Newish User / Questions / Problems / Thoughts

[UglyBob]

Hello Everyone,

I'm new here, this is my first post. I hope I'm not doing anything wrong!

I'm almost 40 years old and I live in the USA. I was told by a girlfriend that I stop breathing in my sleep about 20 years ago, but I didn't think much about it. For the last several years I have known that I most likely have sleep apnea, but with so many other medical bills and appointments I slacked on doing anything about it until very recently. I think that is all the necessary background information.

After an at home sleep study I was told that I needed to have a Titration test done in a lab. I had that done last week, and got my results today. They are linked below. I highlighted the area that says what they will order me. (C-Flex + equipment at 13 cm H2O) I'm still new to this but it looks like that is technology and not a specific machine, it also doesn't seem to be auto. Most people in here seem to recommend auto machines.

I don't like, or trust this doctor's office to do anything to help me. My girlfriend and I have both used this doctor's office, and it's obvious they care more about money than the patients. I don't plan on using them anymore. Just to be clear, I'm not one of those people that doesn't trust any doctor, it's just this office and if I had realized it was the same one that treated her I would have never chosen them to begin with.

Sorry for the small book above but I figured it might help with my questions.

1. Is the recommendation from the office a good one, or would you recommend something different? Why?
2. Does anything from my report stand out in any way? Like I said, this is all new to me.
3. Does anyone have anything else to add that wasn't mentioned above?

Thanks a lot!

Titration Results - https://drive.google.com/open?id=1gAqYc ... lqT_UCob0D

[Dog Slobber]

What stands out to me is

REM related AHI: 23.3
Apnea/Hypopnia Index: 18.2

This puts you into the category of moderate Sleep Apnea, and yes I would agree with CPAP therapy.

I'd also try to get an Auto-adjusting machine. Sounds like they want to get you a Respironics DreamStation, which is a fine machine. Though more people around here seem to prefer the ResMed AS 10 AutoSets.

[ChicagoGranny]

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I wouldn't put up with that. No medical professional is allowed to order a machine or mask for me. I (and my insurance policy) pay for the equipment, so I am going to control what is ordered.

I would insist on an Auto machine (The machine can also be set to CPAP as per the script.). Specifically, I would get a ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier, https://www.cpap.com/productpage/resmed ... t-humidair .

If you get a straight CPAP, what happens later if you find out an auto is a better choice? You're screwed.

[Cardsfan]

Make sure to get a copy of your prescription to keep for yourself. That way, you have control over where you can get your supplies. You do not have to limit yourself to one supplier. You can get much info about the different machines at our sponsor's website, www.cpap.com.

[UglyBob]

Thanks for the replies. I told them not to order anything until I give them the go ahead. I also asked to speak to the doctor to get the explanation of why they "need" me to get that type. I was told that the doctor doesn't make phone calls so I would have to schedule an appointment. I'm now looking for a new doctor.

My primary care doctor just got back to me and said he would have no problem writing a prescription. Now I have to decide what machine to get. I've read a lot of posts, and recommendations, but I really haven't seen many recommendations that make a great case for one machine over another, just auto over preprogrammed.

[Pugsy]

Couple of recent threads where pros and cons of the brand were discussed.

viewtopic/t177839/Buying-used-CPAP-Drea ... -risk.html

viewtopic/t177435/Cheapest-place-to-buy ... -CPAP.html

A not so recent thread but full of good information
viewtopic/t172310/How-Important-is-the- ... nions.html

Limit your machine research to the ResMed AirSense 10 AutoSet or the Phillips Respironics DreamStation Auto CPAP.
Make sure your doctor writes the specific brand and model name in full....and checks the box "do not substitute".
Make sure it includes the words "with heated humidifier".
Prescription for the mask is also needed....
"mask of patient's choice" is sufficient that way you can change your mind and get a different mask later if you want to try something new.

[UglyBob]

Couple of recent threads where pros and cons of the brand were discussed.

viewtopic/t177839/Buying-used-CPAP-Drea ... -risk.html

viewtopic/t177435/Cheapest-place-to-buy ... -CPAP.html

A not so recent thread but full of good information
viewtopic/t172310/How-Important-is-the- ... nions.html

Limit your machine research to the ResMed AirSense 10 AutoSet or the Phillips Respironics DreamStation Auto CPAP.
Make sure your doctor writes the specific brand and model name in full....and checks the box "do not substitute".
Make sure it includes the words "with heated humidifier".
Prescription for the mask is also needed....
"mask of patient's choice" is sufficient that way you can change your mind and get a different mask later if you want to try something new.

Thanks a lot! Now it's time for a few dumb questions.

1. My understanding is that a mask that only covers the nose won't work if you breathe through your mouth at all while sleeping. Is that correct?
2. Is there any way to know for sure how you breathe while sleeping? There's nothing on the test that shows that is there?

I'm assuming I'm a mouth breather, but I don't know for sure. My girlfriend thinks I do, but she's a pretty heavy sleeper and can fall asleep quickly, unlike me, so she only notices my sleep if she wakes up during the night.

3. I know this is a personal preference, and it will probably depend on the machine I choose, but does anyone have any recommendations on masks that are noticeably more comfortable than others? (I know they'll all suck, at least at first) Masks to avoid?

