Call from Pulmonary Doctor's office after 2nd study

This morning I had a call from my Pulmonlogist's office after my second sleep study night. No surprise...I have apnea. I have an appoint with the Pulmonary Doctor pre-scheduled for next Thursday. The caller said the Doctor likes me to have used the unit before the appointment. I asked if this is a test unit. She answered "No, the tech has suggested a C-Flex unit and Zest Mask ." When I asked for a better description including manufacturer, she said she didn't know the answer.

I explained that I already had determined I'd like a ResMed S9 AutoSet Auto CPAP with H5i Humidifier and Resmed Swift FX nasal pillow. She explained that I'd need to discuss that with the Doctor. It should be noted that I was not provided an option to try a nasal pillow at my sleep study simply a mask over my nose with headgear was used. So, I guess I'm delayed a week. An additional note: when I told the caller I wanted a machine with data capability, she indicated Medicare requires all have cards. I assume if there's a card, the machine is data-capable? Or, is there something else I'm missing?

Am I in for a fight here with my Doc? I have no idea whether a nasal pillow will work better for me, or not. But, I didn't like the air rush when I opened my mouth during the sleep study using the nose mask.

I have a second questions also. What the heck is the difference between an APAP and CPAP machine. Is the ResMed S9 both?

I have no idea whether a nasal pillow will work better for me, or not. But, I didn't like the air rush when I opened my mouth during the sleep study using the nose mask.

You are opening your mouth, Wonka. That's going to happen in ANY nasal or nasal pillow mask. You have to learn to keep your mouth shut . Some people use a chin strap or tape to help. Otherwise you need a FF mask.

Your doctor's order for the mask should read "mask of patient's choice". That way you can try any mask you want until you find THE mask for you. This is important. You have to have the freedom to keep trying masks until you can find one you can be comfortable in 7 to 8 hours per night. Don't let him lock you into a particular mask, leaving you to fight with the DME if it doesn't work for you.

I have a second questions also. What the heck is the difference between an APAP and CPAP machine.

CPAP's run at a fixed pressure all night long, regardless of whether you need more or less at a given moment. APAP has an auto-adjusting feature so that you can set a range of pressures and the machine will adjust up or down within the set range according to your needs. APAP's can also be run in CPAP mode.

Is the ResMed S9 both?

There are THREE ResMed S9 models. The Escape CPAP (AVOID at all costs, NO data), The Elite (CPAP) and the Autoset (APAP) Be sure your doctor specifies the particular one you want--either the Elite or the Autoset.

Wonka wrote:This morning I had a call from my Pulmonlogist's office after my second sleep study night. No surprise...I have apnea. I have an appoint with the Pulmonary Doctor pre-scheduled for next Thursday. The caller said the Doctor likes me to have used the unit before the appointment. I asked if this is a test unit. She answered "No, the tech has suggested a C-Flex unit and Zest Mask ." When I asked for a better description including manufacturer, she said she didn't know the answer.

I explained that I already had determined I'd like a ResMed S9 AutoSet Auto CPAP with H5i Humidifier and Resmed Swift FX nasal pillow. She explained that I'd need to discuss that with the Doctor. It should be noted that I was not provided an option to try a nasal pillow at my sleep study simply a mask over my nose with headgear was used. So, I guess I'm delayed a week.

Am I in for a fight here with my Doc? I have no idea whether a nasal pillow will work better for me, or not. But, I didn't like the air rush when I opened my mouth during the sleep study using the nose mask.

I have a second questions also. What the heck is the difference between an APAP and CPAP machine. Is the ResMed S9 both?

JUST GET THE S NINE AUTOSET.. you will be glad when you know whats going on that you did get it!
yes, you can run it cpap or apap. cpap is ONE straight pressure at a time.. one, thats it... you can change it, but its still just one..
apap you can run a range in case you need more on your back, less on your side, the auto will follow you breath by breath like a lonesome puppy, plus
if you find your magic number, you can set on straight cpap.. your magic number can change too, so get the autoset..

the air rushing out of your mouth with nasal mask is only newbie issue, dont worry about it, when you get your training wheels off, youll know how
to work it, but yes, it feels creepy! are you a mouth breather? any nasal issues? deviated septum?

if youre a good nose breather, a nose pillow mask like the swift fx is a great place to start.. and if you do leak from your mouth, thats an easy fix down
the road..
just get the AUTOSET! s nine autoset.. youll be in the driver seat..
we can give you the software, and send you the manual.. and hopefully your doc will be enthusiatic about you wanting to be a part of YOUR OWN therapy!

Wonka wrote:I have no idea whether a nasal pillow will work better for me, or not. But, I didn't like the air rush when I opened my mouth during the sleep study using the nose mask.

You'll get that "air rush" out your mouth when you open it, whether you are wearing a nasal mask (covers the nose) like you were wearing in the sleep study, or whether you're wearing a nasal pillows mask like the Swift. The only way you wouldn't get the rush of air out the mouth is if you're wearing a "full face" mask (covers mouth and nostrils.) Were you waking up from sleep with air rushing out your mouth during the study? If so, a FF (full face) mask might be the best choice of mask for you.

Wonka wrote:I have a second questions also. What the heck is the difference between an APAP and CPAP machine. Is the ResMed S9 both?

The machine you mentioned wanting (the ResMed S9 Autoset CPAP) is both. It's a CPAP machine that can be set for either "cpap" mode or "autotitrating cpap" mode. Any brand of autopap can be used as a simple CPAP. Two machines in one.

