Had UPPP, Do I Have To Get A New Doc, To Get Help With This?

[-SWS]

Looking forward to hearing how tomorrow's visit went, Jan. Good luck!!

[Muffy]

I would run EPR at 3 if I were using a ResMed with that feature, which would mean that my pressure might need to be 3 cm higher to make up for that drop in exhalation pressure.

Wouldn't that simply bring you back to where you started from?

Or worse?

Also, I would avoid the generalization that EPR needs automatic compensation by raising baseline pressure. Concerns that this phenomenon may exist were raised by a lone researcher at the release of that adjunct, but were based on a single patient who was awake at the time. Several variables need to occur simultaneously for that phenomenon to exist.

Howzat Thing Work?

However, if airway compromise occurs during active EPR phase, one could argue (1) whether or not airway could recover between EPR termination and initiation of next breath; and/or (2) is the type of event clinically relevant. It would seem that apneas would create an issue, whereas hypopneas would be addressed by the "IPAP effect" of the "baseline". Regardless, I'd really like to see a little more objective data about expiratory adjuncts before a concept of "knit one, purl two, unravel three" is adopted.

On UP3 and nasal CPAP:

Uvulopalatopharyngoplasty may compromise nasal CPAP therapy in sleep apnea syndrome Am. J. Respir. Crit. Care Med., Vol 154, No. 6, 12 1996, 1759-1762.
IL Mortimore, PA Bradley, JA Murray and NJ Douglas

Uvulopalatopharyngoplasty (U3P) has been advocated for treatment of snoring and sleep apnea/hypopnea syndrome (SAHS), but often it does not effect a cure, so that other therapy (CPAP) is often required. We hypothesized that patients with U3P will have increased mouth air leak during CPAP because of loss of the soft palatal seal. This may result in decreased tolerance and compliance if CPAP therapy is required after U3P. We have therefore compared CPAP tolerance in 13 awake normal male subjects, 13 male patients with SAHS and 13 male patients treated with U3P, all naive to CPAP and matched for age and body mass index. All normal subjects and patients with SAHS were able to tolerate pressures of at least 20 cm H2O without mouth air leak or appreciable discomfort. In contrast male U3P patients started to leak air via the mouth at a mean CPAP pressure of 6.8 (SD, 2.4) cm H2O and were able to tolerate a mean maximal pressure of only 14.5 (SD, 2.6) cm H2O, which was significantly less than that in the other two groups (p < 0.001). We also examined nasal CPAP compliance (machine run time) in eight patients with SAHS who had previous U3P compared with 16 patients with SAHS without U3P. Both groups were matched for age, body mass index, and apnea/hypopnea index. Patients with U3P had significantly lower compliance (mean, 3.5 h/night) compared with patients without U3P (mean, 5.7 h/night), p = 0.01. We conclude that U3P may compromise nasal CPAP therapy by increasing mouth air leak and reducing the maximal level of pressure that can be tolerated.

As noted, all these guys were awake.

If "soft palatal seal" is that critical in the mechanics of nasal CPAP (and that variable should be removed in using FFM, hybrid-style, or "that other" method), then one would only have to worry about "mouth leaks" if you had a UP3, and clearly, that's not the case.

Impact of Upper Airway Surgery on CPAP Compliance in Difficult-to-Manage Obstructive Sleep Apnea Ranju Chandrashekariah, MD; Ziad Shaman, MD; Dennis Auckley, MD Arch Otolaryngol Head Neck Surg. 2008;134(9):926-930.

Sleep apnea surgery is typically undertaken with a curative intent, although a cure is often not achieved, especially in obese patients with severe OSA. Concern has been raised that some upper airway surgery, particularly UPPP, may lead to a loss of the soft palatal seal needed to pressurize the upper airway with CPAP, thus decreasing CPAP tolerance and adversely impacting CPAP compliance. In support of this finding, a retrospective study suggested that having undergone a UPPP was an independent risk factor for CPAP noncompliance (odds ratio, 4.5; P = .05). However, in both of these studies, CPAP compliance before vs after surgery was not compared, but rather CPAP compliance in patients who had undergone surgery was contrasted with compliance in those who did not undergo surgery. Furthermore, both of these studies examined UPPP surgery alone. None of the patients in our study who had a UPPP underwent this surgery in isolation but rather as part of a combined surgery. Although awake pressure tolerance measures were not obtained in our study, intolerance of CPAP during sleep was not found, and clinically significant oral leaking on CPAP was not documented.

