Hi! I'm new and I'm here for a reason; I need help! My story: I'm a 41 year old full time Boise State University student. The BSU insurance coverage doesn't cover apnea tratments or sleep studies- luckily my long time family doctor- who diagnosed me and tried to get someone to do a sleep study for free, bless his heart, actually convinced a local medical supply distributor to donate the use of a CPAP free of charge for as long as I'm alive. Pretty cool, huh? They set me up with a Remstar Automatic that had the smart card since I hadn't done the sleep study, and I used it for a couple weeks, long enough for my doctor to be able to look over the results and determine the pressure settings. From the first day I used it, drastic changes began taking place. You know the story, I felt ten years younger overnight, no bags under my eyes, the whole nine yards. Energized. Even stayed awake in my MicroEconomics class. It was sweet. They ended up trading me the auto for a Remstar Pro c-flex with a setting of 16. Here's what sucks: From the first night with the traded out machine, I went back to my previous condition- not all the way mind you, but I'm fatigued, huge bags under my eyes again, I have to sleep at least two hours longer, etc.
It seems easy to assume I just need to set the pressure higher, right? (Doc's script allows for a range between 10-19) Problem is, I wake up every morning feeling completely blown out- my chest kinda hurts like I just got done exercising. I feel like the pressure needs to come down... ya know? Any suggestions?
Help! My settings are all wrong!
The difference comes into play between the two machines is in how they function.
The Autopap would run at a much lower pressure a majority of the time (say 6-10cm) then only increase pressure (to 16cm) when it actually was needed, BUT it would do that most likely when your asleep so you never really noticed it.
By contrast, the straight cpap machine (Pro w/cflex) doesn't work that way. It basically has a single fixed pressure programmed (16cm) and can only ramp up to that pressure over time called a Ramp timer. The timeframe for normally doing that is 5-45 minutes for your particular machine.
The only way to return to the lower pressure is by going back to the autopap machine. If you still have your cpap prescription you can order one on-line, they are good for 2 years. Nothing special needed for ordering the autopap.
Now if your wanting to simply reprogram your existing machine so it functions more like the autopap you can do that too. The Pro w/cflex is a good machine. The part your missing however is how severe are those events that need the 16cm pressure to clear, what I mean by that is how many of those events take place per night and or how much time do you spend with those events. That information would be found on the autopap reports. It can be only 2 minutes or 2 hours per night. If a majority of your SDB events are eliminated at a lower pressure then you can probably get by with a lower pressure on your Pro. Studies show a pressure of only 8-10cm pressure can eliminate 70% or more of events seen in the avg. patient. With an autopap or cpap your only gaining at most 20% more.
But the bottom line is getting to sleep and using the machine. If you don't sleep or use the machine because it is too high then it does no good to struggle along with it there. If the machine's settings is keeping you from sleeping then change the settings. So here's my suggestion;
Set your low pressure to 6-10cm (use 10cm if you can tolerate it).
Set CFlex to position 2.
Set Ramp timer to 30-minutes.
Set High pressure to 10cm.
Now, when you start off sleeping you put on your mask, hit the On button, immediately hit the Ramp down button. The machine will go from 10cm to 6cm and start that 30-minute timer. Then every 5-minutes it will increase pressure until it exhausts that timer or reaches the high 10cm pressure.
By the time that timer expires you should be asleep, if not, you hit the Ramp down button again and it will restart the timer for another 30-minutes. You can repeat hitting the ramp down as many times as you like. But after 30-minutes the machine will be at 10cm pressure, enough to clear a majority of your events but not high enough to interrupt your sleep. You make these changes by entering the setup mode by unplugging the machine, then holding down the two left/right arrow buttons while plugging the machine back in. It flashes the LCD display, beeps, first field is hours of use >4hrs, use left/right buttons move to next field, Ramp up/down buttons change values, hitting the On/Off button exits the setup mode.
Then if your still not feeling better with the above settings, you can always increase the high pressure to 11cm going all the way back up to your 16cm if needed. Other things that can help is taking care of nasal congestion, use BreathRight strips, saline spray, sleep on your stomach or side.
The Autopap would run at a much lower pressure a majority of the time (say 6-10cm) then only increase pressure (to 16cm) when it actually was needed, BUT it would do that most likely when your asleep so you never really noticed it.
By contrast, the straight cpap machine (Pro w/cflex) doesn't work that way. It basically has a single fixed pressure programmed (16cm) and can only ramp up to that pressure over time called a Ramp timer. The timeframe for normally doing that is 5-45 minutes for your particular machine.
The only way to return to the lower pressure is by going back to the autopap machine. If you still have your cpap prescription you can order one on-line, they are good for 2 years. Nothing special needed for ordering the autopap.
