Can't recommend Good Morning Snore Solution

tan wrote:

palerider wrote:

tan wrote:

chunkyfrog wrote:I agree with Granny. 4-20 is ridiculous.

Yes, looks ridiculous to me, too. But it seems like there are people even on this board who don't think it is ridiculous by agreeing with the insurance's determination to refuse a titration study

4-20 is the best *starting point* then you adjust from there.

Yes, that is what I did: self-titration. Hard to go over 15 though, even with EPR==3. It is just I think that professional titration could have been a much better and faster option. Who knows... maybe... I need a VPAP, but how can one tell...

while you're set on that, and nothing I can say will make a difference, there is one point, a "professional titration" is a very disruptive procedure, all you have to do is browse this board for a while to see MANY MANY MANY posts from people who spoke of the terrible time they had, wires, noises, only slept a couple hours... and ended up with a prescription that didn't suit their needs because those two hours in an unfamiliar bed in unfamiliar circumstances.

vs a longer term titration in your familiar settings with the equipment you'll be using, and thus ending up with, after some tweaking, a much better setting that fits the majority of people better than that "professional" (and hugely expensive) one did.

palerider wrote: while you're set on that, and nothing I can say will make a difference, there is one point, a "professional titration" is a very disruptive procedure, all you have to do is browse this board for a while to see MANY MANY MANY posts from people who spoke of the terrible time they had, wires, noises, only slept a couple hours... and ended up with a prescription that didn't suit their needs because those two hours in an unfamiliar bed in unfamiliar circumstances.

vs a longer term titration in your familiar settings with the equipment you'll be using, and thus ending up with, after some tweaking, a much better setting that fits the majority of people better than that "professional" (and hugely expensive) one did.

Hmmm, I get your point but the way you put all this makes real life stories doctors prescribing VPAPs with advances features after titration studies like fairy tales. How do I self-titrate myself to prove that I may need a VPAP? How do I know RERAs are taken care of?

ChicagoGranny wrote:Do you practice good sleep hygiene, have a moderate, regular exercise program and eat a good diet?

I try to.

Try not! Do. Or do not. There is no try!

if there is a case of untreated UARS, practicing a good sleep hygiene alone will not provide the sought relief, will it?

tan wrote:and after I have been given the machine with 4/20 setting

You were given an original RX with 4/20 on a CPAP and not a Bilevel? Curious that your Sleep DR did that.

tan wrote:...Besides, FFM itself does not prevent mouth opening. And even if FFM fits well, my mouth runs dry anyway.

I normally only get dry mouth if there are large leaks in the mask.

Some masks are better than others. Just because a mask is a FFM doesn't mean it is good if you open your mouth. I have a Quatro Air which provides for a good seal, but if I open my mouth it doesn't work well. My F&P 432 is a better mask for that. I can open my mouth all day long and I don't get large leaks... however, the mask does have an avg higher leak rate than the Air.

What is is response to the Insurance denial from your Dr? how does he suggest to remedy?

Most insurance requires cpap "failure" before they will even consider bilevel.
If that failure requires additional expense and suffering, that is acceptable to them.
The key is to find out what pressure is effective, and if the machine "pegs" at 20, without adequate therapy,
they have no choice.

ChicagoGranny wrote:

tan wrote:He (doctor) also said the patient agreed.

Your doctor must be stupid to write this. I am sure the insurance people got a good laugh out of a doctor saying the patient was advising on what tests to undergo. It is good for the patient to ask for certain tests. But a doctor is stupid for writing this to the insurance company.

I don't see anything stupid in the following notes used for getting insurance authorization, which I requested for review:

Problem #1. Sleep apnea, obstructive (ICD-327.23) (ICD10-G47.33)
Due to residual fatigue and sleepiness in the context of CPAP compliance. The patient was advised to undergo a CPAP titration. He is in agreement. We will attempt to obtain prior authorization.

tan wrote:I saw what doctor wrote: request for a titration study because the patient still has OSA symptoms to determine proper pressure.

What you are saying in this quote and what the insurance company says in their letter indicates that the insurance company has zero idea that the doctor wants to test you for UARs. Does he? Or does he just want to titrate you for OSA?

Correct, nothing about UARS. Titration only because of hypersomnia despite CPAP usage. It could be his negligence or just because insurances are reluctant about treating UARS and he needed to provide a "proper" justification. Such situations are not unheard of:
So he wrote a script for a CPAP titration, but my insurance won't cover it b/c they said I just had a sleep study that didn't meet the requirements for having sleep apnea and thus im ineligible for a titration study. However, they continue to pay for my CPAP machine for whatever reason, which i'm lucky for.

Krelvin wrote:

tan wrote:and after I have been given the machine with 4/20 setting

You were given an original RX with 4/20 on a CPAP and not a Bilevel? Curious that your Sleep DR did that.

4/20 suggests that, if APAP is up to the job, Bilevel is not justified. I would be curious if my doc could prescribe Bilevel. Based on what?

palerider wrote:

tan wrote:

chunkyfrog wrote:I agree with Granny. 4-20 is ridiculous.

Yes, looks ridiculous to me, too. But it seems like there are people even on this board who don't think it is ridiculous by agreeing with the insurance's determination to refuse a titration study

Actually 4-20 with ramp is the worst treatment setting. It's the failure setting.

You have the needed machine to optimize your treatment, you just need the steering wheel (software) and the will to make the treatment yours. There is no magic OTC BULLET, for most it requires work to get it right.

10cm is about the avg needed pressure, starting with a setting of 7 to 12 for a few nights should give you better data, and a idea of where to adjust to. By posting the daily data others can better help you. Jim

Krelvin wrote: What is is response to the Insurance denial from your Dr? how does he suggest to remedy?

