Norm for switching machines

Hi, is there any standard for time required for a machine to be deemed ineffective for a person? Does one have to use a CPAP for a month before you "fail" the CPAP therapy and move on to Bi or ASV...

A lot depends on WHY it is not effective for you.

chunkyfrog wrote:A lot depends on WHY it is not effective for you.

As in it's not stoping or reducing apnea because it's not designed for the specific apnea the patient has but Dr's prescribe it because insurance says you must try it first

So let's say someone needs BiPAP because they need 20cm and can't exhale even with CPAP set to full EPR. How long does patient have to try to make it work before it is deemed a failure?

one needs to actually have something to treat before one can expect to have any significant improvement.

palerider wrote:one needs to actually have something to treat before one can expect to have any significant improvement.

http://imgur.com/gallery/o7hko/new

Sleep study reported "there is a clinical suspicion of sleep apnea" Why would they say that with an AHI of 3? Maybe because my tiny little AHI of 3 is producing symptoms that others may experience at 15 or 20. I have an irregular heart beat (heart is fine, had echocardiogram, heart looks perfect), high blood pressure (I'm 30 and weight 160 lbs), morning head aches, day time fatigue (previously diagnosed as chronic fatigue syndrome), brain fog (also previously wanted to diagnose me with depression for that one), frequent night time urination. It just fits so perfectly. It's almost funny.

jjsemperfi wrote:

palerider wrote:one needs to actually have something to treat before one can expect to have any significant improvement.

http://imgur.com/gallery/o7hko/new
Sleep study reported "there is a clinical suspicion of sleep apnea" Why would they say that with an AHI of 3? Maybe because my tiny little AHI of 3 is producing symptoms that others may experience at 15 or 20.

no, the "recommendation" was "because there is a clinical suspicion of sleep apnea in this patient" which means, you went in to the doctor and told him you were tired and sleepy and other things that lead to a clinical suspicion of sleep apnea.

and, if you read down at the bottom of the titration report, you'll notice:

Trial of CPAP at 5cm/H2O with a respironics pico S mask and inline heated humidification may be considered even though the patient did not meet criteria for CPAP therapy at home.

jjsemperfi wrote:I have an irregular heart beat (heart is fine, had echocardiogram, heart looks perfect), high blood pressure (I'm 30 and weight 160 lbs), morning head aches, day time fatigue (previously diagnosed as chronic fatigue syndrome), brain fog (also previously wanted to diagnose me with depression for that one), frequent night time urination. It just fits so perfectly. It's almost funny.

that's the "clinical suspicion" part... you have a lot of the symptoms, however, according to your home sleep test, AND the in lab test, AND the reports you've pasted here, what you don't appear to have is any significant amount of sleep disordered breathing. (sleep apnea)

which leads me back around to what you quoted above... you've got to have something to treat before you can expect improvement.

Is your physician trying to do an alternative treatment, but your insurance is wanting you to attempt CPAP therapy? That is odd as you have a lot of the symptoms of obstructive sleep apnea, but the sleep study did not show you qualified for a CPAP device.
I'd hate to even suggest, but have you thought about a second sleep study to confirm this apnea hypopnea index? I'm not a physician by any means, but it is something to bring up with your provider, in my opinion.
If I could attempt to answer your original questions it is probably going to be according to regular guidelines. So I would expect they want a three month evaluation looking at thirty days of consecutive use. You would need to use the therapy to fulfill your portion of this and use it over four hours a night (that is a minimum, you should use it from when you go to sleep to when you wake). Then review this data to show if the CPAP therapy is effective at helping you. Where the confusion is at is that your AHI is at 3, which is controlled. So if the CPAP drops this to 1...it wouldn't really be considered anything significant.

I hope this makes sense in some way! God bless!

thecpapguy! wrote:Is your physician trying to do an alternative treatment, but your insurance is wanting you to attempt CPAP therapy? That is odd as you have a lot of the symptoms of obstructive sleep apnea, but the sleep study did not show you qualified for a CPAP device.
I'd hate to even suggest, but have you thought about a second sleep study to confirm this apnea hypopnea index? I'm not a physician by any means, but it is something to bring up with your provider, in my opinion.
If I could attempt to answer your original questions it is probably going to be according to regular guidelines. So I would expect they want a three month evaluation looking at thirty days of consecutive use. You would need to use the therapy to fulfill your portion of this and use it over four hours a night (that is a minimum, you should use it from when you go to sleep to when you wake). Then review this data to show if the CPAP therapy is effective at helping you. Where the confusion is at is that your AHI is at 3, which is controlled. So if the CPAP drops this to 1...it wouldn't really be considered anything significant.