Now if your wanting to simply reprogram your existing machine so it functions more like the autopap you can do that too. The Pro w/cflex is a good machine. The part your missing however is how severe are those events that need the 16cm pressure to clear, what I mean by that is how many of those events take place per night and or how much time do you spend with those events. That information would be found on the autopap reports. It can be only 2 minutes or 2 hours per night. If a majority of your SDB events are eliminated at a lower pressure then you can probably get by with a lower pressure on your Pro. Studies show a pressure of only 8-10cm pressure can eliminate 70% or more of events seen in the avg. patient. With an autopap or cpap your only gaining at most 20% more.
But the bottom line is getting to sleep and using the machine. If you don't sleep or use the machine because it is too high then it does no good to struggle along with it there. If the machine's settings is keeping you from sleeping then change the settings. So here's my suggestion;
Set your low pressure to 6-10cm (use 10cm if you can tolerate it).
Set CFlex to position 2.
Set Ramp timer to 30-minutes.
Set High pressure to 10cm.
Now, when you start off sleeping you put on your mask, hit the On button, immediately hit the Ramp down button. The machine will go from 10cm to 6cm and start that 30-minute timer. Then every 5-minutes it will increase pressure until it exhausts that timer or reaches the high 10cm pressure.
By the time that timer expires you should be asleep, if not, you hit the Ramp down button again and it will restart the timer for another 30-minutes. You can repeat hitting the ramp down as many times as you like. But after 30-minutes the machine will be at 10cm pressure, enough to clear a majority of your events but not high enough to interrupt your sleep. You make these changes by entering the setup mode by unplugging the machine, then holding down the two left/right arrow buttons while plugging the machine back in. It flashes the LCD display, beeps, first field is hours of use >4hrs, use left/right buttons move to next field, Ramp up/down buttons change values, hitting the On/Off button exits the setup mode.
Then if your still not feeling better with the above settings, you can always increase the high pressure to 11cm going all the way back up to your 16cm if needed. Other things that can help is taking care of nasal congestion, use BreathRight strips, saline spray, sleep on your stomach or side.
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Apneic Nation
- Posts: 17
- Joined: Thu Mar 23, 2006 2:00 pm
I don't want to sound unappreciative, because I need all the help I can get- but I know how to change the settings, use the ramp feature, I know the difference between an APAP and a CPAP, and I don't have a problem falling asleep or keeping the mask on- what my problem centers around is trying to decide whether I need to go up or down on my pressure. Doc says from looking at the smart card that I occasionally would take it all the way to twenty; and that I was still snoring infrequently, thus his determination to start me off on the Remstar Pro with a setting of 16- he scripted me a range from 10-19. The first night I used the set pressure (as opposed to the auto) and all subsequent nights since, I have slept, but felt fatigued and unrested upon awakening, and the fatigue gets worse as the day progresses. I would normally think I should up the pressure, except for the fact that my lungs kinda hurt when I wake up, and I've heard that means my pressure settings are too high. I changed it to 18 last night, and I still feel all fatigued. Any suggestions?
Suggestion no. 1 : The Remstar Pro is a set pressure machine, not an automatic. So which kind of machine do you have right now? What is it set on?Apneic Nation wrote:I don't want to sound unappreciative, because I need all the help I can get- but I know how to change the settings, use the ramp feature, I know the difference between an APAP and a CPAP, and I don't have a problem falling asleep or keeping the mask on- what my problem centers around is trying to decide whether I need to go up or down on my pressure. Doc says from looking at the smart card that I occasionally would take it all the way to twenty; and that I was still snoring infrequently, thus his determination to start me off on the Remstar Pro with a setting of 16- he scripted me a range from 10-19. The first night I used the set pressure (as opposed to the auto) and all subsequent nights since, I have slept, but felt fatigued and unrested upon awakening, and the fatigue gets worse as the day progresses. I would normally think I should up the pressure, except for the fact that my lungs kinda hurt when I wake up, and I've heard that means my pressure settings are too high. I changed it to 18 last night, and I still feel all fatigued. Any suggestions?
Suggestion no. 2: Get the info from the smartcard, and share it with us.
Suggestion no. 3: Give us some background - what were your sleep study results? How long have you been using cpap? Are you sure your mask isn't leaking?
I don't think hurting lungs mean your pressure is too high - they mean your not used to breathing against the pressure you're getting. The soreness usually wears off once your muscles are get used to breathing like that.
Suggestion no. 4: (probably should have been no. 1) Try to get your doc to explain things and cooperate with you - and unless you have a good reason to do otherwise - trust him. He's seen you data, which none of us have. Let him know how you feel and ask him what he suggests.
O.
