Sleep Study Part Deux

[Rustyolddude]

T Minus 24 Hours & counting....

It was just about a month ago that I set upon this journey, for reasons yet unknown to me, I get a re-do on the test. I bought the Cliff Notes & study guide, took the practice sleeping exam every night, logged every day in my sleep diary and cautiously tried the hypnotic blue pills to be certain I didn’t drive naked to the burger shack for a 3AM snack.

Tonight I will make my incursion into electronic Lilliputian. Once again I’ll endure the turmoil of having marshmallow Peeps mashed into my freshly shorn scalp. The torture of having hair ripped from my legs and chest with tape not designed to be removed, the resulting 3 day rash on my neck and face and the tape goo that takes a week to get rid of. I’ll fight back the anxiety of having voyeurs watching and recording my slumber. I’ll endure a cold hospital breakfast and possibly a leaf blower rudely stuck to my face at some obscene hour of the morning. This time my little blue pill of blissful sleep will spare me the hours of staring and making faces at the camera above me and help erase my memory of the intrusions by those struggling to keep me wired to their mind reading devices.

When the sun rises again, I should know whether I’ll be hanging around the Hose-Head camp or hoisting my bindle stick and heading off on my journey into diagnoses yet unknown. Part of me dreads an affirmative diagnosis and having to submit to the alien face sucking overlords, while another part of me craves a peaceful night sleep like a junkie craves their next fix. After years of suffering, I accept my fate like a soldier entering a fierce battle, I know not waits for me on my journey to the Valley of Peaceful Sleep but I will advance, retreat is not an option.

It’s been a great learning experience thus far, AHI, RDI, RLS, CPAP, APAP, BI-PAP, ASV, OSA, MSA, CSA, Rain-Out, Fully Data Capable. I’ve got the secret Hose-Head code words down pat. You’ve thoroughly convinced me that cats are the primary cause of sleep apnea; there are just too many cat people on the support forums for it to be a coincidence. You’ve up-armored me with your knowledge and I’m better prepared for the battle. I know what I need to ask of the sleep lab and a pretty good idea what I’ll be looking at in the data.

Even if I’m defeated by the lack of an affirmative apnea diagnosis, I’ll come away with an understanding of OSA & CPAP and should I encounter a Hose-Head in my travels, they needn’t be self conscious of their therapy.

As I walk off into the sunset, pillow holstered under my arm, AmbienCR in my cartridge belt, I bid you adieu and a restful night’s sleep. Tomorrow will be a new dawning, another step in my quest for sleep.

[ricochetv1]

Wow! You get breakfast? I got a swift kick out the door at 5am with a, "We'll call ya!"

[silver123]

Well...meow to you too.and best of luck with the sleep study. Please let us all know how it goes.

silver

[jdm2857]

I got a breakfast ticket good at the hospital cafeteria.

And my cats have arranged to watch you all night via the infra-red camera in the study room and the net. They've already made sure that you're getting extra-stick tape.

[BeanMeScot]

Shave the legs. The hair grows back...

I got cold pasteries and OJ for breakfast.

[rosiefrosie]

I got a luke warm cup of coffee. Woof! Woof! I'm a dog person. Thanks for the good read, am looking forward to more.

[Muse-Inc]

Gee, I got zip to eat or drink! Maybe I missed it 'cause I was in the shower so long trying to get the goo off my fur...horrible stuff.

[Rustyolddude]

Looks like I’m sticking around at least for a little while. I survived the battle but just barely. They never told me that the second study was actually going to be for titration, I assumed it would be a second try at a split study. When I arrived, tech said I was getting the hose, all night. So they stuck a ResMed Quattro on my face and wired me up. (don’t know how happy the wife is gonna be with that stream of air blowing out the front) Honestly, I was way less anxious this go around, I’d be willing to even say calm & relaxed when I arrived. Had plenty of TV time while they were working with other patients, took my AmbienCR, 12.5mg right before they began wiring me up. They tucked me and I was out. At some point, I must have developed a leak and the tech came in and cranked the headgear down, I’ve got nice red mask marks this morning. Anyway, with that intrusion, my sound sleep was over with, pretty much fought sleep all night. Tried everything to occupy my mind, counting, etc. They were willing to give up at 6:30am, I stuck my ear plugs in and asked for another hour.

