Need some suggestions on equipment

Hi, I am new to cpap therapy, have been using it now for 4 nights and so far so good, I guess. My biggest complaint so far is a sore right ear where the headgear sits. I have been trying to make adjustments, obviously one ear is lower than the other. The machine that I am using is on a trial basis for one month. It is a regular cpap and not an auto. Because I live in Ontario apparently there are many loops to jump through to be eligible for an auto to have it covered by ADP. During my sleep study if I had been able to stay sleeping on my side all night I would have had very few apneas, but because I have pain I tend to toss and turn a lot and end up on my back much more than I would like, so had many apneas and hypopneas. My Rem index was 42.4/hr, Apnea index was 6.3/hr, Supine index 51.4/hr and Hypopnea index 17.2/hr. My respiratory Disturbance index was 23.5/hr. I didn't get much stage 3/4 sleep total of 21.9% and the percentage of REM was 10.7. The Dr. gives a generic prescription for 5-15. They have me set at 7 for the present which I know is low. I am thinking that because I have more events when I am laying on my back as opposed to my side that my pressure may need to be different in both instances. Would this not make it better to have an auto machine that would take that into account rather than having them up the pressure on a straight cpap? I want to get the best machine that I can, but of coarse want the coverage from ADP as well. It makes a difference in coverage of $780 for a straight cpap to $1200 for an auto.

I also have the EPR set to 3, and I have a ramp set up for 15 minutes. I feel like the machine wants me to breath faster than I want to....is this normal when getting used to it? I really like how quiet the machine is.

My initial complaint was that I couldn't go to sleep. It usually takes me over an hour to get to sleep. When I went for the sleep study I never dreamed they would tell me that I have sleep apnea. I am taking some anxiety pills for the first couple of weeks while I am starting this journey so that I can get to sleep and tolerate something on my face. So far it is working. Will see what happens when I stop taking them. The RT told me that cpap won't help me fall asleep any sooner, just helps with the rest of the trouble.

I can't find anything on the machine to check if I have had any events etc. All I can find are the total hours that it has been used. I really want to be able to keep track of what is going on. The more I see that it is working the more compliant I will probably be.

I have been reading a lot of posts on this website and the Our Wisdom. It has been so helpful for me to take the steps to getting a machine and treatment.

Please excuse my rambling on and on. If I need to clarify anything, just let me know.

Marlene

Hello & Welcome, Windmill ! Glad you found this forum—SO much useful info and everyone here is so willing to help!

If you complete your profile to let all know what kind of machine you are using, I'm sure we'll be able to help.

"You are getting sleepy . . ."

The current equipment that I have is a Resmed Elite with Humidaire 3i. My mask is a Swift LT for her. This is a trial machine for one month and is a regular cpap. I am wondering with the numbers (that I posted in my first message) from my sleep study if an auto would be of a benefit or not? I didn't get any info about what the requirements were for an auto, she just gave me the regular. I don't want to buy something and then wish I had researched farther.



Thanks

The machine you list is a straight CPAP machine yet you say the doc prescribed you 5-15. That sounds like a generic Auto CPAP prescription. You also didn't mention a titration study. Did they ever put you on a CPAP machine in the sleep lab? If they didn't then that would also lend credibility to my theory that the doctors prescription is for an Auto CPAP.

If that is an Auto CPAP prescription then why did the DME give you a straight CPAP machine? Do they think think they have the right to play with your pressure and guess what is correct for you? Who decided to set you up with a pressure of 7? Was it the DME? Determining what pressure is correct for you should be between you and your doctor. If you don't know whether that prescription is for Auto or regular CPAP then verify it with your doctor. Then if the prescription is not clear enough make the doc write a new one that is VERY clear so the DME cannot misinterpret.

Another possibility is that the prescription refers to a ramp pressure of 5 with a straight CPAP pressure of 15. If that is the case then did you mean to say that your machine is set with a ramp pressure of 7 and a straight CPAP pressure of 15?