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| Mask: AirFit™ P10 Nasal Pillow CPAP Mask with Headgear |
| Additional Comments: Machine: Resmed AirSense10 for Her with Climateline heated hose ; alternating masks. |
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Apneic Nation
- Posts: 17
- Joined: Thu Mar 23, 2006 2:00 pm
Suggestion #1
........ I have the set pressure Remstar- they only allowed me the use of the auto unit to determine what pressure I need, as I don't have insurance that covers this, and didn't do a sleep study. Docs script, like I said before, is for a range between 10-19, and the set pressure is set on 16. Though last night I changed it to 18.
Suggestion #2
........I was mistaken about the unit they swapped me out to, it's a Remstar Plus, not the Pro, thus no smart card.
Suggestion #3
See first post for background info.... I never did a sleep study because my insurance co. won't cover apnea treatments or sleep studies. As far as leakage, it doesn't seem to be when I'm laying there awake, obviously I can't tell once I'm asleep; I don't think this is the problem, as I'm using the same mask I was when I was getting good results with the autopap.
Suggestion #4
As I'm pretty low income- full time college student- and had to go outside the university's coverage plan to see my old family doctor, and barely had enough to pay for that appointment, Doc has taken it upon himself to help me on this issue without charge, setting up a deal with a local med supplier to give me free use of a machine- I don't have the option of continued visits to my doctor to dial in exactly the best settings, etc, so I'm attempting this on my own. I called his office, the other day, and his nurse advised me that the script allowed me to experiment with the range, and now that is what I'm trying to do. See? I tried 18 last night, tonight I will try 14- because 18 felt the same as 16.
As it stands right now, and considering how well the autopap was working, and how crappy I'm feeling now, I'm going to assume the autopap is the best thing for me. Unless of course going my trying different settings proves fruitful. The local med supplier lady told me they would not let me continue to use the autopap, saying something about it costing over 2 thousand dollars. After pricing them on CPAP.com, I'm tempted to just bring the silly thing back to the med supplier and turn it in. Two thousand dollars my eye, it was the Remstar auto.
I'll experiment with the settings and after a few weeks if I haven't found one that makes me feel as good as the autopap I'll just sell something and buy one myself.
Do people use the autopaps on a continual basis?, and is there a significant benefit to have full time auto-titration as opposed to set pressure?
........ I have the set pressure Remstar- they only allowed me the use of the auto unit to determine what pressure I need, as I don't have insurance that covers this, and didn't do a sleep study. Docs script, like I said before, is for a range between 10-19, and the set pressure is set on 16. Though last night I changed it to 18.
Suggestion #2
........I was mistaken about the unit they swapped me out to, it's a Remstar Plus, not the Pro, thus no smart card.
Suggestion #3
See first post for background info.... I never did a sleep study because my insurance co. won't cover apnea treatments or sleep studies. As far as leakage, it doesn't seem to be when I'm laying there awake, obviously I can't tell once I'm asleep; I don't think this is the problem, as I'm using the same mask I was when I was getting good results with the autopap.
Suggestion #4
As I'm pretty low income- full time college student- and had to go outside the university's coverage plan to see my old family doctor, and barely had enough to pay for that appointment, Doc has taken it upon himself to help me on this issue without charge, setting up a deal with a local med supplier to give me free use of a machine- I don't have the option of continued visits to my doctor to dial in exactly the best settings, etc, so I'm attempting this on my own. I called his office, the other day, and his nurse advised me that the script allowed me to experiment with the range, and now that is what I'm trying to do. See? I tried 18 last night, tonight I will try 14- because 18 felt the same as 16.
As it stands right now, and considering how well the autopap was working, and how crappy I'm feeling now, I'm going to assume the autopap is the best thing for me. Unless of course going my trying different settings proves fruitful. The local med supplier lady told me they would not let me continue to use the autopap, saying something about it costing over 2 thousand dollars. After pricing them on CPAP.com, I'm tempted to just bring the silly thing back to the med supplier and turn it in. Two thousand dollars my eye, it was the Remstar auto.
I'll experiment with the settings and after a few weeks if I haven't found one that makes me feel as good as the autopap I'll just sell something and buy one myself.
Do people use the autopaps on a continual basis?, and is there a significant benefit to have full time auto-titration as opposed to set pressure?
If you're having such problems with the swapped out machine, why not see if they'll just give you the auto back? State your case. Let them know how wonderfully it was working and how terrific you felt, and how that's all changed for the worse with this new machine. I realize that your doc went the extra mile for you and arranged the equipment, but honestly...and I'm not in any way minimizing a wonderful act by your doctor and the equipment supplier... if it's not WORKING with the new machine, then you need to speak up and get that situation rectified.