[Pugsy]

Mouth breathing is only really bad for therapy when you do a lot of it to the point that the bulk of your therapy pressure is exiting out the mouth.
Random occasional mouth breathing probably isn't a big deal unless it wakes you up when you do it.

Do you normally breathe through your nose just fine during the day? If so, start with a nasal interface mask.
Will worry about any potential mouth breathing if/when it happens.

Now if you have a chronically congested nose and you just have to breathe through your mouth even during the day then you might as well start with a full face mask. If you can't get your nose clear enough during the day it will probably mean quite a bit of mouth breathing at night.

I thought I was a mouth breather because I woke up (pre cpap) with a sore throat and dry mouth...and I probably was mouth breathing or actually most likely gasping for air because of the apnea events I was having.
I breathe through my nose just fine during the day though...so I really didn't want to go down the full face mask road unless I just had to so I started with a nasal mask anyway....despite people telling me that I was a mouth breather.
Once my cpap pressures were holding my airway open and no more apnea events to speak of I quit having the dry mouth or sore throat and the leak lines on my reports showed only rare times with possible mouth breathing.

The less area of the mask touching the skin requiring a seal...the easier it is to keep a seal.
Full face masks simply have more real estate needing to maintain contact with the skin than nasal masks.

If you feel like you just have to have a full face mask...look at the Respironics DreamWear Full face mask or the ResMed F30.
Least amount of stuff on the skin as possible with a FFM.

If you want to try a nasal interface mask...nasal pillows have the least amount of surface area needing to maintain contact with the skin.
I use one that doesn't even have headgear....see the mask in my equipment profile at the bottom of this post.

Nasal pillow masks with the most silent venting....ResMed P10 AirFit....F & P Brevida....both very comfortable considering.
Essentially silent in terms of venting and to feel the vented air you have to put your hand about an inch from the vent holes.

[zonker]

Thanks for the replies. I told them not to order anything until I give them the go ahead. I also asked to speak to the doctor to get the explanation of why they "need" me to get that type. I was told that the doctor doesn't make phone calls so I would have to schedule an appointment. I'm now looking for a new doctor.

My primary care doctor just got back to me and said he would have no problem writing a prescription. Now I have to decide what machine to get. I've read a lot of posts, and recommendations, but I really haven't seen many recommendations that make a great case for one machine over another, just auto over preprogrammed.

THIS-Hands.jpg

so MUCH this. on both counts. any other newbie reading this: the doctor works for YOU. if you have the option, find one that will.

it also brings up the point that any doctor can write a 'script.

you, uglybob, are going to go far in therapy fast!

[UglyBob]

Thank you everyone! You've all been very helpful, especially @Pugsy I think I've decided on the AirSense 10 AutoSet with HumidAir Heated Humidifier with an AirFit P10 Nasal Pillow Mask. The "Heated Humidifier" part means that it comes with the specialized hose, right?

Again, I really appreciate everyone being so helpful. It's rare to see that these days.

[Okie bipap]

No it doesn't. It simply means it has a built in humidifier. You need to include the Climateline hose which is the heated hose. Some machines come with the Climateline hose and other don't.

[UglyBob]

No it doesn't. It simply means it has a built in humidifier. You need to include the Climateline hose which is the heated hose. Some machines come with the Climateline hose and other don't.

Thanks, I'm glad I asked. Should I buy the hose, is it necessary? Can I buy it later without a prescription?

[Pugsy]

The machine should have a hose included when buying from a brick and mortar DME supply house. It can be either the slimline non heated hose or the ClimateLine Air heated hose.
You should just be able to tell them which one you want.

Hoses don't require a prescription though. Neither one requires a RX when bought separately. Available online often for substantially less than a DME will want to charge for one.

A heated hose isn't a critical need though just to use the humidifier....you can still use the humidifier and get added moisture with a non heated hose.
The heated hose comes in handy if your bedroom air is on the cool side or if you get condensation in the mask or hose.
I use a heated hose year round though...just use cooler hose air temps in the summer and warmer hose air temps in the winter.
The heated hose allows for greater customization of the hose air temps and the humidity delivered along with a more consistent delivery.

Here's a combo provider manual so you can read up on what all your options are and what the machine will do.
https://www.respshop.com/manuals/ResMed ... %20her.pdf

[ChicagoGranny]

2. Is there any way to know for sure how you breathe while sleeping? There's nothing on the test that shows that is there?

If the sleep lab was competent, the fact that they recommended a full face mask (FFM) is an indication they observed mouthbreathing during the study.

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My primary care doctor just got back to me and said he would have no problem writing a prescription.

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Last year, the very good sleep doctor that I used had her clinic closed by the group it belonged to. She retired and moved away. I spoke to my family doc about this. He will do anything I need in terms of prescriptions and letters of need and compliance to my insurance company and DME. This is a better deal for me as I will do this and annual physical exam in one visit.

[slowriter]

I would insist on an Auto machine (The machine can also be set to CPAP as per the script.). Specifically, I would get a ResMed AirSense™ 10 AutoSet™ CPAP Machine with HumidAir™ Heated Humidifier, https://www.cpap.com/productpage/resmed ... t-humidair .

Personally, this is what I would do.