Muffy

[jnk]

I believe it may often be people who do not like the idea of CPAP in the first place who seek out, or are steered toward, UPPP. So, in harmony with the statements of limitation in the studies, I would tend to discount compliance comparisons. But that's just my personal interpretation bias.

Excellent point on the EPR thing. Thanks. I agree that I would only raise pressure in conjunction with raising my EPR if the AI estimate from my machine indicated to me that it had become necessary to do so afterward, but I would watch the numbers closely to see. Good idea?

Jan seems to be having more trouble with HI than AI. And one of my many problems is that I am a bilevel user, so I would always think in terms of EPR on 3. I would put it on 4 if that were possible!

If you don't mind my asking, I am curious about your experienced take on bilevel (or autobilevel) and dental appliances for UPPP patients who are having comfort and efficacy issues with PAP therapy. Last resorts? Early resorts? One of many tools in the SDB kitchen? Other?

I am really glad you are in this thread. I have a feeling there are a lot of PAP-with-UPPP people out there trying to figure out what they should do and what specifically they should speak to their doctors about.

[DreamDiver]

I have to agree -- this is an amazing thread. I'm learning a lot.
Jan - does this mean you should consider a full face mask or even a whole-face mask?

[SaltLakeJan]

Good morning to all, and many thanks for the suggestions, which I briefly scaned. The positive feelings I received, from all the good wishes, were a tremendous boost. Many thanks.

Last night, I continued to find a way to eliminate sleeping on my back. Bought some leaden-like tennis balls from a Dollar Store. Secured three on each side between two pieces of cloth. The balls are placed in a V shape, & about three inches in from the edge of my shoulder to just below mid back. I can lie on my side comfortably, but if I roll to my back, the hard tennis balls dig into my back, and even in my sleep, I quickly roled back to my sides.

I used the same neck cushion as before. I won't repeat this method again. During my sleep, something I do dislodges the tube from my mask. This sets off a loud racket -

However except for the Leak, the LCD stats were better than the previous night.

5-5-2009 Leak 0.34 AHI 4.3 AI 0.0 HI 4.2 I had to stop CPAP after 3 hours and 16 minutes. The positioinal cushion for my neck wasn't going to succeed, and I wanted a good nights sleep for my Doctor's appointment today.

DreamDiver I have been looking for a ff mask. My DME only had one ResMed ff mask in store. It didn't come close to fitting me. I'm not familiar with a whole faced mask.

Thanks for everyone's efforts to get me to this point.

Jan

[SaltLakeJan]

I'm going to keep my notes in this post for my experiences today. My Daughter picked me up for the Doctor's appointment. We saw the doctor talking at the Desk when we went in. He looked to be about 55, tall & slender.
Prior to my appointment, he had sent extensive forms for me to complete, on past health, current health. Surgeries, hospitalizations.etc. And, any prior CPAP experience including sleep studies, titrations. He was familiar with the contents of the forms. He was especially interested in the UPPP surgery, & wanted the details of that plus all information on previous nasal surgery. I had nasal surgery in 2002, this was one record I didn't copy. He wants a copy of this. He groaned, when I told him I recalled "ALL and tubinates were in the same sentence."

He examined my mouth and throat and said I do have more of my upper palate than most have after UPPP surgery. He added, that doesn't mean there is much there, just a little more than most. However, he said the interior of my nares is parched & cracked with pockets of infection that I had no idea was there. I explained I had nasal infection and raw places, had stopped therapy for 10 days in March, to allow it to heal, had used nasal irrigation. He said good practice, but not yet healed.