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| Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear |
| Humidifier: S9™ Series H5i™ Heated Humidifier with Climate Control |
| Additional Comments: original pressure 8cm - auto 8-12 |
Apneic Nation wrote:
That "10-19 range" is ONLY valid for use with an autopap. You no longer have an autopap (basically the DME screwed you pulling the ole switcheroo).
This range established by your doctor is below and above what the actual pressure is you need and based upon his experience (nothing wrong with that). But it has NO bearing whatsoever on the machine you NOW have which is a Pro or a Plus straight cpap machine, doesn't matter which one they function identically the same.
The machine you now have should be set to 16cm NOT 18cm or 19cm. Increase your pressure too high by only 1cm and you can trigger a whole series of pressure induced central apneas which can be dangerous especially when you get in the high teen range. If you were at 19cm your 3cm over what your doctor suggested from the autopap trial.
16cm was your 90% pressure found on the autopap, that is the pressure you should enter in any straight cpap machine like the Pro or Plus. Your doctor suggested a 3cm upper limit so you have a few cm's to increase should you need it, but that is ONLY valid for use with an autopap.
Next, I tried to explain the differences between the machines mentioned to what you have, your autopap trial was set for a "range" of 10cm to 19cm. That means your doctor wants you at a minimum pressure of 10cm, and that is if set where any autopap would start off with pressure delivery. It would then increase pressure as high as 19cm should it need to. But 16cm is still your titrated or 90% pressure.
But your DME switched machines, the machine you NOW have you don't set it up that way, as there is NO range to set. So to get the machine you now have to function like the autopap you once had, I suggested you set the pressure at 10cm. This would be the same as the autopap had starting out. I also indicated that the 10cm pressure is not so bad by itself as studies from Resmed and others show a pressure of only 8cm can eliminate nearly 70% or more events for the avg. patient. So trying the 10cm high pressure, you have a good chance of eliminating more than 70% of your events. If you still don't feel good you bump it by 1cm each night until you reach 16cm again. You don't go screwing around with 18 or 19cm pressure.
So your 41 and still a full time student? I guess the best things is if you don't want suggestions then don't ask the questions.
then wrote:They ended up trading me the auto for a Remstar Pro c-flex with a setting of 16.
Forget what your doc's script says and especially what the nurse said, you don't understand either one of them, only thing pertinent on that script is your 16cm pressure. That's it.Suggestion #1
........ I have the set pressure Remstar- they only allowed me the use of the auto unit to determine what pressure I need, as I don't have insurance that covers this, and didn't do a sleep study. Docs script, like I said before, is for a range between 10-19, and the set pressure is set on 16. Though last night I changed it to 18.
That "10-19 range" is ONLY valid for use with an autopap. You no longer have an autopap (basically the DME screwed you pulling the ole switcheroo).
This range established by your doctor is below and above what the actual pressure is you need and based upon his experience (nothing wrong with that). But it has NO bearing whatsoever on the machine you NOW have which is a Pro or a Plus straight cpap machine, doesn't matter which one they function identically the same.
The machine you now have should be set to 16cm NOT 18cm or 19cm. Increase your pressure too high by only 1cm and you can trigger a whole series of pressure induced central apneas which can be dangerous especially when you get in the high teen range. If you were at 19cm your 3cm over what your doctor suggested from the autopap trial.
16cm was your 90% pressure found on the autopap, that is the pressure you should enter in any straight cpap machine like the Pro or Plus. Your doctor suggested a 3cm upper limit so you have a few cm's to increase should you need it, but that is ONLY valid for use with an autopap.
Next, I tried to explain the differences between the machines mentioned to what you have, your autopap trial was set for a "range" of 10cm to 19cm. That means your doctor wants you at a minimum pressure of 10cm, and that is if set where any autopap would start off with pressure delivery. It would then increase pressure as high as 19cm should it need to. But 16cm is still your titrated or 90% pressure.
But your DME switched machines, the machine you NOW have you don't set it up that way, as there is NO range to set. So to get the machine you now have to function like the autopap you once had, I suggested you set the pressure at 10cm. This would be the same as the autopap had starting out. I also indicated that the 10cm pressure is not so bad by itself as studies from Resmed and others show a pressure of only 8cm can eliminate nearly 70% or more events for the avg. patient. So trying the 10cm high pressure, you have a good chance of eliminating more than 70% of your events. If you still don't feel good you bump it by 1cm each night until you reach 16cm again. You don't go screwing around with 18 or 19cm pressure.
So your 41 and still a full time student? I guess the best things is if you don't want suggestions then don't ask the questions.
