Newbie – received report today from MD on sleep apnea test

[no1texan]

Last Thursday, Jun 14, I had the sleep apnea test. Today I received a call from the doctor with the results. He said “I have bad news and good news.” The bad news is that you have a severe case of sleep apnea, lowest oxygen saturation of 56%. The good news is that when we put the CPAP/BIPAP on you at pressures 21/17 cm H2O the oxygen saturation was 94%. I have a copy of the full report but I don’t understand it.

For a very long time I have been very exhausted and tired and have not slept well and tired when I got up. From what I have heard and read, I hope I will see a difference after I start wearing the CPAP. When should I start seeing a difference in how I feel after using the CPAP for a while?

The doctor has written a prescription for EO470 Bi-level: Diagnosis 327.23, Respironics BiPAP Pro Fi-Flex, Humidification Heated (E0562). My daughter has sleep apnea and has the ResMed S9 Elite CPAP with a humidifier and she likes it a lot. I had planned on asking for the S9 Elite but maybe the Respironics BiPAP Pro Fi-Flex is better. Don’t know.

I am 72 years old, in fairly good health except for being morbidly obese at 276 pounds, 5’9” tall, diabetes 2 and controlled hypertension. I am on a program to lose this weight, high protein and low carb diet. I walk daily 2.5 miles. Hopefully the CPAP will help give me more energy and help me fight the “battle of the bulge.”

Any comments will be appreciated.

[MaxDarkside]

When should I start seeing a difference in how I feel after using the CPAP for a while?

Welcome to the club !!! I can't comment too much on the equipment, I have a ResMed S9 AutoSet and I like it. Others will comment I think on the equipment.
Regarding the question above about feeling better, it depends a lot on the person I think. For me, some things I could notice the next morning, I felt better in a "I feel great/not good" at the same time. Some things after a week or so, like I could feel my lung capacity become much much improved. The daytime grogginess took a lot longer and I'm still battling it a bit after 7 months but making progress. With us, good sleep starts with apnea treatment and after we get a grip on that, then we start learning other ways to make sleep, and life, better.

Bless you as you start the journey... You've come to the right place, that I am CERTAIN.

[BlackSpinner]

At your pressures the BiPap is a better fit then an S9 Elite. The BiPap allows for easier breathing.

Everyone is different - some people notice the difference in one day, one week, one month, some only when looking back at 6 months. However your brain, heart and organs will notice the difference even if you don't.

[jweeks]

The bad news is that you have a severe case of sleep apnea, lowest oxygen saturation of 56%.

Hi,

That number is extremely scary. I am surprised that they let you go home from the sleep study without either a machine or a portable oxygen bottle. At the very least, they should have told you to not sleep until you get this fixed. I am so glad that you were tested, and that you have a plan going forward.

The pressures that they found for you, 21 inhale and 17 exhale, is up on the high side. There really is no correlation between how serious of a case you have and the high pressure. For example, there are people with bad cases that only need a little pressure, and the opposite, folks with a really mild case that need very high pressures. What the higher pressure does mean is that it is generally a little harder to get use to, and a little harder to get a comfortable fit without having problems with leaks. Don't let this freak you out. Rather, just being a little realistic that you might end up doing some problem solving along the way. The good news is that a lot of folks here have been through this, including myself starting 4 years ago. This is doable.

Some people do get a big burst of energy right from day number one, but that isn't generally the case. However, given an O2 level that is that low, I suspect you are going to get a bit of a pop right off the bat. For example, if you feel terrible today, and you increase how good you feel to just awful, that is still going to be a major improvement. In my case, once I started on CPAP, I had so much extra useful time and energy that I had to take up a new hobby. From there, most people see a pretty steady improvement over the course of 4 to 6 months. You have some damage from lack of O2 to overcome, and you probably have a huge sleep debt that you have to pay back.

One more note about weight. I was about 330 lbs going into my sleep study. Some folks say OSA is caused by being overweight. The more enlightened folks know that isn't the true cause. The cause is typically a structural problem in your airway. Weight does tend to make it worse. Interestingly, some researchers are saying that OSA causes the weight gain, rather than the weight gain causing the OSA. To bottom line this, some folks find it much, much easier to lose weight after getting on the hose. I am not sure why, but getting good sleep, having a better attitude, and having more energy make the weight loss journey all that much more feasible.