I’m dead tired and it’s gonna be a loooong day here at work, barely functional.

Tech was rather funny, he reviewed the last study and said “You didn’t sleep!”
This morning he said the same thing. Well duh! How do you think I ended up here?!

The Doc. reviewed the data & my sleep diary and said I had a consistent number of mini events, what he meant by that is anyone’s guess. Basically, every time I’d just nod off, I’d wake up (in spite of the AmbienCR). He said when I was titrated to 10cm/H2O these events ‘seem’ to disappear. I can say this, I wasn’t experiencing the breathing effort while on my back which is how I normally sleep (picture a posed person in a casket, that’s my sleep position). Doc wants to try 10cm in my home environment for 2 months to see how I do.

I felt pretty comfortable, the FF mask didn’t bother me one bit save for the tech cranking it down on my face, nose bridge is a bit sore but I know I can do a better job of adjusting the mask properly. The pressure didn’t bother me either. I got to keep the mask I used in the sleep lab. I was also able to sleep on my side without breaking the seal and felt comfortable. As a side note, I’m used to wearing a paint respirator for extended periods of time so that’s probably why I don’t have a phobia with a FF mask.

The Doc normally goes with auto machines but in my case he wanted to go straight CPAP, DME came in with a Repironics M series Pro with humidifier & smart card. She was nice enough, American Home Patient DME. I declined to take the machine with me until I looked at the numbers & total out of pocket cost with my insurance. It looks like it’s a wash, between CPAP.com and my cost with my insurance. I don’t know if I should try to push the Doc. for an Auto “just in case” especially since it can be set for a fixed CPAP pressure but my circumstances are rather unique so it may not be worth the hassle or be an advantage. Comments? When I asked about pulling the data off the machine, she said there wasn’t any way for me to do that. I will have to mail the card every 30 days. The sleep lab has a patient support meeting once a week in the evening and they will read the cards as well. I need to look into the M series Pro and see if there is any data, AHI, Leak etc. that can be accessed on the LCD display, anyone care to inform me? I’ll probably wait a bit on the card reader.
One thing that bothered me, when they first fitted the mask, I got stuffy. The Tech said he turned DOWN the humidity to take care of it which is consistent with what I’ve read here. When I mentioned during the DME spiel, she said to crank up the humidity. Correct me here; it is decrease when you encounter stuffiness, right?

I signed a release and they will be mailing me the results of both studies. Dunno how long that will take. But I’m curious to see the numbers.

[jdm2857]

The M Series Pro has some efficacy data available via the machine's display. However, it is an average of (I think) weekly data. Many people reset that average every day so that it winds up display the last day's numbers instead.

[Pugsy]

The M Series Pro has some efficacy data available via the machine's display. However, it is an average of (I think) weekly data. Many people reset that average every day so that it winds up display the last day's numbers instead.

Yes, it is only an average of 7 day or 30 day AHI and leak rate, & therapy hours.
No breakdown otherwise between Apnea vs Hypopneas. Has to be reset daily to zero if you want to document nightly AHI and leak which BTW I found to be way less than accurate once I did get the software.
The ResMed data capable machines do a much better job with what is shown on the LCD screen than the Respironics. So.....for Respironics data capable machines I personally could never be satisfied without having the software available.

[ricochetv1]

I suggest you hold-out for an APAP. They are all fully data capable, they are billed the exact same as a CPAP to your insurance, and it'll will only cost the DME profit. When it comes down to that, I'd say keep your options open.

[Rustyolddude]

CPAP Night One:

Decided to go ahead & pick up the machine from the DME. Had I known the insurance/$$/deductible/cost over 10 months numbers in advance, I would have left the hospital with it. It was a one-stop shop, titration study, post study morning consult with the pulmonary Doc. and take your equipment home the same morning. Kudos are owed to my Doc. after reading all the waiting stories here, especially with folks whose conditions are far more severe than mine. My heart goes out to you.

