Just diagnosed

So, for the last number of years I have slept like crap...

I got the idea that I may need a sleep study from a friend that has Sleep Apnea. Looking back, I guess the first indication that I had a problem was in 2007 in Afghanistan. I was at approx. 9000 ft. above sea level and frequently woke up gasping for air. All the docs there did was give me Ambien. After a number of months I got better but not completely. Since then I have had an airway phobia or claustrophobia related to having my airway blocked or covered. Before this I never even thought about my airway...

Anyway, the Sleep study told me I have Severe OSA. Here is the run down:

Total time - 471 min
Sleep time - 409 min (sure seemed like I was up more than that...)
Seep efficiency - 87%
Sleep onset latency - 8 min
REM stage latency was delayed - 231 min
Central Apneas - 1
Mixed apneas - 3
Non-obstructive hypopneas - 183
RERAs - 81
Total apnea/hypopnea events - 198 (does not seem to add up...)
AHI - 29
Respiratory disturbance events - 279
RDI - 41
Arousal events - 136
Arousal index - 20
Heart rate average - 62 bpm
Heart rate max - 104 bpm
Average O2 saturation - 94%
Lowest O2 Saturation - 84%
O2 saturation below 90% - 9 min

Conclusion:
The patient exhibits severe obstructive sleep apnea and hypopnea with sleep fragmentation and frequent arousal.

A week later I had a titration study performed and eventually settled down with BIPAP since I couldn't relax with the CPAP. I think I maxed out at 12 or 13 IPAP and 4 EPAP on a FFM since I am a mouth breather.

I very much want to make sure I get an auto machine because the higher rate kept me from falling asleep after I woke up during the night. Once the tech turned the flow down I went back to sleep. I was told that the higher pressure was needed to keep the number of events down.

Any advice on how to get the doc to give me the right machine? I think this clinic supplies Resmed equip.

I also had a hard time keeping the Resmed mask sealed if I slept in any position other than on my back. What is a good FFM for sleeping on my side?

Any other advice?

Welcome to the community:

If you insist on a Bipap , I believe both Resmed and Phillips are data capable but not necessary auto adjusting , you should ask for an auto adjusting one Phillips is a pr760 and the Resmed will say vpap auto .

As for a mask it becomes a very personal thing, I like the F10 fullface, many people like the new nasal mask like the P10 or the N10 , all of which are air fit masks.
Meaning the air pressure inflates the seal to make it seal .

read through : http://maskarrayed.wordpress.com/taming ... ge-quattro

good luck on your new adventure

AEmedic wrote: Any advice on how to get the doc to give me the right machine? I think this clinic supplies Resmed equip.

I also had a hard time keeping the Resmed mask sealed if I slept in any position other than on my back. What is a good FFM for sleeping on my side?

tell the doc to write you an rx for the vpap auto

grayghost has a good suggestion for the full face mask. adjust it while you're laying down, at pressure, and if leaks are still annoying, look into mask liners (search the forum).

read the other posts on that blog that grayghost pointed you to.

palerider wrote: tell the doc to write you an rx for the autoset, (not the escape auto, make sure he says 'autoset').

PR, he thinks he needs a "BiPAP," which the AutoSet doesn't do. He'd need to get the doc to specify an autopressure bilevel machine.

AEmedic, a lot of doctors have their head stuck in the last century and don't like auto machines, so be prepared to have a fight about getting the doctor to specify auto. Emphasize having to fight the pressure to go to sleep. Lots of docs don't realize that you set a pressure range on an auto machine, you don't just plug it in and let it find the pressure.

Terminology note: "Bilevel" is the generic term. "BiPAP" is a Philips Respironics trademark. "VPAP" or "AirCurve" is the corresponding ResMed trademark. Technically it's the same, although quite a few people misuse the term BiPAP when they should say bilevel.

AEmedic, check my signature line for a lot of links to help you adjust and not get screwed by the medical mafia.

All the ResMed bilevel machines are pretty good. There are manual and auto bilevel machines.

There's are new ResMed bilevel models with "AirCurve 10" model names. The current ResMed S9 VPAP machines are fine as well, so I wouldn't worry too much about whether you get the new model AirCurve 10 or S9 model. I'm not sure the AirCurve models are available yet.

I'm puzzling over the "non-obstructive hypopnea" comment. I haven't heard that before. I wonder if that's some sort of indication of something like central apnea.

archangle wrote:

palerider wrote: tell the doc to write you an rx for the autoset, (not the escape auto, make sure he says 'autoset').

PR, he thinks he needs a "BiPAP," which the AutoSet doesn't do. He'd need to get the doc to specify an autopressure bilevel machine. \

oops, yes, sorry, edited.

Patrick is a good assignment but probably overdue
Welcome back to the states. I was assigned to AES for over 13yrs.

AEmedic wrote:Any advice on how to get the doc to give me the right machine?