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Brent Hutto
- Posts: 181
- Joined: Thu Mar 02, 2006 12:55 pm
Apneic,
Here's the thing. Quite possibly when you had the AutoPAP machine it was spending a bunch of the night blowing around 10cm. Under certain conditions (maybe supine position and/or REM stage sleep) your pressure needs were a lot higher but you may have only experienced 15-19cm of pressure for an hour here and there. If so, that 10cm is a lot easier to breathe against than anything over 15cm. That would explain why CPAP at 16cm is so uncomfortable. So in that sense, yes the APAP is a much better machine for your needs because it'll potentially let you spend several hours a night at a comfortable pressure.
Don't worry about some of the more obtuse responses questioning your sanity or intellegence. If someone at the doctor's office said it's OK to go from 16cm up or down within the originally-prescribed range then you're not going to kill yourself doing it. That said, I doubt very much that an increase from 16cm to 18cm is going to make you a whole lot better off and it will be just that tiny bit harder to stay compliant.
If I may thread-jack for just a moment with a political comment...
It's an oddity how on the one hand when anybody says on this forum that they don't want to experiment with their own treatment prescription and would only work through their doctor and DME they are questioned about the trustworthiness of their medical profesionals. Yet on the other hand when Apneic Nation asks for advice before changing his own pressure setting by a couple centimeters he's told that he's going to suffocate himself with central apneas and ought to shut up and do what he's told.
Apparently the only derision-proof opinion to express around here is that you think you'll wheedle a prescription out of a doctor somewhere and buy a Remstar Auto with Cflex, heated humidifier, Encore Pro, MyEncore and a cheap Hong Kong cardreader. If you want to move far from that cliche it's good to have a thick hide.
Here's the thing. Quite possibly when you had the AutoPAP machine it was spending a bunch of the night blowing around 10cm. Under certain conditions (maybe supine position and/or REM stage sleep) your pressure needs were a lot higher but you may have only experienced 15-19cm of pressure for an hour here and there. If so, that 10cm is a lot easier to breathe against than anything over 15cm. That would explain why CPAP at 16cm is so uncomfortable. So in that sense, yes the APAP is a much better machine for your needs because it'll potentially let you spend several hours a night at a comfortable pressure.
Don't worry about some of the more obtuse responses questioning your sanity or intellegence. If someone at the doctor's office said it's OK to go from 16cm up or down within the originally-prescribed range then you're not going to kill yourself doing it. That said, I doubt very much that an increase from 16cm to 18cm is going to make you a whole lot better off and it will be just that tiny bit harder to stay compliant.
If I may thread-jack for just a moment with a political comment...
It's an oddity how on the one hand when anybody says on this forum that they don't want to experiment with their own treatment prescription and would only work through their doctor and DME they are questioned about the trustworthiness of their medical profesionals. Yet on the other hand when Apneic Nation asks for advice before changing his own pressure setting by a couple centimeters he's told that he's going to suffocate himself with central apneas and ought to shut up and do what he's told.
Apparently the only derision-proof opinion to express around here is that you think you'll wheedle a prescription out of a doctor somewhere and buy a Remstar Auto with Cflex, heated humidifier, Encore Pro, MyEncore and a cheap Hong Kong cardreader. If you want to move far from that cliche it's good to have a thick hide.
The best laid schemes o' mice and men
Gang aft a-gley;
And leave us naught but grief and pain
For promised joy
--Robert Burns
Gang aft a-gley;
And leave us naught but grief and pain
For promised joy
--Robert Burns
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Apneic Nation
- Posts: 17
- Joined: Thu Mar 23, 2006 2:00 pm
First of all, let me explain a couple things. My doctor has been a family friend for over 25 years, he's actively involved and extremely helpful in many aspects of every member of my family's lives. Which is why he went so far out of his way to help with my problem at no charge. He is a very respected and well known physician in this part of the country. The DME rep that I have been working with is extremely knowledgable in all aspects of sleeping disorders and treatments. I find him to be very helpful and sincere, and I'm neither stupid nor gullible in any way. The DME are absolutely not pulling the wool over my or anyone elses eyes, especially my doctor. They are in fact providing me with this equipment at no charge, as I have inadequate insurance to cover it. There isn't anything going on that I'm not aware of, including the interactions between and decisions made by both my doctor, and the rep from the DME, who, BTW has a graduate degree in pulmonary therapy and studied under the doctor who was responsible for bringing sleep apnea and it's treatments into the public spotlight a number of years back.
Upon getting the information from me regarding whether or not my lousy university insurance (the insurance is lousy, not the university) would cover a sleep study and/or subsequent treatments, which it would not, my doctor actively tried to find somewhere or somehow that I could get the sleep study either done for free, or if medicaid would pay, or whatever, unsuccesfully. His nurse called me a few weeks later with the good news that doc had procured an agreement from the local DME to provide me with this equipment at no charge- sort of as a service to the community, which I'm sure they get to write off. It was decided by the rep and doc that because I would not have the benefit of the sleep study, they would provide me with an autopap with accompanying card reader to use for two weeks, whereupon they would review the data and set me up with a regular CPAP machine.