Originally they were going to give me an Auto (DME had an Auto ready to go and had to go exchange it for a CPAP) but the pulmonary Doc. specifically requested a straight CPAP, don't know why but not for me to argue at least right now. The Doc. is well respected & my condition is rather unique, even the DME said I wasn’t the typical CPAP patient since my weight is normal compared to the typical candidates so I'll go with what the Doc. says, for now. Pressure fixed at 10cm. The hospital gave me the Quattro mask I used for the study, one that they had obviously test fitted/used & re-sterilized. By close examination, it was new. I got a second new Med. Quattro from the DME as well. I'm going to leave it unopened until I’m satisfied that the Quattro is going to work, be easier for me to trade an unopened mask for another with the DME.

One thing that really ticked me off was the mask fitting by the sleep technician; I have a nice sore on my nose bridge as a result. He cranked in the mask down way too tight and wasn’t receptive to me twiddling with it, he didn’t bother adjusting the knob for proper fit, so I just suffered with it. He was a nice enough guy but not versed on patient comfort. His instructions for adjusting the mask were to grasp the elbow, mash the mask into your face & tighten the straps. Thankfully cpaptalk folks educated me better than that. Last night, I cleaned the mask, shaved, used chapstick and gently fit the mask to my face. I tweaked it while lying down, lifting it reseating it, tightening it just a little until I killed all the leaks under full pressure. I could feel the seal inflate against my face. I was able to roll to either side without leaks. I think I had to adjust it one more time during the night.

I washed then filled the humidifier, set it to 1, no problems being stuffy, no rain-out. Some very smart & helpful user here had posted in a thread, which I saved to my notes, the method of routing the hose. “Run the hose between the top of the pillow & headboard, adjust the length & center up so that you can roll to either side”. I actually tucked it between the top edge seam of the mattress. I apologize for not making note of that users name but I owe you a big thank you. This worked like a charm. I was able to move all over my pillow without even noticing the hose and without having leak issues.

I was really beat from not having slept much the night of the titration; I set my machine up in the spare room so as not to bother the wife until I adjust to things, I flushed my sinuses, took an AmbienCR and went to bed around 10pm. The M series Pro is noisy! Sounds like a motel vacuum cleaner, I donned my ear plugs; Howard Leight Maxlit (great & comfy plugs, the best I’ve ever used and I’ve tried dozens of brands), hit the ramp, C-Flex set to 3, tossed a washcloth over the lighted buttons and nodded off.

According to the machine this morning I had 9.2 hours of therapy. No newbie issues, no claustrophobia, (I’m used to wearing a paint respirator for extended periods & used to SCUBA dive) no removing the mask. Bridge of my nose is still a little sore but I know it was from the sleep lab experience as I didn’t have problems last night. I was able to sleep on my back comfortably almost the entire night; this has been an issue for me for some time. I’m not comfortable on my side, shoulders bother me and I get killer ear aches that wake me. Soundly sleeping on my back is difficult because as I nod off, breathing effort/snoring/apneas causes me to wake.

No problem adjusting to the pressure, my face felt a little puffy this morning but that cleared up. I can’t really judge my wakefulness and alertness until later in the day but so far, so good for night 1. I can’t find my earplugs this morning, I don’t recall eating any lime marshmallows, I had removed them when the sun woke me.

I’m going to have to talk to the DME about the machine noise as it’s not going to fly like it is. If it were constant, it would be tolerable but the sound it makes as I’m breathing is going to drive me & more importantly the wife nuts. I would really appreciate any suggestions, I had it sitting on a washcloth on the nightstand. I might try sticking it inside the nightstand if I have room to route the power & hose.

Noticed that there wasn't a date set on the machine, I need to look into doing this. Going to pop the Smartcard out next week and stop by the hospital sleep lab next week on support night and have them print out my data and see how things are looking.

If it hadn’t been for the helpful folks here on cpaptalk.com, I would not have had a good experience. I’m off & running on the right foot thanks to all of you.