A few alternatives: paying out of pocket for the sleep study or trying once again, since I am changing my insurance carrier soon. I decided to wait a bit, while trying something else in the meantime. There is a mixed response on various oral appliances, which I am testing in combination with CPAP.

Goofproof wrote:

palerider wrote:

tan wrote:

chunkyfrog wrote:I agree with Granny. 4-20 is ridiculous.

Yes, looks ridiculous to me, too. But it seems like there are people even on this board who don't think it is ridiculous by agreeing with the insurance's determination to refuse a titration study

You have the needed machine to optimize your treatment, you just need the steering wheel (software) and the will to make the treatment yours.
There is no magic OTC BULLET, for most it requires work to get it right.

There is one OTC, which seems to have some effect: BreatheRight nasal strips which help with flimsy nostrils. After I switched to nasal pillows P10, such strips are not really needed.

10cm is about the avg needed pressure, starting with a setting of 7 to 12 for a few nights should give you better data, and a idea of where to adjust to. By posting the daily data others can better help you. Jim

I am already up to 15 with EPR==3, started from 4. Flow limitations are lower but still present, I have difficulties on exhale, which why I can't go higher at the moment.

tan wrote:I am already up to 15 with EPR==3, started from 4. Flow limitations are lower but still present, I have difficulties on exhale, which why I can't go higher at the moment.

You may be fouling yourself up badly by setting the pressure that high. What was the lowest pressure that gave you a good AHI?

You seem to be chasing data on flow limitations by raising your pressure very high. This high (and possibly unnecessary) pressure could be causing most of your problems.

Look at your SH daily stats and tell us what your FL Med average is for the last seven days. You will have to look at each of the seven days and calculate an average.

If you are looking at the graphic for FL, you may be unnecessarily concerned. My FL chart looks ragged but I sleep the entire night, feel energetic the next day, rarely feel sleepy in the afternoon and am alert until near bedtime. So I repeat myself, if you are chasing FL data with high pressure, you may be screwing yourself.

BTW, I agree with the suggestion about sleep hygiene. Anyone having problems with sleeping or sleepiness during the day should become very disciplined with sleep hygiene. Moderate exercise and good diet are a part of sleep hygiene.

But post your FL data and see what people say.

palerider wrote:a "professional titration" is a very disruptive procedure, all you have to do is browse this board for a while to see MANY MANY MANY posts from people who spoke of the terrible time they had, wires, noises, only slept a couple hours... and ended up with a prescription that didn't suit their needs because those two hours in an unfamiliar bed in unfamiliar circumstances.

vs a longer term titration in your familiar settings with the equipment you'll be using, and thus ending up with, after some tweaking, a much better setting that fits the majority of people better than that "professional" (and hugely expensive) one did.

Well said.

Sheffey wrote:

tan wrote:I am already up to 15 with EPR==3, started from 4. Flow limitations are lower but still present, I have difficulties on exhale, which why I can't go higher at the moment.

You may be fouling yourself up badly by setting the pressure that high.

I may or may not. I presume you are aware of Dr. Krakow articles on UARS. His approach may be arguable but certainly deserves consideration. Also, I have read on other apnea boards about a few cases when pressure was gradually increased to, for instance, 16cm, as a result of which, flow limitations completely subsided and sleep normalized. I thought I should try it as well.

What was the lowest pressure that gave you a good AHI?

4, but APAP almost immediately jumps to 8 at the onset of sleep and can go as high as 9-14, sometimes even 17, because of snoring/flow limitations (I guess cause leaks were normal), but AHI has consistently been under 1, even when I limited the upper pressure to 9. But what value does AHI have in case of UARS, unless I am imagining this? Some doctors argue that AHI is not a good indicator at all, especially when it comes to UARS.

You seem to be chasing data on flow limitations by raising your pressure very high. This high (and possibly unnecessary) pressure could be causing most of your problems.

Once again: I try to find the pressure above which APAP won't go. I merely try to follow the path of others who succeeded combating UARS. I asked other board members to post their FL charts. Only a few shared: those who had FL flat 0 claimed a good sleep, those who had a ragged FL struggled. It is then when I made my conclusions about trying higher pressures to bring FL down.

Look at your SH daily stats and tell us what your FL Med average is for the last seven days. You will have to look at each of the seven days and calculate an average.

If you are looking at the graphic for FL, you may be unnecessarily concerned. My FL chart looks ragged but I sleep the entire night, feel energetic the next day, rarely feel sleepy in the afternoon and am alert until near bedtime. So I repeat myself, if you are chasing FL data with high pressure, you may be screwing yourself.

ok, you may be right. Or may be not. What was your untreated AHI and RERA? In my case, they were 5 and 17, in other words, the latter was a most likely contributing factor to poor sleep. What were yours?

Sheffey wrote:

palerider wrote:a "professional titration" is a very disruptive procedure, all you have to do is browse this board for a while to see MANY MANY MANY posts from people who spoke of the terrible time they had, wires, noises, only slept a couple hours... and ended up with a prescription that didn't suit their needs because those two hours in an unfamiliar bed in unfamiliar circumstances.

vs a longer term titration in your familiar settings with the equipment you'll be using, and thus ending up with, after some tweaking, a much better setting that fits the majority of people better than that "professional" (and hugely expensive) one did.

Well said.

hmmm, I had a titration study 6 years ago and my experience was quite good, despite "being wired". But I discontinued the therapy on my own because of disturbing rainouts during colder time of the year.

This is what I am trying to accomplish:

Eventually I decided to start raising the lower pressure limit and when I hit 16, all the flow limitations and nearly all the snoring vanished, I started sleeping through the entire night and all was right with the world.