CPAP study failure...what next?

I was recently diagnosed with moderate sleep apnea, although I have probably had it for many years.

I recently had a CPAP study, although I hesitate to even call it that. I was sent home with a ResMed 10 set to 4-12 on a Thursday with an set of nose pillows. I barely got 10 minutes of instruction on the machine. I thought I would also get a couple mask to try but no, I was only given one option and I chose the set of nose pillows.

The first night using the small pillow was a failure. I could not exhale though my nose at all. I spoke with the doctor's office the next day but was given no helpful advise. I wasn't asked to come in to check the machine or see what could be done with a different nosepiece or mask. The technician later claimed to have offered that option, but he didn't and it isn't in his after visit notes. His attitude was there is nothing wrong with the machine, it won't go any lower, it was calibrated correctly, and did I have some breathing abnormality I didn't disclose. I hug up on the moron. Yes, I will use the term moron. He actually suggested I try inhaling through my nose and exhaling through my mouth. What would reverse snorkeling breathing do? It was by now Friday afternoon with no way to contact the doctor directly, and the CPAP due back on Monday morning.

I tried the other two sizes. The medium was marginally better but exhaling was very difficult. Basically I would end up gasping at which time a blast of air was pushed through my nose. Sleep was impossible. I gave up. I packed up the ResMed.

The doctor put in a request for a new study which the insurance company denied. They will authorize giving me a machine, a Resmed Air Sense S10 or a Respironics Dream Station 2. But then what? It won't operate at a lower pressure. I have no clue about whether any mask will work or at what pressure.

Any advice would be helpful.

Eastward wrote: ↑

Fri May 26, 2023 5:14 pm

Any advice would be helpful.

it's that low pressure of four.

i know you think it's too high. i and many others here had the same impression when we first started. in reality, if you raise the minimum pressure to say 6 or 7, viola! you'll find it easier to breath.

good luck!

Get the provider manual for your machine so you can change some settings tonight.
The manual explains how to get to the secret menu where you can change the pressures.
https://www.respshop.com/manuals/ResMed ... %20her.pdf

Make these changes..
Mode...keep it in auto mode
Minimum pressure ...set it to 7 (don't freak out, there is a method to my madness and I will explain)
Maximum pressure....you can leave it at 12 for now...if you reach it then you may need to increase the max a bit but since this is just a weekend trial...not all that critical at least for now.

Turn on EPR full time if it isn't on already and set it to 3.

Use the size of nasal pillow that seems the most comfortable but I would start with the medium for now.

Don't use the ramp feature...turn it off...don't freak out...again there's a method to my madness.

Do all this right now and try these settings and just see how the breathing/exhaling goes. Report back please.
Don't wait until bedtime tonight.

I will explain the "method to my madness" thing in just a little bit.

Trust me...just try the settings I suggested and tell us how it feels.

So...ramp off...don't use the ramp at all.
Minimum 7
Max 12
EPR...full time at 3 setting.

Get OSCAR so that tomorrow morning we can see how things went.
If your machine doesn't have a SD card in it ...go get one right now. Any SD card will work...generic from WalMart works fine...no larger than 32 GB though and actually 8 GB is plenty big but they are hard to find sometimes.

OSCAR https://www.sleepfiles.com/OSCAR/
http://www.apneaboard.com/wiki/index.ph ... stallation
http://www.apneaboard.com/wiki/index.ph ... rpretation
http://www.apneaboard.com/wiki/index.ph ... ganization organize and how to do screen shots.
wiki/index.php/Oscar:organize Wiki

http://www.cpaptalk.com/viewtopic/t1585 ... eview.html

Thank you for the quick replies. More in depth than anything I got from the Doctor or his staff.

I don't have a machine at this moment The CPAP "trial" was a few weeks ago. For the study I wasn't allowed to change the settings. I have no idea if EPR was even enabled. Something the doctor said makes me think it wasn't.

I will have to have to get the prescription filled. Any preferences regarding ResMed vs Phillips?

Eastward wrote: ↑

Fri May 26, 2023 7:07 pm

Any preferences regarding ResMed vs Phillips?

