Typical Newbie with no clue... but need help ASAP

OK... the long and short of it is that I am the poster child for sleep apnea... A little overweight, thick neck, snore like crazy (until palate surgery) etc... Oh yeah... and a heart attack at 48 yrs old. Other than that and being tired ALL the time life is great!

So.... have tried and tried to get used to CPAP , etc... My last sleep study (third one) had me asleep for 45 minutes of the 6.5 hrs I was there (not typical... but not unheard of either). ULTIMATE Catch-22... not enough data for the insurance company to authorize a new CPAP machine.

OK... enough of the tale of woe. I have a new Sleep Center, new doctor and an new enthusiasm to get this under control. Either through my insurance company or through my own purchase, I want to buy the BEST CPAP/ BI-PAP / auto -titrating / VPAP /auto set /self regulating /individual breath analizer / exhaling enhancer blah blah blah that I can.

As you may have guessed by now... I am reasonably well read on the subject yet STILL totally and completely clueless as to the latest technologies and how they might help me. The last time I looked at this my 401K was growing and my kids thought I was cool-- so you know it was at least a decade ago!

MY QUESTIONs AFTER A LONG POST:

1) Is there a particular thread, or an online resource, that you can point me to that has a good description of the difference between all these devices? for example, is bi-pap the same as auto titrating, etc...

2) With Resmed and Respironics as the two premium brands, are there specific devices you would recommend if $$$ were no object?

3) Anything else I should know that I am too ignorant to ask.

Thanks in advance for any help. I realize that this type of "Beginners 101" can be repetitive and boring for the "pros" here... but I have a limited time before I have to choose so I need to "short circuit" the process a bit.

Thanks much.

Tired Guy wrote:. . . I have a new Sleep Center, new doctor and an new enthusiasm to get this under control. Either through my insurance company or through my own purchase, I want to buy the BEST CPAP/ BI-PAP / auto -titrating / VPAP /auto set /self regulating /individual breath analizer / exhaling enhancer blah blah blah that I can. . . .

The most important thing is to get a full-data machine, one that will monitor your breathing and leaks overnight. Rested gal's list of such machines, as of 10/08, is here: viewtopic.php?p=307168#p307168

Other helpful info from the yellow lightbulb of wisdom, above: our-collective-cpap-wisdom/409/CPAP-Mac ... eper).html

Even if you pay out of pocket, you'll still need a prescription to get a machine. That may require a cooperative doc, if you don't have a valid titration for him to use in writing you a prescription. Personally, if I had had a heart attack, I would want a valid titration, even if that meant I had to let them give me a pill to be sure I slept.

A full-data CPAP is good enough (unless you need bilevel). A full-data APAP (auto-adjusting machine) is better (if, again, you don't need bilevel). A bi-level (or biPAP) is needed if your titrated pressure is over 15, according to present protocol. A bilevel gives different pressures for inhale and exhale more effectively than a CPAP or APAP with exhale-pressure relief, like EPR or flex. An auto-adjusting bilevel is the more recent beast out there. That 's what I use. If you have needs beyond treating obstructive sleep apnea, as proved in a titration, there are other machines designed to address complex sleep apnea and other conditions that involve central apneas or problems with breathing patterns. That's why I'd want a successful titration if I were you.

The newer machines are quieter and more convenient than the older ones. ResMeds give great data conveniently from the screen on top of the machine. If you are going to buy software, you might want to look at the Respironics machines. Their software is more popular and easier to use.

Hit the yellow lightbulb of wisdom, above, hard. And run searches in this forum here for more info. Then go to cpap.com and read their FAQs and run some machine comparisons. That should get you back up to speed fairly quickly.

jeff

Welcome, you are in the most important place to insure your therapy will be successful. This is the best place to get advice on the best equipment for your individual sleep problems. You state that you have a new sleep Dr. If you do not have a past sleep study that has been conclusive, get one done. Then have a titration study done. Get copies of both your studies. With those in hand, the best qualified people here can suggest the best equipment for you. Some type of "auto" machine is most desirable, as well as fully data capable and associated software so you can monitor your data and progress. Good luck, and stay with the program, you will be glad you did.

Georgio

Had to laugh....

Read the "Yellow bulb of wisdom above" twice before I realized there actually WAS a yellow bulb of wisdom.

Thought that it was sort of a catch phrase or new age "think deeply" reference LOL

thanks for the replies.... The irony, which I referenced obliquely, is that my last sleep study was inconclusive due to the fact that I didnt fall asleep (there HAS to be a Steven Wright comedy routine somewhere in that phrase!!).

Previous sleep studies showed severe sleep apnea but no indications of any Central sleep issues (sorry... cant remember the correct term).

thanks again... other thoughts welcome and appreciated!

One other thing: If you had palate surgery, you might not be the perfect candidate for an auto machine. (Autos often use snores to sense the need for more pressure.) That's no biggie, though. As long as you have full data and the right machine for your needs, you can keep your PAP therapy effective.

