New and without a sleep study

[BuffaloMark]

Hello and thanks for taking the time to read this. My Dr and I Firmly believe I have sleep apnea due to all my symptoms. I went to a sleep Dr who was 90% positive I have sleep apnea as well. Here comes the problem. I have a very high deductible through my work and the Dr wanted two sleep studies done to confirm and get it covered through insurance. Well thats just not going to happen...

So heres where I'm at now. I have purchased a Remstar-pro C-flex plus model 460P with a humidifier and a full face mask.

So my question is this, Do I start in just Cpap mode at say...8 and then wait a few days and see what the data is? Or do I start in Apap mode with a range from 5-15 and check the data?

Thanks,

Mark

[Julie]

The second idea is better... what are you doing about a mask (which is usually the big issue for newbies)?

[Ontario CPAP]

I'll give you my story and let you draw your own conclusions as to how to use your machine.

My family doctor scheduled me for a sleep test after I was complaining of poor sleep. When I went for the test, I was hooked up to a bunch of instruments (EEG, respiration, ECG, oxygen level) but not a CPAP. A week later they provided me with the results of the test: severe OSA with an AHI near 50.

Next, I was given an APAP to take home. I used it in auto mode in the range 4 to 20 cmH2O for two months. It collected the data on its SD card, which I brought back to the sleep doctor. They analyzed the data and found an 95% upper average pressure of 8 cmH2O.

I then had my second sleep study, this time a titration study using a CPAP. Throughout the night during the study, a technician steadily increased the machine pressure while taking more data (EEG, respiration, ECG, oxygen level.)

Following the titration study, the doctor found my AHI dropped below 5 for pressures over 7 cmH2O. Using this and the APAP data she prescribed me to use a fixed pressure of 9 cmH2O. She explained a variable (APAP) pressure would only be needed if there was a significant difference in AHI caused by sleeping on my side versus back, which wasn't the case for me.

I was then given a fixed pressure CPAP machine set to 9 cmH2O which I have been using since last October. My average AHI is less than 1.

(BTW: I also tried three different masks and found the swift FX nasal pillow the most comfortable.)

Hope this helps.

[bwexler]

You need to trade your 460P for a 560P if you are going to skip your sleep studies.
The 560p allows you to set a range of pressures which many refer to as auto titrate. This accomplishes the same task as the second sleep study you are bypassing. The first study determines that you have sleep apnea, the second determines the proper machine setting.
You can accomplish the same task with your current machine by making a wild guess at the correct setting, look at your data and make small adjustments as you zero in on the correct settings over the course of a month or 2. The auto machine will adjust to what you need every few breaths throughout the night. Things Chang as you roll from your side to your back, or enter REM sleep etc.
The 460P stays at the single pressure you guessed was what you need.

[sc0ttt]

Your 460p will determine the best pressure for you using one of the trial modes. But for long-term it will only do a single pressure - which is fine for a lot of people.

SMART TECHNOLOGY MODES
The REMstar PRO 460 offers three operational modes -- Auto-Trial, CPAP-Check, and straight CPAP -- to help optimize your sleep therapy settings.

Auto-Trial Mode delivers breath-by-breath Auto-CPAP therapy for up to a total of 30-days. At the end of the Auto-Trial period, the device will automatically transition into the CPAP-Check mode at the pressure the patient was at or below 90% of the trial period time. (Note that Auto-Trial mode is for temporary use only and must be used for a minimum of 3 nights to be effective. The REMstar PRO is NOT an Auto-CPAP Machine.)

CPAP-Check Mode checks on the user every 30-hours to determine if therapy pressure is optimal. If not, it automatically adjusts the nightly fixed CPAP pressure by 1 cm H2O (with maximum upper and lower limits of 3 cm) to obtain an ideal pressure.

Straight CPAP Mode is for use when therapy with no changes or checks is preferred. In straight CPAP mode the REMstar PRO will not make pressure checks or adjust therapy levels although normal therapy data will still be tracked.

[BuffaloMark]

I bought a brand new never opened Resmed Comfort Gel on Craigslist for $20.

My PC dr did however give me a prescription for a mask though.

Won't A-Trial help figure out where I should be as far as pressure goes?

[palerider]

You need to trade your 460P for a 560P if you are going to skip your sleep studies.

you are incorrect,

the 460 has an evaluation mode where it acts much like a apap for a period, a real auto titration, an then after a set period of evaluation, switches to cpap mode, with a further examination and possible adjustment on periodic basis.

[palerider]

Won't A-Trial help figure out where I should be as far as pressure goes?

you are correct, please ignore bwexler in this instance.

[Guest]

I bought a brand new never opened Resmed Comfort Gel on Craigslist for $20.

My PC dr did however give me a prescription for a mask though.

Won't A-Trial help figure out where I should be as far as pressure goes?

The problem is the trial period only last for 30 days. After which it automatically reverts to straight cpap mode. This quote is from cpap dot com

Smart Technology Modes

The smart technology of Auto-Trial Mode and CPAP-Check Mode offer up to 30 nights of auto adjusting capability. During that period of use the system functions as an Auto CPAP delivering an adaptive pressure on a breath by breath basis. Following the set time of the Auto-Trial mode, the machine functions as a CPAP delivering the pressure that the patient was at or below 90% of the time.

I think you will be better off with a 560P long term but hey if you want try the Auto-Trial Mode if it hasn't already been used up.

[BuffaloMark]

So...I slept for 10.2 hours last night and it appears that I pulled the mask off for three of them and had a large leak.

but in A-trial mode set from 6-17 it looks like I had .10AHI with the pressure mostly at 11 all night. it stated that 95% would be 10.5, and I had 18 vibrating snores. Thoughts?

Ill keep checking the data.

[palerider]

So...I slept for 10.2 hours last night and it appears that I pulled the mask off for three of them and had a large leak.

but in A-trial mode set from 6-17 it looks like I had .10AHI with the pressure mostly at 11 all night. it stated that 95% would be 10.5, and I had 18 vibrating snores. Thoughts?

Ill keep checking the data.

that sounds *awesome*

how do you feel?

I suggest running the data on the sd card through sleepyhead if you haven't already, and possibly bumping the starting pressure to 7, or 8.

[Pugsy]

There is a way to get more than 30 days apap trial mode with the 460. It involves a total reset of the therapy hours to zero...so any old therapy data gets erased. Not a big deal if the data is in the software. I think the last I read about this reset is that it can be done 5 times before it no longer will give you apap mode. The provider/clinical manual explains how to do the reset if a person wants to do it. It's easy to do.