APAP= autotitrating cpap, or "autopap." Also called "self adjusting CPAP." Can be used as a CPAP or as an Autopap. In autotitrating mode, two pressures are set. A "maximum" and a "minimum" pressure. In APAP mode, the machine varies the pressure between the min and the max throughout the night, to try to prevent apneas. The most important pressure to set right on an autopap, imho, is the minimum pressure. I think the minimum pressure should usually be set high enough to prevent most apneas right from the get-go.

CPAP = continuous positive airway pressure. Blows one pressure all the time, although some CPAPs have exhalation pressure reduction features like Respironics C-Flex feature (and A-Flex in their autopaps) and ResMed's EPR feature. C-Flex and EPR both drop the pressure some when you breathe out, but they do it differently from each other.

janknitz & elena-

Please accept my "thank you" for the prompt responses.

I will ask for the ResMed S9 AutoSet.

elena- I do have nasal breathing problems (and had deviated septum surgery years ago...it didn't help). I also have Asthma. As a result, I assume I breathe a lot through my mouth while sleeping. I'm not sure how much I breathe through my mouth, but I snore...so it must be fairly often. Does that mean a nasal pillow arrangement won't work for me?

elena- I do have nasal breathing problems (and had deviated septum surgery years ago...it didn't help). I also have Asthma. As a result, I assume I breathe a lot through my mouth while sleeping. I'm not sure how much I breathe through my mouth, but I snore...so it must be fairly often. Does that mean a nasal pillow arrangement won't work for me?

No, it doesn't mean that at all.

Sleep techs SWEAR that we breathe through our mouths because of air hunger, and when we are getting the optimal pressure we don't mouth breathe. Some sleep techs ALWAYS fit patients with a nasal mask or nasal pillows during titration and swear they work well.

You do need to work on any nasal congestion--try a neti pot or saline rinse to clear the nose, and use either a steroid nasal spray or oral antihistamine (or both) to clear sinus congestion, especially during allergy season. Once you get things cleared out, you'll be amazed at how much a nasal pillow mask can help KEEP your nose clear.

Asthma won't be affected by your mask choice (you will need exhalation pressure relief at first for comfort), though when I get short of breath from asthma I sometimes want to open my mouth in the nasal pillows and--YUCK Vortex!. So you need good asthma control in any case. It's made me more consistent with my asthma management, which is a good thing!

Wonka wrote: when I told the caller I wanted a machine with data capability, she indicated Medicare requires all have cards. I assume if there's a card, the machine is data-capable? Or, is there something else I'm missing?

That card can contain only what the machine is capable of reporting. The data Medicare requires is only compliance or usage information, as in how often and how long you used the machine. So you could be told a machine is data capable and it could be true, but that data could be worthless in helping you troubleshoot your treatment. You already know how much you used it! Your best bet is to get the exact name of the machine and check it out. The names are often so similar it's easy to get mixed up - work from written material, not memory (especially with untreated sleep apnea).

kteague wrote:

Wonka wrote: when I told the caller I wanted a machine with data capability, she indicated Medicare requires all have cards. I assume if there's a card, the machine is data-capable? Or, is there something else I'm missing?

That card can contain only what the machine is capable of reporting. The data Medicare requires is only compliance or usage information, as in how often and how long you used the machine. So you could be told a machine is data capable and it could be true, but that data could be worthless in helping you troubleshoot your treatment. You already know how much you used it! Your best bet is to get the exact name of the machine and check it out. The names are often so similar it's easy to get mixed up - work from written material, not memory (especially with untreated sleep apnea).

OK. I understand. Is the ResMed S9 AutoSet Data-capable, or not? If it is, how do I obtain the software?

The ResMed S9 AutoSet is fully data capable if you don't get the Escape Auto model. Find a user named Uncle_Bob and read his signature line for the software.

Resmed has FOUR (4) S9 models:
The Elite CPAP and the Autoset give detailed data, with the Autoset giving more.
The Escape comes in a CPAP and an Auto model--AVOID BOTH AT ALL COSTS--compliance data only--useless to anyone but the insurance company!

My list of machines that record "full data" (AHI and leak info) and those that don't -- updated through March 2010:
viewtopic.php?p=307168#p307168

The ones in blue record full data. The ones in red do not.

In case the DME tries to convince you that a machine provides the kind of "data" you want to see, simply because it happens to have a card stuck in it:
viewtopic.php?p=344265#p344265

For some entertaining reading about that:
check out LinkC's post on page 2 of this thread:
viewtopic.php?p=342111#p342111

And roster's post on page 3 of that same thread.

Wonka wrote:...have nasal breathing problems...I assume I breathe a lot through my mouth while sleeping...I snore...so it must be fairly often. Does that mean a nasal pillow arrangement won't work for me?

Maybe -- I wore a pillow mask for almost 2 yrs and I have 30+ yrs of allergies+sinusitis+vasomotor & gustatory (means certain foods cause congestion). Worked fine for me until I lost about 45#s and started mouth leaking but I was a fat, dumb, & happy in my slow recovery hosehead with a no-data CPAP and completely unaware I was losing therapy air via small little puffs of air, not enough to make that hissing sound we so come to hate! By the time I found this forum & got educated, I'd lost about 55-60#s with a noticeably thinner face and throat area. Sleep doc saw 2 of us successful wt loss hoseheads that morning who were complaining -- he said I'd lost so much wt that I could no longer maintain the velolingual seal that keeps us from letting air escape...oh lovely, sucessfully lose a lotta wt and now I gotta start wearing a FFM? I now wear the RespCare Hybrid which combines pillows with an oral cushion, comes with 3 sizes of oral cushion and 3 sizes of pillows that can be adjusted to 2 heights. A lot of us here wear it; it's comfortable!