The sleep business it pretty corrupt so the only way to make sure of anything is for you to read and learn so you don't get taken like the rest of us who learned the hard way. Even the VA and military docs are still in the learning curve on sleep apnea and yours is complex where you have central and obstructive apneas.

AEmedic wrote:A week later I had a titration study performed and eventually settled down with BIPAP since I couldn't relax with the CPAP. I think I maxed out at 12 or 13 IPAP and 4 EPAP on a FFM since I am a mouth breather.

Many people can't get enuff air at 4cm so be aware of that and learn how to adjust the machine yourself instructions are available here and many other places in the web. Beware that to much pressure can increase your centrals and make you feel worse.

Doesn't matter central or obstructive both reduce your SPO2 which will kill you over time.

Work on learning to breath thru your nose you will have less trouble with this therapy if you can. Nasal pillows are much more comfortable and easier to seal since they cover less surface area. If you have trouble breathing thru your nose while awake you should get that repaired asap. If you don't breath thru the nose while awake you certainly won't when asleep.

Thanks for the responses everyone!

I will take note of all the advice and I am going to read the blog that was mentioned as soon as I finish this post.

"I'm puzzling over the "non-obstructive hypopnea" comment. I haven't heard that before. I wonder if that's some sort of indication of something like central apnea." - I have no idea... LOL

I tend to have allot of sinus issues but most days I can breath clearly through my nose. When ever I exert myself at all I default to the mouth and even to fall asleep I usually need to breath through my mouth. I'm not sure but that could be the apnea driving me to behave this way.

Either way, I think I am going to at least try to use a nasal mask to see if I an get it to work.

"non-obstructive hypoapnea" = hypoapnea. It's just what it says, a constriction but not a complete obstruction of the airway, resulting in hypoxia but not a cessation of breath.

AEmedic wrote:When ever I exert myself at all I default to the mouth and even to fall asleep I usually need to breath through my mouth. I'm not sure but that could be the apnea driving me to behave this way.

Apnea does not cause that but anytime we can't get enuff O2 thru the nose it is a natural reaction to open the mouth. Which is why I mentioned getting the nose fixed first even before you start cpap.

Guest wrote:

AEmedic wrote:When ever I exert myself at all I default to the mouth and even to fall asleep I usually need to breath through my mouth. I'm not sure but that could be the apnea driving me to behave this way.

Apnea does not cause that but anytime we can't get enuff O2 thru the nose it is a natural reaction to open the mouth. Which is why I mentioned getting the nose fixed first even before you start cpap.

Thank you for the advice!

I have had two surgeries on my sinuses. One for a deviated septum and the other for too many nasal polyps to mention...

AEmedic wrote: I have had two surgeries on my sinuses. One for a deviated septum and the other for too many nasal polyps to mention...

OIC

how much do you think the polyps contribute to your apnea condition?

Guest wrote:how much do you think the polyps contribute to your apnea condition?

I don't think they contribute, other than limiting how well I can breath through my nose.

So, today was the post titration doctor visit...

This visit makes me realize that the doctor cares very little about me or my personal desires or needs. He had decided that I would be getting the most basic machine that he could provide. He didn't specify a brand or model, just that it would be a non-auto Bilevel with a fixed 10/6 setting. When I asked him what machine he didn't know or really care as long as it could be set the way he wanted it. It was very frustrating but I kept up with my explanation about how an auto type machine would suit my needs better. He wasn't getting it and proceeded to tell me he didn't prescribe them and that the "auto titration" was not beneficial to me and no one he has treated has ever needed one.

At that point I explained that I appreciate his professional position but that I know my body and of course related as much as I could remember of the benefits of an auto bilevel machine, all of which I learned here. I finished with the fact that I guess I'll have to go for a second opinion elsewhere. At that point he raised his eyebrows and slowly described that he doesn't know why I wouldn't just go with his recommendation, but he would be willing to prescribe what I was asking for. So I walked him through this list:

Resmed VPAP auto, Aircurve 10
Optional heated humidification unit
Optional heated hose

I need to go back to the sleep lab for a mask fitting appointment to see what they have that will fit me best, then they will send in the script for pre-authorization with Tricare.

If it all turns out, that's great. If not, and they try to provide a brick, I guess I'll find another doc.

AEmedic wrote:If it all turns out, that's great. If not, and they try to provide a brick, I guess I'll find another doc.

Here's the good news....in the 2 main bilevel pressure machine lines (ResMed or Respironics) as long as either PR System One in Respironics or ResMed S9 (or newer) there are no bricks. All the bilevel machines today are full data machines...even the non auto adjusting bilevel machines. Just because they only do fixed bilevel doesn't mean they don't gather full data.
ResMed or Respironics doesn't make a brick in the bilevel models of their latest models.

The AirCurve line which is the newest ResMed bilevel model line...I don't know when it is going to be made available...last I heard was sometime in October.