This is a hurdle that you can overcome. There are folks here that want to see you win. I know you can do it.

-john-

[Pugsy]

Welcome to the forum.

Give me a minute and I will send you a private message with a link for the provider manual for the PR System One BiPap Pro.
For your pressure needs...this is a much better machine. The Elite that your daughter has won't even go as high as you need.
Check out my signature line for software options. SleepyHead will work just great with your new machine.

I own pretty much the same machine as you will be receiving. I think you will find that the way it delivers your pressures will be easier to adjust to than a straight cpap machine like your daughter's.

[archangle]

I had planned on asking for the S9 Elite but maybe the Respironics BiPAP Pro Fi-Flex is better. Don’t know.

BiPAP is a brand name for "bilevel CPAP." It's a slightly different form of CPAP. It's sort of the next step up. It's not better for everyone, but it's better for you.

Respironics (Philips Respironics Series One or PRS1) machines are roughly equivalent to ResMed S9 machines. It's sort of a "Ford vs. Chevy" comparison.

ResMed S9 VPAP machines deliver the same kind of therapy as a PRS1 BiPAP machine.

Be sure you get a Philips Respironics System One BiPAP machine that looks like this:

or like this with the humidifier

https://www.cpap.com/cpap-machine/respi ... iflex.html

If it says "Respironics" and doesn't say "Philips Respironics" on it, it's an old model that lacks important features of the newer models.

Be careful with the DME (CPAP seller). Some of them make used car dealers look honest.

Read Janknitz's blog for info on dealing with DMEs.

[robysue]

Last Thursday, Jun 14, I had the sleep apnea test. Today I received a call from the doctor with the results. He said “I have bad news and good news.” The bad news is that you have a severe case of sleep apnea, lowest oxygen saturation of 56%. The good news is that when we put the CPAP/BIPAP on you at pressures 21/17 cm H2O the oxygen saturation was 94%. I have a copy of the full report but I don’t understand it.

For learning more about what your report actually says about your condition, you should click on the Light Bulb at the top of the forum. You might also find my Understanding the data in your sleep study report worth reading through.

Others have given you some sound advice concerning the machine that's been prescribed. It's worth noting that there is a bi-level in the Resmed S9 series: It is the Resmed S9 VPAP Auto. It offers more data on the machine's LCD, but if you download data into your computer, the S9 does not offer any more full efficacy data than the PR System One BiPAP Pro or Auto does. Also worth noting is that the PR System One BiPAPs have Bi-Flex, which provides a bit of extra pressure relief beyond that which comes from the drop from IPAP to EPAP; to the best of my knowledge, the S9 VPAP does not have a way to provide additional exhale relief beyond the drop from IPAP to EPAP. Given those high pressures that you'll be dealing with, having Bi-Flex may (or may not) make a difference to your comfort in using the machine.

For a very long time I have been very exhausted and tired and have not slept well and tired when I got up. From what I have heard and read, I hope I will see a difference after I start wearing the CPAP. When should I start seeing a difference in how I feel after using the CPAP for a while?

The honest answer is: It depends.

A few lucky souls take to PAP like ducks to water and feel better almost immediately.

A few unlucky souls spend months and months on therapy before they get all their adjustment issues sorted out things and start to feel better. A few of these unlucky souls even feel worse for a while before they start to feel better---I was one of them: The first three months were a living hell for me, but by around the end of my eighth or ninth month, I finally had started to feel better. Sometimes those of us with difficult adjustment periods have other issues that adversely affect the quality of our nightly sleep and those issues must also be dealt with before we notice much difference in how we feel.

Judging from what most people write, it seems that the average new CPAPer tends to start seeing some signs of improvement in a few weeks to a few months. And the first signs that CPAP is working can be subtle and easy to miss if you are not looking out for them. For many people, the first positive sign is a reduction in the number of nightly trips to the bathroom. For me, it was that the constant low-grade pain in my hands and feet went away---which was totally unexpected.

Best of luck and here's a sincere wish that you turn out to be a "duck" who feels better right away!