He frequently asked my Daughter what she had observed regarding where we were in my history/life experience. She surprised me with some of her answers. We recently sold our vacation home in California She and her husband had frequently vacationed with us. She had previously told him her husband had sleep apnea. He asked if she had ever heard me snoring or calling out in my sleep. She had, and she added she had heard me lightly snore, then stop for longer than she liked, then sputter a bit. Then go thru the routine again. I told her ladies didn't snore, and If they did, she shouldn't tell on them. (feeble joke)

He asked very penetrating questions regarding fatigue, how long? Had my father snored, yes? He also asked me to recall what I could of my 2000 sleep study & titration? I had already given him the copies. He is in the same health system as my 2000 study. I had asked for a complete copy of that study & titration. I have read on this forum that people don't believe they get the complete copy. He had contacted the original lab, & had pages more than was given to me. This was pre UPPP. I knew none of this: (ResMed VPAP System was used to provide Positive airway pressure. Nasal CPAP was discontinued and BiPap attempted, however respiratory abnormalities were not as well controlled with IPAP 8-9 cm H20) He pointed out on SpO2 that oxygen was below 90, but didn't give a specific figure)

(So folks, it is true many of us do not get complete records of the sleep studies we have paid for.)

He told us at this point that I presented him with a complex situation. (Darn, I was so caught up, I didn't ask what specificially was complex, was it the UPPP or what? He asked If I would agree to a Titration, he left the room to determine availability.

Dana used that opportunity to tell me she had gone with her husband to his sleep doctor, and this doctor had impressed her. He had asked many questions, but had listened as intently. By now, I was exhausted, & wasn't listening as carefully as she was. She observed, he wouldn't be making arrangements for titration if he wasn't going to accept you as a patient.

He came back in the room, and picked up a document I had given him - It was my LCD list. My heart sank, when he looked down at it, and asked, what is this? I had explained to her, how important it was for me to have a data capable machine. As he was looking at me for an answer, she was shaking her head & using a sign we had pre-arranged. If she thought I might be saying the wrong thing, she would open her purse. He was called out of the room before I could answer. And, my daughter was reiterating, that he impressed her, far more than either of her husband's two inadequate sleep doctors, and she was going to urge her husband to change to this Dr.. Her rational was a patient can quit a doctor at any time, but a doctor doesn't usually leave a patient. She pointed out that when I told him, I had changed the pressure on my machine since the get-go, and he said he thought that was appropiate. (I told him I had called the doctor's office, and told them if they objected to let me know)

When he came back, I asked him what machine he might suggest for me? He said with my nares in the condition they were, and with the surgical history, I needed abundant humidity and he recommended Fisher & Paykel machine and humidifier - I didn't recall any software with Fisher & Paykel. And Dana was opening and closing her purse and giving me significant looks. We had been there just over two hours. When we came out, I was half-way sick at heart. She observed, "You can fight that battle another day." We were going out for dinner, but I had to check the computer to see if F&P has software. Apparently some models do, but it is reserved for clinicians according to the site I checked. & I don't even know the specific model of F&P. I had asked the type, he answered CPAP. I asked why CPAP, he said CPAP is far more capable than many realize.

I am anxious for feedback tomorrow.

[-SWS]

I'm going to keep my notes in this post for my experiences today. My Daughter picked me up for the Doctor's appointment. We saw the doctor talking at the Desk when we went in. He looked to be about 55, tall & slender.
Prior to my appointment, he had sent extensive forms for me to complete, on past health, current health. Surgeries, hospitalizations.etc. And, any prior CPAP experience including sleep studies, titrations. He was familiar with the contents of the forms. He was especially interested in the UPPP surgery, & wanted the details of that plus all information on previous nasal surgery. I had nasal surgery in 2002, this was one record I didn't copy. He wants a copy of this. He groaned, when I told him I recalled "ALL and tubinates were in the same sentence."

He examined my mouth and throat and said I do have more of my upper palate than most have after UPPP surgery. He added, that doesn't mean there is much there, just a little more than most. However, he said the interior of my nares is parched & cracked with pockets of infection that I had no idea was there. I explained I had nasal infection and raw places, had stopped therapy for 10 days in March, to allow it to heal, had used nasal irrigation. He said good practice, but not yet healed.

So far he sounds okay to me, Jan.

Can I suggest any brand of locally-available saline gel for those cracked nares? Here's an example: http://www.walgreens.com/store/product. ... d=prod4998# .
It's gel-based, like Vaseline. But accidental and repeated small-dose inhalations would not be at risk of gradual build-up/accumulation. That, in turn, means no lipid pneumonia risks--- as can be the uncommon but unfortunate case with repeated/accumulated accidental lung exposures to petroleum jelly (that can actually lose safe viscosity inside warm nares).

