Coming back to therapy

sleepy-k · Post by **sleepy-k** » Fri Dec 05, 2014 9:28 am

Hi all,

I was originally diagnosed several years ago, and while my compliance was great for awhile, it wasn't the silver bullet for my sleepiness I'd been hoping for. I started finding excuses and haven't regularly been using my cpap for a year or more. My weight has changed over the years, and being heavier now than before, my partner tells me my snoring has gotten much worse, so I know I need to come back to therapy.

One issue I've had is with my mask. I started with nasal pillows, and while they work reasonably well, I have a hard time with them when I'm at all stuffy. (Due to a deviated septum and perhaps some other nasal issues I need to get checked, one nostril is often much more constricted.) Because of this, I'd like to get a full face mask so I can still breathe through my mouth when my nose isn't cooperating. Any recommendations?

I'd also like to know what things I should be replacing on my machine. I know I need new filters, but do I need new hoses or anything after this long? (I have an S9 autoset on cpap mode.) What do I need to be aware of to put my machine back into regular service after collecting dust for awhile?

Lastly, my insurance has changed and we've moved to a new area. I talked to my new provider and got a list of DMEs that are in-network. Nearly all of them have names involving falls or prosthetics or other such types of equipment and none are particularly convenient, so I doubt their expertise in cpap tech. I also would have to pay 30% out of pocket. My assumption is that DMEs are more expensive, so with all of this, I'm tempted to forgo insurance and use cpap.com. Thoughts? I know I need to upload my original prescription (and hope that it isn't expired), but are there other things I should know?

I also realize I should probably find a new sleep doctor in the area and probably get rechecked, but I want to at least get going again for a temporary solution before going back to the doctor.

Sheriff Buford · Post by **Sheriff Buford** » Fri Dec 05, 2014 9:35 am

Hoses are cheap, so I'd get a new one. I would put a new filter in, and run the machine for a few minutes to blow out any dust. Then replace the filter again. If you are looking for a popular full face mask, I'd recommend the Resmed F10. I would also immediately restart therapy... tonight... at your previous settings. You can tweak the numbers after a few weeks. See a doctor is not mandatory, but I would start therapy now.

Sheriff

library lady · Post by **library lady** » Fri Dec 05, 2014 9:51 am

You mention being stuffed up, and some nasal issues. This makes me wonder if a full-face mask might be a better choice for you than pillows or nasal mask, since it will allow breathing through your mouth, especially if you have a cold. I have used Quattro Air and AirFit F10, and much prefer the F10, as the headgear is minimized - it uses the same cushion.

About DMEs, you might try going to the stores and interviewing them to see what options they have for you before making a decision. Certainly going to cpap.com for supplies is an option; many people here bypass insurance and use it. I use a local independent DME that is part of the Mayo Clinic here in Rochester MN so I haven't had to deal with the crappy ones. I don't know that brick and mortar DMEs are necessarily more expensive; they have limitations placed on them by insurance and the government, but there are some sneaky ones, and many offer poor service.

photonic · Post by **photonic** » Fri Dec 05, 2014 11:38 am

If you think you are a heavy mouth breather you might consider using the Oracle mouth mask. It solved all of my mask problems and combined with the Hozer hose manager, I am having no mask problems at all even with headcolds.

sleepy-k · Post by **sleepy-k** » Fri Dec 05, 2014 5:28 pm

Well, poo.

I just looked up my old prescription, and it looks like it was for 12 months only. I think I can order new filters without a prescription, but I need one for a mask?

I guess I've gotta find a new doctor around here. I assume one will make me go through another sleep study before giving me a prescription? Any chances my previous doctor would simply renew an old prescription?

Julie · Post by **Julie** » Fri Dec 05, 2014 8:20 pm

You can buy 'replacement parts' for masks with no script at Cpap.com and then just put it together.

OkyDoky · Post by **OkyDoky** » Fri Dec 05, 2014 8:49 pm

I bought my p10 on Amazon at a very reasonable price and I saw N10's there. Also check out Ebay.

sleepy-k · Post by **sleepy-k** » Tue Dec 09, 2014 8:32 pm

So, in an effort to get a new prescription and go about this in the "proper" way, I went to see a sleep doc today. He did give me a script for a mask, but does want to do another sleep study (split between baseline and titration), since I was on a rather low pressure setting before (6), and thinks bipap may be a better option.

My question though. The S9 has "expiratory pressure relief" and bounces between 4 and 6 all night as I breathe in and out. How exactly is that different from bipap? Does bipap just allow for greater pressure pressure differences on inhale and exhale? Would I need a different machine for true bipap?

palerider · Post by **palerider** » Tue Dec 09, 2014 8:51 pm

sleepy-k wrote:Does bipap just allow for greater pressure pressure differences on inhale and exhale? Would I need a different machine for true bipap?

yes, and yes.

epr is much like a limited bilevel, (bipap is a trademark of philips respironics)

cathyf · Post by **cathyf** » Tue Dec 09, 2014 9:27 pm

sleepy-k wrote:My question though. The S9 has "expiratory pressure relief" and bounces between 4 and 6 all night as I breathe in and out. How exactly is that different from bipap? Does bipap just allow for greater pressure pressure differences on inhale and exhale? Would I need a different machine for true bipap?

Have you experimented with the EPR at all? I ran it at a level of 1 (default) at first, and then one night tried setting it to 3. THAT was a mistake! The mask "throbbed" with every breath! Kept me awake, and then when I did get to sleep, it woke me back up. Those bi-level machines are a lot more money, so make sure that you can really benefit before signing on. It's one thing to recommend this after a sleep study where the professionals can observe how you react to the different machines, but this sounds more like a WAG than a well-thought-out recommendation.

palerider · Post by **palerider** » Tue Dec 09, 2014 11:48 pm

cathyf wrote: setting it to 3. THAT was a mistake! The mask "throbbed" with every breath!

after seeing what it does at epr 3 (which is equiv to a PS of 3 on a bi-level, imagine what it's like at 6, or more

sleepy-k · Post by **sleepy-k** » Wed Dec 10, 2014 10:39 am

Have you experimented with the EPR at all?

I haven't. While I know I can tweak settings, I haven't played with anything other than humidity. I don't trust myself yet to play too much. Given the low pressure setting I have (6), I don't know that the EPR can do much more than go down to 4. I've never had a problem with it.

this sounds more like a WAG than a well-thought-out recommendation.

Yeah, considering he only had baseline study results from 3 years ago, I'm not sure what led him to suggest bipap. I think I'm tempted to stay with my cpap/EPR unless there's a compelling reason.

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