[Pugsy]

Also worth noting is that the PR System One BiPAPs have Bi-Flex, which provides a bit of extra pressure relief beyond that which comes from the drop from IPAP to EPAP; to the best of my knowledge, the S9 VPAP does not have a way to provide additional exhale relief beyond the drop from IPAP to EPAP.

This is indeed true. S9 VPAPs don't offer Resmed's usual EPR exhale relief. I guess that they think the exhale relief is sufficient. It probably is for most people but there could be a few who like or need BiFlex just like some people might like the roaming or fixed pressure support the best. I found both brands extremely comfortable and that is why I have both the PR S1 BiPap Auto and the S9 VPAP Auto. There are features in each that I like that the other doesn't do..very minor and just more of a personal preference as to how it feels and not related to therapy effectiveness.

[archangle]

This is indeed true. S9 VPAPs don't offer Resmed's usual EPR exhale relief. I guess that they think the exhale relief is sufficient. It probably is for most people but there could be a few who like or need BiFlex just like some people might like the roaming or fixed pressure support the best. I found both brands extremely comfortable and that is why I have both the PR S1 BiPap Auto and the S9 VPAP Auto. There are features in each that I like that the other doesn't do..very minor and just more of a personal preference as to how it feels and not related to therapy effectiveness.

I suspect that the idea is that EPR essentially adds to the bilevel function. If you put an EPR of 3 on top of bilevel, you are effectively lowering EPAP.

[chunkyfrog]

Welcome, Tex.
You are in good hands here.

[jnk]

Part of what rounds the curves in a VPAP is Easy-Breathe.

[no1texan]

WOW!! What a group of fine people!

A Texas size thank you to each of you for taking your time to stop and write a reply to my post. I find it is not always easy to write a reply to a specific topic. I often will write what I want to say in Word, make all my changes and then post it. Takes more time but I am more comfortable doing it this way - I heard someone say years ago that the secret to conveying a message that will be heard is to be clear, be clear and be clear. So I try to do this when I write and all of you have been so clear and shared such vauable information with me.

I feel very confident and upbeet to start using my CPAP or whatever the correct name is. I will say that I am very committed to this change in my life. I am in the autumn years of my life but in no way ready for the rocking chair. I use to be an avid runner and trained for the Houston marathon in 1994-reached 18 miles in training @ 2:37-but injured my ankle and was not able to run in the marathon. But there is always next year especially with the aid of dealing with this condition I had no idea I had.

Every reply includes valuable information but most important a real sense of caring. This means a lot to me.

I am hoping to get my CPAP on Friday. The provider is Preferred Homecare. So next week I will post an update and maybe after "getting my feet wet" I will quack like a duck [re: reply from robysue]

[Tino2You]

hi no1texan,

Welcome to the club! I am a relative newbie as well and while there is little I can add to what the others have said I like you found this forum BEFORE I got my machine and it made a HUGE difference.

Whether you choose the PR S1 BiPap Auto or the S9 VPAP Auto, you should ask your doctor to be very specific with his prescription. As someone pointed out already, DMEs are in business and will give you what gives them the most profit, not what gives you the most therapy. Also (and something I just found out for myself) a heated hose sounds like a luxury, but when you have semi cold air blasting up your nose in the middle of the night, it soon is apparent it is necessary.

Try on as many masks as the DME has. Lay down and ask to have it attached to your machine while it is on. Fighting leaks is a pain. Face farts will wake you up! Your pressure could relegate you to full face or hybrid masks. I'll let others that are more familiar with your pressure (21/17) weigh in. But take your time and get a mask that fits and that feels comfortable. You will be wearing it for 1/3 of your day (hopefully). Also, start reading the various masks on cpap.com (our host). Both the description of the masks and the customer reviews are beneficial (but take care with the reviews..what fits one person may not fit another).

Take care,
-tino

[SleepTechTN]

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[truckee147]

I think you will find your energy will go up once you get some good hose time. I found if I got 4-5hrs on the hose my energy improved greatly through the day. The tough part was adaptiNg to the mask but it comes in time.read the thread on " change " as it will help. Just keep posting your questions here and you will get great answers. Good luck