep study as the pressures seem pretty high but they are treating you with no central apnoea,

[raisedfist]

Are you putting on and fitting the mask with the full EPAP pressure of 20?

[Pugsy]

In S mode there is no easy breath

Yes there is.

EasyBreathe.JPG