I knew none of this: (ResMed VPAP System was used to provide Positive airway pressure. Nasal CPAP was discontinued and BiPap attempted, however respiratory abnormalities were not as well controlled with IPAP 8-9 cm H20) He pointed out on SpO2 that oxygen was below 90, but didn't give a specific figure)

(So folks, it is true many of us do not get complete records of the sleep studies we have paid for.)

He told us at this point that I presented him with a complex situation.

Given their comments about experimentally abandoning CPAP, then observing respiratory abnormality/dyscontrol on BiLevel's IPAP of 8-9 cm, I wonder if you manifested or presented what is sometimes called Complex Sleep Apnea Syndrome or Complex Sleep Disordered Breathing (CompSAS/CSDB).

He came back in the room, and picked up a document I had given him - It was my LCD list. My heart sank, when he looked down at it, and asked, what is this? I had explained to her, how important it was for me to have a data capable machine. As he was looking at me for an answer, she was shaking her head & using a sign we had pre-arranged...

...When he came back, I asked him what machine he might suggest for me? He said with my nares in the condition they were, and with the surgical history, I needed abundant humidity and he recommended Fisher & Paykel machine and humidifier - I didn't recall any software with Fisher & Paykel. And Dana was opening and closing her purse and giving me significant looks. We had been there just over two hours. When we came out, I was half-way sick at heart. She observed, "You can fight that battle another day."

It sounds as though he would like you to trade your current data-capable CPAP machine in to get a different CPAP machine that is not data capable---under the premise of getting that superior F&P humidification. That truly is superior humidification IMO.

You can fight that battle another day or just sidestep that battle altogether, by buying a separate F&P external humidifier for your current data capable CPAP machine:
https://www.cpap.com/productpage/fisher ... ifier.html (that's the same superior humidification---and fixed-pressure from either CPAP machine would be identical).

Of course, if you had your husband order it, then you could tell the doctor never mind---that you received an F&P humidifier as a gift. Humidifiers don't require a prescription. But if you decide to go that route, you might want to hold off until you at least find out from your upcoming PSG exactly which machine type you'll be using. It sounds as if CPAP may actually be better for you than BiLevel. But if you just so happen to have CompSAS/CSDB, then an ASV machine might turn out to be what you'll soon receive instead.

In the meantime, you might want to turn up the humidity a bit on your current humidifier. That alone may suffice.

[SaltLakeJan]

SWS, I won't pretend my intellect if on a par with yours. However, tonight our minds had similar thoughts. I got out of my bed & a restless sleep to post. I don't have to do it all. It is as you say, a Humidifier can be obtained anyway, any place. For that matter, I don't have to commit to the doctor. But I will go ahead with the titration. - I can take it one day at a time. With the guidance you are kind enough to consider for me, If I want a different machine,I can ask my internist - who definitely isn't a rocket scientist - for the prescription.

However, the Doctor I visited today, has an excellent reputation. Innovative, & committed to his patients and their welfare. He is the Medical Director of the largest Sleep Disorders Center, connected to a major hospital here. I"m going to think about it for a couple of days. Perhaps, he might be an approachable kind of guy. The throught runs thru my mind now - that I could ask him if F&P can be neogotiated Explaining how much daily data means to me - using the example of my close control of my diabetes. The reason I want software is that I have been "spinning in place" for 5 months. I don't want to do that again.

You questioned if centrals are mentioned in the old sleep study - It isn't very clear - but the word central is listed - can't read the rest of it. He wasn't bothered by me setting the pressure. I had it at 9-8, and zipped it to 10-8. It irritated my nose, and I backed it down to 10cm. He advised, until the titration, June 7th, that I not increase my pressure.

SWS - after your post, I decided I don't have to do anything tomorrow - I can wait to see what happens.
You weren't here to debate my thoughts - but your post stood in for you - did a nice job too.