The rep called me after looking at the data and told me they would probably set my pressure at 14 because that was where the "90%" was.. A couple days later, after a meeting with my doctor, my rep called me again and said doc wanted to start me out at 16 because I was still snoring infrequently and according to the data occasionally the pressure would hit 19-20. He told me to bring in the autopap and they would do the "ol' switcheroo". There was never any intention of "duping" me or anyone. And the 10-19 was never a script for the autopap, as I had gone to 20 a number of times and if it were set to top out at 19 that would never have happened, right?
So like I was saying before, the Remstar Plus set at 16- doesn't do for me what the autopap did, which was make me feel rested and refreshed- even though I do sleep for 4 hour or longer stretches, something I haven't done in years. But I feel very fatigued and drained.
I called the DME, and my specific rep was on vacation, so I talked to a different girl, the same one who actually showed me how to use the machine when I first got it, and she told me to that change the settings, I would need a new script from the doc. She also told me to ask the doc for a "range" of settings, that way I could try different settings and find the best one for me. So I called the doc's office , and talked to his personal nurse, who I also know very well, and told her the whole story, and that I needed a new script before I could change the settings. So it's not like I'm trying to monkey around with this against ANYONE'S advice,. The nurse spoke with doc at some length about this, then called me back. She told me that the verbal script doc related to the DME already allowed for any setting in the range of 10-19, not any specific range setting, and everyone, including the doc, the nurse and the girl at the DME were well aware we were talking about the Remstar Plus..
I called the DME back, and upon me telling her that my doc said the decision he told the rep was to allow me to change the settings anywhere from 10-19, she told me she had located the other reps file on me and indeed that was true, and subsequently instructed me how to change the settings. Now whether or not that is a "correct" way to script a setting for a cpap is beyond me, but considering it sounds like this is a common thing I trust that the experience the DME and the doctor together has in this matter pretty much trumps you Snoredog.
And by the way...
Yes, I'm 41 , and I'm not "still" in school, I'm "back" in school -working on my masters degree. You sure seem like a pretentious jag, maybe you need to adjust YOUR settings..
Brent Hutto:
I appreciate the support, thanks for your insight. I'm a little confused by your last paragraph, though...
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Upon getting the information from me regarding whether or not my lousy university insurance (the insurance is lousy, not the university) would cover a sleep study and/or subsequent treatments, which it would not, my doctor actively tried to find somewhere or somehow that I could get the sleep study either done for free, or if medicaid would pay, or whatever, unsuccesfully. His nurse called me a few weeks later with the good news that doc had procured an agreement from the local DME to provide me with this equipment at no charge- sort of as a service to the community, which I'm sure they get to write off. It was decided by the rep and doc that because I would not have the benefit of the sleep study, they would provide me with an autopap with accompanying card reader to use for two weeks, whereupon they would review the data and set me up with a regular CPAP machine.
The rep called me after looking at the data and told me they would probably set my pressure at 14 because that was where the "90%" was.. A couple days later, after a meeting with my doctor, my rep called me again and said doc wanted to start me out at 16 because I was still snoring infrequently and according to the data occasionally the pressure would hit 19-20. He told me to bring in the autopap and they would do the "ol' switcheroo". There was never any intention of "duping" me or anyone. And the 10-19 was never a script for the autopap, as I had gone to 20 a number of times and if it were set to top out at 19 that would never have happened, right?
So like I was saying before, the Remstar Plus set at 16- doesn't do for me what the autopap did, which was make me feel rested and refreshed- even though I do sleep for 4 hour or longer stretches, something I haven't done in years. But I feel very fatigued and drained.
I called the DME, and my specific rep was on vacation, so I talked to a different girl, the same one who actually showed me how to use the machine when I first got it, and she told me to that change the settings, I would need a new script from the doc. She also told me to ask the doc for a "range" of settings, that way I could try different settings and find the best one for me. So I called the doc's office , and talked to his personal nurse, who I also know very well, and told her the whole story, and that I needed a new script before I could change the settings. So it's not like I'm trying to monkey around with this against ANYONE'S advice,. The nurse spoke with doc at some length about this, then called me back. She told me that the verbal script doc related to the DME already allowed for any setting in the range of 10-19, not any specific range setting, and everyone, including the doc, the nurse and the girl at the DME were well aware we were talking about the Remstar Plus..
I called the DME back, and upon me telling her that my doc said the decision he told the rep was to allow me to change the settings anywhere from 10-19, she told me she had located the other reps file on me and indeed that was true, and subsequently instructed me how to change the settings. Now whether or not that is a "correct" way to script a setting for a cpap is beyond me, but considering it sounds like this is a common thing I trust that the experience the DME and the doctor together has in this matter pretty much trumps you Snoredog.