Because you have been previously diagnosed with severe sleep apnea, and have had a heart attack.....I would want to get on cpap asap. If there is any way you can utilize the equipment that you have during the period you are having a current study and selecting new equipment, I would do so. If you list all the equipment you have here, as well as your titrated pressure and the pressure your machine is set at, maybe you can get enough help you can use it until you have new equipment. It does take real resolve and determination to get accustomed to the equipment, it sounds like you have that now, you can do it.

Georgio

jnk wrote:One other thing: If you had palate surgery, you might not be the perfect candidate for an auto machine. (Autos often use snores to sense the need for more pressure.)

Good point, Jeff.

jnk wrote:That's no biggie, though. As long as you have full data and the right machine for your needs, you can keep your PAP therapy effective.

I agree. People can do a fine job tweaking their therapy with a CPAP machine that can show them AHI and leak info. Doesn't have to be an autopap to get excellent treatment.

Tired Guy wrote:The irony, which I referenced obliquely, is that my last sleep study was inconclusive due to the fact that I didnt fall asleep (there HAS to be a Steven Wright comedy routine somewhere in that phrase!!).

I agree. I've had one sleep study, didn't sleep, even with two Ambien in me, and I can not imagine ever successfully getting diagnosed or titrated in a lab.

For me it's as foreign to me as if I showed up at the emergency room with an obvious compound fracture in my leg, and they told me to hop on the treadmill for an hour to prove I have a problem and find out just how broken it is.

JNK, thanks for clarifying the auto machine choice. I had heard that mentioned before, now I'm curious.

What brands of apap machines require a snore to signal an increase in pressure? I'm guessing Resmed is one?

What if you have not had palate surgery, don't snore, but have apnea events? Does this mean (that) brand machine will not respond and will not treat your apnea?

I think I only "snore" a little on apap and have many "events" independent of snores, so "that" type of machine is not for me.

I understand that some palate surgery patients still snore after a period of time.

Any additional information on this subject is appreciated.

Thanks,
Georgio

Georgio wrote: . . . Any additional information on this subject is appreciated. . . .

Hope this points in a direction for further research . . .

"UPPP is usually a contra-indication to auto-CPAP, whatever the device . . . "
--http://www.erj.ersjournals.com/cgi/reprint/12/4/753.pdf

"The use of APAP is not indicated . . . in patients with previous uvulopalatopharyngoplasty (UPPP) when the APAP algorithm is based on snoring detection."
--http://www.fsm.it/archest/pne/pdf/61/3/ ... nfulla.pdf

"The REMstar Auto has the capability to detect snoring vibrations and adjust the pressure accordingly."
--http://sleepapnea.respironics.com/techn ... ation.aspx

"ResMed AutoSet devices . . . respond to snoring . . ."
--http://www.resmed.com/en-us/clinicians/ ... clinicians

Snoring is only one thing that autos respond to. Flow limitations still occur after UPPP, for example, but the nature of the flow limitations may be different--so I assume it depends a lot on the individual patient's interaction with the machine.

UPPP is only one thing that can make a patient less likely to benefit from APAP use night-to-night. Autotitrating machines haven't been around all that long, so their algorithms have a long way to go to work for the majority of patients as advertised, in my not-so-humble opinion. Thus, the continued importance of AHI and leak data.

As far as understanding autos, you may benefit from watching one of ResMed's indoctrination/propaganda films ( ) designed to explain how their particular algorithm is supposed to work: http://www.resmed.com/en-us/clinicians/ ... 40x380.swf

"(Autos often use snores to sense the need for more pressure.)"

OK, thanks I did more research and now I get it. All autos use more than just snores (such as: flow limitations, apneas, hypopneas) to adjust pressure.


Thanks,

Georgio

Tired Guy wrote:Had to laugh....

Read the "Yellow bulb of wisdom above" twice before I realized there actually WAS a yellow bulb of wisdom.

Thought that it was sort of a catch phrase or new age "think deeply" reference LOL. . .

You are thinking deeeeeeply. Feeeel yourself baaaaask in the glow of the great yellow lightbulb of wisdom hovering above all our posts. Look into that light. Let its wisdom seep into you. Be warmed and healed by its beaming positive energy--positive-airway-pressure energy. Let the bulb shine on your path to better breathing for further comprehension and increased powers of life. May your journey continue under the floating yellow beacon to restful, contented slumber, as we all dream the dream of CPAP healing in forum-guided togetherness.

ROTFL, jeff.
Perfect.
O.

JNK, you are starting to sound like "Carbonman"! Does that happen to all CPAP users? LOL

Georgio

Georgio wrote:JNK, you are starting to sound like "Carbonman"! Does that happen to all CPAP users? LOL

Georgio

To which of my personalities was that question addressed?

I'll admit to being an aspiring Carbonman. We are a lot alike. Well, except for the fact that the Colorado biking commission pays me good money never to be seen in public wearing spandex shorts.