Back to bed - "See" you soon. Jan

[Muffy]

I needed abundant humidity and he recommended Fisher & Paykel machine and humidifier

Sounds like he is a fan of "Thermosmart" technology. Note that not all F&P machines have that:

F&P Brochure

If you don't mind my asking, I am curious about your experienced take on bilevel (or autobilevel) and dental appliances for UPPP patients who are having comfort and efficacy issues with PAP therapy. Last resorts? Early resorts? One of many tools in the SDB kitchen? Other?

2 (or 3) of the more expensive tools in the SBD kitchen. But if you need to stir the spaghetti sauce, don't grab the garlic press.

Given their comments about experimentally abandoning CPAP, then observing respiratory abnormality/dyscontrol on BiLevel's IPAP of 8-9 cm, I wonder if you manifested or presented what is sometimes called Complex Sleep Apnea Syndrome or Complex Sleep Disordered Breathing (CompSAS/CSDB).

Based on the first titration, there certainly does seem to be a CompSAS component:

TITRATION 4-25-09 FINDINGS:
RESPIRATORY EVENTS & OXGENATION:
Patients oxy. sat. above 90% majority of time. The most striking finding is the difference in natures of apneas. In Previous study, she had predominance of obstructive apnea. In this study, she had central apneas or hpopneas up to 84 events per hr. With Occasional Obstructive apneas up to 16 per hr. Respiratory distress 81 events per hr.
SLEEP ARCHITECTURE: 419 min of recorded sleep. Sleep Latency 67.5 min. Sleep period 346 min. No Rem Sleep during study.

What medications were you on back then?

I wouldn't even consider an ASV approach until you get a handle on nasal infection, adequate humidity, leak control, aerophagia, sustained compliance, some semblance of normal sleep and stabilization on ANY kind of PAP. THEN, if necessary, break out the flash.

The overwhelming contributor of the breathing instability of CompSAS is sleep instability, so, "IMO", in the-chicken-and-the-egg problem, stable sleep is the rooster.

Y'know, I read this in the 2008 study

Couldnt complete observations, leads came off during study.

and think, "Man, that sounds screwy. Why not just put them back?"

Here comes Mrs. Skeptical again.

BTW, where are these sleep labs located? I hope they're not on top of Brighton.

Muffy

[-SWS]

Given their comments about experimentally abandoning CPAP, then observing respiratory abnormality/dyscontrol on BiLevel's IPAP of 8-9 cm, I wonder if you manifested or presented what is sometimes called Complex Sleep Apnea Syndrome or Complex Sleep Disordered Breathing (CompSAS/CSDB).

Based on the first titration, there certainly does seem to be a CompSAS component:

TITRATION 4-25-09 FINDINGS:
RESPIRATORY EVENTS & OXGENATION:
Patients oxy. sat. above 90% majority of time. The most striking finding is the difference in natures of apneas. In Previous study, she had predominance of obstructive apnea. In this study, she had central apneas or hpopneas up to 84 events per hr. With Occasional Obstructive apneas up to 16 per hr. Respiratory distress 81 events per hr.
SLEEP ARCHITECTURE: 419 min of recorded sleep. Sleep Latency 67.5 min. Sleep period 346 min. No Rem Sleep during study.

What medications were you on back then?

Well I'm sure glad you thought of looking for that post. I was getting ready to ask Jan if she would mind posting some more details from her sleep study. She already did!

And that sheds a different light on key considerations. Based on that preliminary PSG information, ordinary APAP and even auto BiLevel are starting to shape up as, in all likelihood, poor modality choices for Jan. And even ordinary BiLevel probably exacerbated respiratory dyscontrol during the PSG, causing that default back to CPAP. ASV may very well be a modality the doctor decides to try. However, well-controlled CPAP may actually turn out to be the best modality.

In any event, I agree about getting all possible sleep-deteriorating factors under control, to minimize sleep dyscontrol itself---which can theoretically contribute to respiratory dyscontrol in CompSAS/CSDB as SAG very well points out. And that makes all those sleep factors below important to at least attempt to manage toward a sleep optimum (as if they were potentially precipitating factors of sleep dyscontrol and thus a contributor toward respiratory dyscontrol---not to mention presently undetermined theoretical CAP or Cyclic Alternating Pattern issues in biology):

I wouldn't even consider an ASV approach until you get a handle on nasal infection, adequate humidity, leak control, aerophagia, sustained compliance, some semblance of normal sleep and stabilization on ANY kind of PAP.

