How do you know what settings to use?

Newbie here.

I may or may not be able to get Medicare to cover a machine. So, if I DIY, how do I figure out settings? I'm assuming I can't get a titration study done if Medicare doesn't pay for the machine. In the absence of a titration study how does a PAPper even know where to begin?

I have AHI 18, diagnosed as moderate OSA. Those are all over 3% desat. Unfortunately, only 5 are over 4% desat (CMS AHI 5) which might disqualify me from Medicare coverage.

I'm guessing I could get a prescription with my diagnosis, but I'm not even certain of that.

Ideas in general?

Can settings be arrived at without a titration study?

How do you pick out a face mask before you even know what species you need? Where do you try them on?

Do you need a prescription for supplies?

Thanx.

FWIW I have more than one person on my ignore list for being gratuitously disrespectful. I do not read (and will not reply to) their comments.

Zeds wrote:Can settings be arrived at without a titration study?

Yes, quite easily in fact. Kaiser does it routinely with their sleep apnea patients. They get an apap machine and the optimal pressures can be determined fairly easily by evaluating the data the machine gathers. They save the titration studies for people who are having some sort of problem. You don't just set them wide open but instead have to monitor the minimum pressure closely which is actually the most important setting.
The wide open range is 4 to 20. Works okay if you don't need more than 7 or 8 to hold the airway open but not so great if you need more than that because they don't do huge increases in the blink of an eye. They go up rather slowly and back down also rather slowly.

Titration studies can get you close but they aren't always perfect either. Mine wasn't...I ended up needing 2 cm more pressure than was advised from the titration study.

Zeds wrote:How do you pick out a face mask before you even know what species you need? Where do you try them on?

You have to do some research as to your own personal needs and preferences and unless you can use a brick and mortar store you can't try them on.

They do require a RX to purchase online but there are ways to get around that fairly easilyse
Now when I say "they" I mean machines and complete mask packages. Mask replacement parts don't require a RX and hoses, filters, etc don't require a RX. Now some DMEs won't sell you anything without a RX but they could if they just would.

To get you started on what mask you might need.

First question...do you have chronic nasal issues that pretty much force you to breathe through your mouth or is your nose clear for the most part and you rarely do any mouth breathing?
If you just have to mouth breathe then look at the full face masks.
If your nose is clear most of the time then look at the nasal interface masks...less skin to have to contact and seal.

You won't want to pay DME prices without insurance covering their part. You can get them much cheaper elsewhere.

Thanks, Pugsy.

I believe I can use nose breathing if I have a heated humidifier.

I am, however, not a candidate for any kind of "used", especially in a mask. That's too much risk of medical catastrophe in my case.

I want to avoid anything that clamps the mouth tight because I have the TMJ from hell, so bad I actually broke my teeth on a nightguard, chewed through a few in a month...

It sounds like Secondwind might have a prescription facilitator?

I am also assuming an up-to-date APAP, like the Resmed for her, with analytical software would allow me to arrive at appropriate settings myself. Am I correct? From what you say, it more or less adjusts to the right setting? I

I believe I qualify for Medicare coverage according to oublished specs (and the sleep MD has made an error), but I'm wanting to research alternative ways of making this happen.

These machines are spendy critters...

Zeds wrote:I am also assuming an up-to-date APAP, like the Resmed for her, with analytical software would allow me to arrive at appropriate settings myself. Am I correct? From what you say, it more or less adjusts to the right setting?

Yes, it would do what you need. Plus it has that extra apap mode that might come in handy.
And yes it more or less adjusts as needed but sometimes we have to give it more of a head start depending on what pressure you end up needing.
Severity of the OSA has no bearing at all on what pressure might be needed.
I have seen people with really severe OSA get by on 6 cm pressure all night and I have seen people like you with mild/moderate apnea needing 20 cm.
It all depends on the airway tissues.

It is pricey for the ResMed machines but I saw one on Amazon (brand new) for a little over $500 and I know you can get the Respironics apap for less.
Don't need a RX there.

It's okay if used masks creep you out for whatever reason but it does mean that mask experiments will be pricey so do your homework deciding on which mask you want to try.
When I was first starting therapy I did my homework and came up with my preferences and chose the ResMed Swift LT nasal pillow...I used it until the new nasal pillow masks were released and I changed masks because the newer ones met even more of my preferences.

You will need to figure out your own preferences and start from there.
If you don't mouth breathe much you won't need anything that does anything to your mouth or TMJ.

For a newbie and someone not needing a full face mask due to mouth breathing I usually suggest that they look at these masks.

Respironics DreamWear (comes in a cushion and a nasal pillow)
ResMed AirFit P10 nasal pillow
ResMed Swift FX nasal pillow
ResMed Swift FX Nano (cushion over the nose).

If you use cpap.com for masks...all the above come with free return insurance which means you have 30 days to get it back to them and get your money back if you hate it. They will help you get the RX also. There are other masks that have free return insurance or some have insurance you can purchase. Beats eating $120 for a mask you hate.
https://www.cpap.com/
Go take a look at all the masks out there..there's a ton of them.

Thanks, Pugsy!

For most patients who you an automatic, it's OK to set the max as high as the machine will go (for most machines, that's 20). The min is a bit trickier, as that number needs to enough most of the time.

Many of the newer machines have an automatic titration mode. It will keep "experimenting" of the course of a prescribed number of days, and then make a determination.

For some patients,very high pressure can bring on Central (or Clear Airway) events. If that's the case you'll need to set a max lower that the machine max. That may also be the case if higher pressure is causing discomfort or mouth-breathing.

D.H. wrote:For some patients,very high pressure can bring on Central (or Clear Airway) events. If that's the case you'll need to set a max lower that the machine max.

Actually it can happen at any pressure for some people. It doesn't have to be "very high" ....I have seen it happen with as little as 5 or 6 cm.
It's not hugely common though and most people won't have centrals caused by cpap pressure but if they do there are ways to deal with it.
Sometimes it's just a matter of maybe limiting that maximum as long as it doesn't let the obstructive stuff worsen.
Sometimes the centrals caused by cpap pressure will go away with time as the body gets used to things.
Sometimes a different machine is needed.
All fixable in some manner or other.