My thought exactly. "5-15" is not a CPAP 'script. That's clearly APAP (although a pretty wide spread). Maybe the doc plans to let the machine titrate and adjust the 'script/settings later. (Lazy SOB...)

I don't know that the script with pressure from 5-15 is for an auto. Apparently from what the RT said the Dr. always gives the same prescription to everyone and then it is trial and error to find the right pressure. I didn't have a titration done. I have had only the one sleep study that found I have sleep apnea. The RT told me that it is very difficult to qualify for an auto here in Ontario for the ADP to cover it. I didn't ask what the qualifications are but think I will be calling to ask. The Dr. seemed very open to whatever I would want to get as they really want me to use it because I have had 2 heart attacks in the past 3 years. I asked him about the prescription and if I would need a different one to get a specific machine as this one is supposed to be a "trial" and he said just to have the RT fax him for any change....I haven't been at this very long so am not sure about a lot of things. The RT did say that she could give me an auto to try but with everything she was telling me thought it wouldn't be of any use. I am beginning to think differently and may call to ask if I can trade my "trial" straight for a "trial" auto. My concern is that I don't want to have pressure any higher than I need or only when I do need it. Since I don't have too much trouble when I sleep on my side and lots when I am on my back does it make sense that I would need different pressures for each or am I just way off?

I think you're getting the runaround from your DME. Your RX is between you and your Dr and it looks like he ordered an auto and the DME is just guessing at your pressure. If you've never been titrated you most certainly will need an auto to zero in on your correct settings, 5-15 may not be where you should start, 5 seems too low, but maybe you can discuss that with your Dr or the "pros" here can help you. I might also suggest you set your EPR at 2 or 1 which may suit your breathing pattern better. My husband has a different machine than yours with Aflex/Cflex, comparable to EPR I think, and he turned them both off as he had the same exhale complaint as you.

I'm in a very similar situation, although I have not gotten a machine yet (a loaner or my own). I was told to have ADP cover you for an auto machine you will have to have substantial "proof" that an auto machine is needed.... also it has to be a dramatic different in pressure between say how you sleep on your back, and how your sleep on your side....

I'm on the fence now on what to get and WHERE to get it... seems like it'll be hard for me to get an auto machine... that's what my sleep clinic told me at least ... I want to as well try and minimize what is coming out of my pocket, and if I don't NEED an auto-machine then I don't... but if I do, my only option may be cpap.com or another online vendor.... I hate how we have to jump through hoops here in Ontario to get proper health care etc....

Marlene,

If they set your machine up the way they should, you can press and hold the left and right button at the same time for a few seconds and the "Efficency Menu" will come up. Scroll down and you can see your nightly pressure, leak rate, AI, HI and AHI. If this menu does not come up, then press and hold the right and down buttons to access the Clinicians menu. You can scroll through and find the same data there, it's just easier the other way. Ideally your AHI should be below 5. If not, you may need some adjustments. For a pressure of 7 an EPR of three seems high to me. If it were me I would reduce that, probably to 1. If you feel comfortable you could try it and see how it feels, and if it affects your numbers. Hope this helps!

Alan

Hi Alan,

Thank you very much! I did follow your instructions and I did get it to come up but each one has no data there...did I read somewhere that I would need to check this before a certain time each day to see it? I have been reading so much stuff I don't know if I am coming or going. The DME didn't explain at all how I could check, I want to be able to see what is going on and if it is working or not. I will try lowering the EPR as well and see how that goes over the next couple of nights.

Marlene

Windmill said,

did I read somewhere that I would need to check this before a certain time each day to see it?

Resmed machines clear their data at noon each day but of course that only applies if their internal clock has been correctly set. remember that Day light Saving may also have interfered with the time set.

Although you can reset the clock through the clinicians' menu, the data will be there if you take the readings early in the morning.