Sounds like he is a fan of "Thermosmart" technology. Note that not all F&P machines have that:

F&P Brochure

That actually looks like a great feature. But if that's one of the features he's after, it's not part of the external F&P humidifier that I have linked above. Thermosmart technology is a circuit-controlled heated tube that helps with rain-out. F&P technology really is superior at the humidification game IMHO. However, Thermosmart may turn out to be unnecessary if rain-out is not a genuine issue. If rain-out is an issue, I'm thinking the Australian heated hose in conjunction with F&P's HC150 external humidifier linked above may be a very suitable alternative.

And again, the current humidifier turned up (either with or without the Australian heated hose) may even suffice.

[SaltLakeJan]

Good Morning to everyone - especially Muffy
Well, it is morning to me - if not everyone else. It is almost noon here. I was toooo tired last night - but slept over nine hours so feel better this morning. It will take me a while to answer all the questions or add information that may help/add to the confusion.

For a long time before & during my 2000 Sleep Study & Titration I experienced Fatigue - Fatigue - Fatigue. My doctor ran every test he could think of- all were negative. After consultation and exams by another doctor, they diagnosed Fibromyalgia and Chronic Fatigue. Coupled with FMS, I had as many as eight sinus infections a year, which was treated with 5 days to two weeks antiobiotics.

SWS, You asked what medications I was taking during the 2000 sleep tests. If I have a major doctor's appointment, I input a copy of my symptoms & medications in my computer.
My sleep tests were in May 2000,I have a list of the prescriptions I took for FMS/CF 3-2000 to 9-2000
Clonazapam 0.5 mg For Insomnia
Neurontin 300 mg Ambien 5 mg
Prilosec 20 mg Trazadone 100 mg
Effexor 75 mg


Reviewing that amount of medication is frightening. What is also frightening, I worked for a Govt Agency, & overseeing Compliance was my prime responsiblity. I am not certain how I did it, but we always kept within the allowable percentile.

How did they affect the sleep study?

I had no reason to doubt the FMS/CF diagnosis. Just having a diagnosis was a relief. The Doctor suggested I start an Educational type support Group. A friend and I began the Group. We had medical professionals come to our meetings and explain how their speciality was linked to FMS/CF and what to do, to try to improve your situation. We kept it going for 13 years - finally running out of ideas. One idea reaccured to me. My prime symptom was severe fatigue. I had a scant few of other problems, but I constantly wondered if I really had Fibromyalgia. When I was diagnosed with sleep apnea in 2000, I seriously considered, that apnea had always been the sosurce of my fatigue. My father was a heavy, you might say Giant Snorer. He died at age 62 of a sudden Mycardial Infarction - heart attack. No previous history. Did I take all those medications with their harmful affects as an exercise in futility?

My doctor used many prescriptions off label in an effort to combat the fatigue. I recall telling him that my fatigue was worse. (Is it any wonder?) I took my self off all the FMS prescriptions within a month because it was obvious to me, that they were not working.

Currently I take a blood pressure pill, one for high cholesterol, and cut a 3 mg Lunesta in half. I also take metiformin for Diabetes.

I asked the sleep doctor 5-5-09 if he considered one and 1/2 mg of Lunesta harmful to Cpap treatment. He said not with that amount. But, asked about my history of Insomnia. I've had it most of my adult life. He countered by asking if my sleeping had inproved since using CPAP. It isn't 100%, but much improved. He said in many people, a type of insomnia is a precursor to apnea, & I may have the type.

In regards to the Centrals, in the 12-2008 sleep study, there was no mention of centrals anywhere. This is the test where the lead came off, and I repeat your query, "Dah, why wasn't it put back on?" I hate to add this, but my observation of the technicians was that they were Keystone Cops pretending to be sleep technicians.

SWS, was it you who asked if the sleep studies were done at Brighton. Nope, all have been at Salt Lake's East Bench elevation of about 4400 above sea level. DH is a former private pilot & is familiar with our elevation.