I hope this makes sense in some way! God bless!

It's probably going to come down to that. Just frustrating. Been out of work for 4 months because of this. A couple people on the forum wondered why my doctor had me do a CPAP sleep study directly after at home study. I personally think my AHI numbers are higher than advertised because 75% of my apnea occurs in a 2-3 hour period. Not all night. So if I sleep for 9 hours. That brings my total AHI down quite a bit. What do I know though. All I know is I sleep like crap and no one can tell me why.

jjsemperfi wrote: I personally think my AHI numbers are higher than advertised because 75% of my apnea occurs in a 2-3 hour period. Not all night. So if I sleep for 9 hours. That brings my total AHI down quite a bit. What do I know though. All I know is I sleep like crap and no one can tell me why.

your ahi is, by definition, an average of events over hours. everybody's AHI would be higher if they ONLY slept when they had events, if you look at enough charts, you'll see that MANY people's events come in clusters, but you count the total hours slept.

you may need to investigate other possible sources for your fatigue besides sleep apnea.

palerider wrote:

jjsemperfi wrote: I personally think my AHI numbers are higher than advertised because 75% of my apnea occurs in a 2-3 hour period. Not all night. So if I sleep for 9 hours. That brings my total AHI down quite a bit. What do I know though. All I know is I sleep like crap and no one can tell me why.

your ahi is, by definition, an average of events over hours. everybody's AHI would be higher if they ONLY slept when they had events, if you look at enough charts, you'll see that MANY people's events come in clusters, but you count the total hours slept.

you may need to investigate other possible sources for your fatigue besides sleep apnea.

I'm all ears to other possibilities. Chances are I've ruled them out. I would just give anything to find out how I would feel with an AHI of less than 1. I grantee I would feel better. Because without a doubt in my mind, these NORMAL apnea events are fragmenting my sleep. Dropping my O2 sats, increasing my heart rate (first sleep study my heart rate got up to 121) and waking me the hell up.

jjsemperfi wrote:I'm all ears to other possibilities.

I'd suggest a second *medical* opinion, the nevada cpap mill isn't cutting it.

or, you could buy yourself an ASV, since you're determined to have apnea.

You say you are 'all ears to other possibilities', so here's one: hyper-ventilation syndrome, or HVS. More recently classified as 'daytime breathing disorder'.

According to one source, a rise in tidal volume from 500cc to 750cc and an increase in resp rate from 12pm to 15pm can be enough - over time, and in some individuals - to change the blood-gas profile enough to create most of the symptoms you list.

The paradox may be that your beathing is adequate during sleep (as the tests show) but giving rise to problems while you're awake.

jjsemperfi wrote:

palerider wrote:

jjsemperfi wrote: I personally think my AHI numbers are higher than advertised because 75% of my apnea occurs in a 2-3 hour period. Not all night. So if I sleep for 9 hours. That brings my total AHI down quite a bit. What do I know though. All I know is I sleep like crap and no one can tell me why.

your ahi is, by definition, an average of events over hours. everybody's AHI would be higher if they ONLY slept when they had events, if you look at enough charts, you'll see that MANY people's events come in clusters, but you count the total hours slept.

you may need to investigate other possible sources for your fatigue besides sleep apnea.

I'm all ears to other possibilities. Chances are I've ruled them out. I would just give anything to find out how I would feel with an AHI of less than 1. I grantee I would feel better. Because without a doubt in my mind, these NORMAL apnea events are fragmenting my sleep. Dropping my O2 sats, increasing my heart rate (first sleep study my heart rate got up to 121) and waking me the hell up.

You could also have UARS but it looks like your home sleep study didn't score RERAa which would be suggestive of the condition:

https://en.wikipedia.org/wiki/Upper_air ... e_syndrome

Unfortunately, most insurance companies will not pay for a machine for someone who is diagnosed with UARS. So even if you think this is applicable and it may not be, if you want to experiment to see if a BiPap would help, you either have to find one to buy on Craig's list (Acceptable ones - http://www.apneaboard.com/wiki/index.ph ... PAP.2FVPAP) or get your physician to write a prescription for one so you can buy it online.

Best of luck.

49er

You say your heart is fine, because you had an echocardiogram. But the only thing abnormal about your sleep steady is the irregular heart rate. Have you seen a cardiologist? Or had a halter monitor? You're experiencing confirmation bias right now- where you're so convinced it's something you are missing something else.

I hate to bring this up now in light of other recent stuff, but I'm beginning to wonder about the sincerity of this one as this is the second thread on the same subject being dealt with, and recent replies re the fact he likely does not have apnea at all have not been responded to appropriately... just keeps coming back wanting a different answer. I so hope I'm wrong!