And by the way...
Yes, I'm 41 , and I'm not "still" in school, I'm "back" in school -working on my masters degree. You sure seem like a pretentious jag, maybe you need to adjust YOUR settings..
Brent Hutto:
I appreciate the support, thanks for your insight. I'm a little confused by your last paragraph, though...
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Last edited by Apneic Nation on Fri Mar 24, 2006 4:59 pm, edited 1 time in total.
I'm a BSU student too! You're right, they do have crappy insurance.
The thing is, and I found this out the hard way, that they don't usually deal with OSA down there. When I went in to see them, they told me that the sleep study would be completely out of pocket. They were wrong. The old insurance wouldn't cover it, but the new insurance that they started using this year does cover it. Call the UHC rep on your insurance card--if it's done by an "In Network" provider, the sleep study will $250 (deductible) + 20% copay. If it's done by an "Out of Network" provider (a good one that can get you in and out very, very fast is "Sleep Evaluation Labs") the deductible is $500 + 50% copay. I haven't found out exactly what the student insurance (UHC) will do with a machine, I just bought mine on the old plastic (at cpap.com, love it) and submitted the receipt to them.
I think the trouble is that the doctors at BSU health center are so busy that they really haven't had a chance to get schooled on the coverage of the UHC insurance. I don't think it's been in use for more than a year. Make sure and call UHC for questions about coverage, don't rely on the doctors. Otherwise, I think the doctors down there are pretty good.
PM me if I can help with anything.
Also, if it's Dr. Reynolds' microeconomics class, you'll probably fall asleep anyway! If it's Dr. Black, then we've got a problem.
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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap.com
The thing is, and I found this out the hard way, that they don't usually deal with OSA down there. When I went in to see them, they told me that the sleep study would be completely out of pocket. They were wrong. The old insurance wouldn't cover it, but the new insurance that they started using this year does cover it. Call the UHC rep on your insurance card--if it's done by an "In Network" provider, the sleep study will $250 (deductible) + 20% copay. If it's done by an "Out of Network" provider (a good one that can get you in and out very, very fast is "Sleep Evaluation Labs") the deductible is $500 + 50% copay. I haven't found out exactly what the student insurance (UHC) will do with a machine, I just bought mine on the old plastic (at cpap.com, love it) and submitted the receipt to them.
I think the trouble is that the doctors at BSU health center are so busy that they really haven't had a chance to get schooled on the coverage of the UHC insurance. I don't think it's been in use for more than a year. Make sure and call UHC for questions about coverage, don't rely on the doctors. Otherwise, I think the doctors down there are pretty good.
PM me if I can help with anything.
Also, if it's Dr. Reynolds' microeconomics class, you'll probably fall asleep anyway! If it's Dr. Black, then we've got a problem.
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CPAPopedia Keywords Contained In This Post (Click For Definition): cpap.com
Last edited by leaveye on Fri Mar 24, 2006 5:05 pm, edited 1 time in total.
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Apneic Nation
- Posts: 17
- Joined: Thu Mar 23, 2006 2:00 pm
Without reading absolutely everything that has already been written, I will add my 2 cents.
I'm sorry you're having to deal with this, especially since the Auto cpap worked so well for you. I'm sure you are very frustrated with all the misunderstands in the posts here.
As others have said, if you are stuck with this machine (and it's nice you were able to get one free of cost), then you should lower your pressure setting on the machine.
I would work your way downward instead of going from 16 to 10. I would set it at 15 or 14, and try that. If it's still causing problems, then go to 13, then 12, etc.
Don't worry about a little snoring, it's the apneas that you need to be concerned about.
The high pressure is what is making your chest hurt. With the machine you have, the only way to deal with that is to lower the pressure.
Good luck with your sleep apnea and in school.
I'm sorry you're having to deal with this, especially since the Auto cpap worked so well for you. I'm sure you are very frustrated with all the misunderstands in the posts here.
As others have said, if you are stuck with this machine (and it's nice you were able to get one free of cost), then you should lower your pressure setting on the machine.
I would work your way downward instead of going from 16 to 10. I would set it at 15 or 14, and try that. If it's still causing problems, then go to 13, then 12, etc.
Don't worry about a little snoring, it's the apneas that you need to be concerned about.
The high pressure is what is making your chest hurt. With the machine you have, the only way to deal with that is to lower the pressure.
Good luck with your sleep apnea and in school.