Yesterday, he said not everyone gets relief from fatigue by Cpap. if it continues past titration, he will give me Provigil, or the new one coming out, the name is something like Nuvigil. Given my experience with the excessive drugs listed above, I would have to investigate thoroughly before I would consider Provigil. (spelling may not be correct) Any thoughts on this?

To all of you who are following this post, especially Muffy, I have copied the 5-5-2009 questions following my doctor appointment post, I'm trying to understand the technical aspect, and add the answers I can. When I consider the brain power behind the queries, I envision them producing enough wattage to run my household for a year. WOW. Jan

[SaltLakeJan]

I'm sending out an SOS

My DME called, originally they were the pits. The Owner (lived in a different city) heard of customer complaints and had what he called a focus group. His DME combined with another DME and has about 30 branches in the State. The owner is what SWS sd R.G would call "one of the good un's. Their business had suddendly dipped, he said he didn't know if it was our economy or if they needed to upgrade their service. I was invited to the focus group, and was frank about specifics of their customer service. He asked for a private conversation with me, and implemented every suggestion I gave.

Well, back to the problem at hand. The DME called, said my Doctor called, & while they don't usually switch machines 5 months after delivery. They are willing to switch my Res Med Elite with Humidifier, for F&P "best" CPAP, with F&P Humidifier - which my RT says is the best humidifier in the industry. He says my new sleep Doctor has clout and told them medically he is prescribing F&P this because of my on-going history of sinus complications.

My R T knows how I value data feedback & the really bad news is that, F&P has NO SOFTWEAR, NOT EVEN FOR CLINICIANS. And the F&P humidifier cannot be linked to any other brand. I asked if any other Brand had humification similiar to F&P. According to his experience - no one does. I have asked them to put a temporary hold on the exchange. I thought of telling the doctor that I have not used the humidifier (this is 100% true) because it is summer, and I didn't think I needed it. And, CAN I HAVE A TRIAL RUN WITH RESMED'S HUMIDIFIER ENABLED? I don't think my Doctor regards data as an important component to sleep therapy. I am so upset, I am going to wait to hear from you all, before making any decisions. J aa n Ja n

[SaltLakeJan]

SWS, Muffy, jnk, DreamDiver,
all opinions valued.
Is is poor judgement to consider the health benefits of daily data, more than the health benefit of humidification? This is a hard one, I will appreciate suggestions, but I realize the decision is mine alone.

I waited for softwear because my 12-2008 sleep doctor sd he was going to change machines - never happened. I used the LCD data daily . . . Inadequate as it is, because it is better than nothing.

Janie - that's what my Mother called me, & I feel like a Janie.

[-SWS]

Jan, I can only tell you what I would do under those circumstances.

I'd simply inform the DME, in an altogether polite but matter-of-fact way, that I'll stick with the data-capable CPAP machine after all. Then I'd simply tell the DME to just order an F&P HC150 external humidifier. I would do it with that same matter-of-fact mindset I had yesterday when I politely told the McDonalds employee to sell me a Southwestern salad for lunch.

I didn't feel the least bit guilty for giving the McDonalds employee that matter-of-fact directive about exactly what I had decided to put in my body for lunch. And I wouldn't feel the least bit guilty for politely and assertively informing the DME exactly which humidification machine I also decided to interface with my own body and data-capable machine at night.

That F&P HC150 will work just fine with your current very data-capable CPAP machine. Fixed pressure is fixed pressure regardless of machine. And adequate humidification is adequate humidification, regardless of method or model introduced. Data denial is the only outstanding issue. If you want to measure your own body's nightly AHI at night, then there should be no crime or guilt attached to that desire. Period!

But if McDonalds Southwestern salads ever become outlawed, then the cornerstone of that entire argument just crumbles...

[-SWS]

The best argument I can think of for not having a data-capable machine available, would be if anxiety associated with tracking that nightly data was observed or predicted by the doctor as potentially being psychologically counterproductive.

Regardless of the health problem(s) at hand, my understanding is that some patients may obsess and become anxiety ridden to the point of hindering health or recovery. That's a valid consideration for any sleep doctor IMHO. But blindly running with unacceptably high AHI can be very counterproductive as well---a far more common scenario I would guess based on countless anecdotes here.