Definitely ResMed.....do not accept any Phillips Respironics machine. Several reasons which I don't have time to go into right now...trust me...ResMed...preferably the AutoSet model unless you have some sort of special needs but you haven't had any real experience to figure out even if you have special needs..
So AirSense 10 AutoSet or AirSense 11 AutoSet.

Sorry...I thought you were using the machine this weekend.

Remind me later to explain the "method to my madness" thing wanting you to increase the pressure when you were already wanting to lower it. I would bet my last dollar that you would find 7 cm with EPR at 3 a LOT easier than straight 4 cm. Using EPR makes you have 2 distinct pressures...one for inhale (that's the 7) and one for exhale (that's what EPR at 3 does...lowers that 7 to 4) and it's the difference that makes it easier and more comfortable.

An update...

I still don't have the CPAP device. Buckle up...

The doctor's office screwed up on the prescriptions somehow by farming it out to two different CPAP providers. One provider reached out to me in July about my insurance denying the prescription because another provider had been authorized.

I contacted my sleep center about this and they provided the contact info after a couple days. That provider didn't ever call me. I called them Friday August 18 and they said they got the Rx for the CPAP device on August 2. The lady tried to brush me off with no apology about not contacting me. I interrupted and asked about the cost. Apparently it is fully out of pocket at the contracted rate. I've been dicked around for several months for this? I told her to put it on hold because I was about to fire my doctor and didn't know who the new doctor will use as a CPCP supplier.

I called my doctor and had the receptionist look over my history. The dates the prescriptions were made and mis-sent shows weeks of delay only to finally send it to an organization as lax as they are. I had the receptionist take a message that the doctor and the sleep center are now fired due to the incompetence of the doctor and his technicians. "No, I do not require a call back. I will contact your office when I need the records sent to a new provider."

I have a referral from my primary with another doctor not affiliated with the HMO. But really, I'm just fed up. I will be filing a formal complaint with the HMO about this whole debacle.

Felt good to vent.

It'll probably be another several months to get a CPAP device.

You can get a prescription for a machine from any physician, dentist, or nurse practitioner. Do you know the breakdown of events in your initial diagnosis (obstructive apneas, central apneas, hypopneas))?

Moderate obstructive I believe, without going back to look at the test results.

If it ever happens again, make sure you have all your data (sleep study, Rx etc.) and then fire your doctor.

Contact your insurance to find out where you can buy the prescribed machine.
If the machine type is one you can afford, consider buying online, out of pocket.
Divide the machine's price by the many weeks of therapy you've been missing, and ask yourself if that saving is worth the continued harm being done to your health by sleep apnea.
You could also divide the machine's present price by about 60 months of use till you can buy the next one with insurance, and ask yourself the same question.
But don't buy before you know what was prescribed.

You don't need insurance's permission to buy.


As for the exhale pressure: you can train yourself gradually to get used to the pressure.
Keep in mind that as a person with sleep apnea, you've been conditioned to being choked on a nightly basis, and your brain has been snapping you out of sleep in order for you to resume breathing. This conditioning can make it frightening for some of us to exhale against CPAP pressure, our brain identifies difficulty, and starts ringing all the panic bells.

I was one of those who panicked - I know what I'm talking about.

FULL STOP.

The lady tried to brush me off with no apology about not contacting me. I interrupted and asked about the cost. Apparently it is fully out of pocket at the contracted rate. I've been dicked around for several months for this? I told her to put it on hold because I was about to fire my doctor and didn't know who the new doctor will use as a CPCP supplier.

You only have this "lady's" word that your insurance doesn't cover the CPAP machine. Make sure you check with your INSURER. Never, never, never, ever, ever, ever take a DME's word for anything.

Ask your insurer how to obtain your Evidence of Coverage (EOC). This is the actual contract between you and your insurer, you've never seen it unless you know to ask. Once you get that (it may be online, or they may have to mail it to you, and most states mandate how long they have to get you the EOC once you have made the request) turn to "Durable Medical Equipment" and see what it says.

With an HMO, you may have to use a particular DME provider to get coverage, if you have coverage for CPAP. Be sure you understand the rules and double/triple check if you can get it covered that your insurance will cover that provider.

If you truly don't have coverage except a contracted price, be sure to compare your out of pocket costs with buying used or privately.