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| Machine: DreamStation Auto CPAP Machine |
| Humidifier: DreamStation Heated Humidifier |
| Additional Comments: Compliant since April 2003. (De-cap-itated Aura). |
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Brent Hutto
- Posts: 181
- Joined: Thu Mar 02, 2006 12:55 pm
Nevermind, it was an off-topic bit of sarcasm. I was just trying to come up with the one piece of advice that nobody on this forum would disagree with (because it has been suggested so often before).Apneic Nation wrote:Brent Hutto:
I appreciate the support, thanks for your insight. I'm a little confused by your last paragraph, though...
Good luck, be well and here's some advice based on my own adult-onset grad school a few years back...don't sweat your grades, just make sure you study a little bit beyond whatever is assigned (even the boring stuff) in every class and you'll learn a hell of a lot in just a couple of years. I only wish somebody had clued me into that when I was dorking around in undergrad school back in 1980.
The best laid schemes o' mice and men
Gang aft a-gley;
And leave us naught but grief and pain
For promised joy
--Robert Burns
Gang aft a-gley;
And leave us naught but grief and pain
For promised joy
--Robert Burns
AN,
Brent is very insightful. His last para was really meant for cpaptalk (us) & not you
Sometimes we are guilty of not reading the original poster's questions properly & some of us can and do give in to the temptation of peddling our own biases (such as about people in the medical profession).
From my reading of your query I offer the following observations
1) Reason the AUTO seemed to offer better therapy was its ability to range up & down as required. It only stayed up for short periods as required & usually then drops back thus easing you breathing out.
2) The fixed setting of 16 cms on the CPAP machine has, and this is normal, caused you to feel chest pain, this can seem very strong but as other posters have pointed out - it does pass within approx 3-4 days. After that you really don't notice it any more. It is due to the extra effort your muscles exert in breathing out agains the machine's pressure.
3) The major difficulty with setting CPAPs to 15-16 cms & over is the difficulty in continually maintaining a good mask seal. It seems to get exponentially harder to do so once the cms passes about 14 cms. I suspect your advisor knows this and was trying to pick a cms that would be the best balance between your highest cms & what allows for a seal one can live with.
4) My hunch (educated guess) is that you would benefit from increasing the cms setting on your Remstar but need to get past the initial chest pains. When I have experienced these, they have been quite bothersome. It has happened to me about 3 times. These were: 1st use of CPAP, then when I switched from a F/F mask to a nasal pillows mask, then once when I switched back from a BiLevel to a CPAP whilst experimenting. I think it is perfectly reasonable for you to up your cms to 16, 17 & on advice to 18+.
The challenges are dealing 1st with the chest pains (but as we have advised these will pass soon), 2nd maintaining a decent seal, 3rd finding a cms that returns you to the best results.
APAP is a luxury, BiLevel also is a luxury *but* CPAP does work. I have little trouble going back to CPAP as I did for the past 3 nights whilst travelling. I used 15cms on my CPAP machine.
Cheers and good luck
DSM
Brent is very insightful. His last para was really meant for cpaptalk (us) & not you
Sometimes we are guilty of not reading the original poster's questions properly & some of us can and do give in to the temptation of peddling our own biases (such as about people in the medical profession).
From my reading of your query I offer the following observations
1) Reason the AUTO seemed to offer better therapy was its ability to range up & down as required. It only stayed up for short periods as required & usually then drops back thus easing you breathing out.
2) The fixed setting of 16 cms on the CPAP machine has, and this is normal, caused you to feel chest pain, this can seem very strong but as other posters have pointed out - it does pass within approx 3-4 days. After that you really don't notice it any more. It is due to the extra effort your muscles exert in breathing out agains the machine's pressure.
3) The major difficulty with setting CPAPs to 15-16 cms & over is the difficulty in continually maintaining a good mask seal. It seems to get exponentially harder to do so once the cms passes about 14 cms. I suspect your advisor knows this and was trying to pick a cms that would be the best balance between your highest cms & what allows for a seal one can live with.
4) My hunch (educated guess) is that you would benefit from increasing the cms setting on your Remstar but need to get past the initial chest pains. When I have experienced these, they have been quite bothersome. It has happened to me about 3 times. These were: 1st use of CPAP, then when I switched from a F/F mask to a nasal pillows mask, then once when I switched back from a BiLevel to a CPAP whilst experimenting. I think it is perfectly reasonable for you to up your cms to 16, 17 & on advice to 18+.
The challenges are dealing 1st with the chest pains (but as we have advised these will pass soon), 2nd maintaining a decent seal, 3rd finding a cms that returns you to the best results.
APAP is a luxury, BiLevel also is a luxury *but* CPAP does work. I have little trouble going back to CPAP as I did for the past 3 nights whilst travelling. I used 15cms on my CPAP machine.
Cheers and good luck
DSM
xPAP and Quattro std mask (plus a pad-a-cheek anti-leak strap)