New here w / cpap question

Hey Lori,

After doing a little more research, I think I'm going to try the REMstar Plus. From what I've read around the net people with hypopnea problems may not benefit from the APAPs as much as other folks. I haven't actually seen my sleep study results, but the doctor did tell me my problem was too many hypopneas per hour. I think I only had only one obstructive apnea during the whole night. I'll know more tonight after I pick up a copy of my study today.

As for the DME, I'm still a little perturbed with my first one. I can see his point as I'm on BlueCross PPO and they only pay him their allowable charge. But even at that, I doubt he'll go hungry. The second DME hasn't called back yet so I'm still unsure of switching DME's or not.

Also, I guess the Activa mask is out. I went to the website and put in my measurements and it said the Activa wouldn't work. I guess the next couple of nights I'll try the moleskin and see if that helps. If not, I'll go Friday and get something else. I was really surprised this morning when I called BlueCross. I asked about how often I could get new masks/equipment and the lady told me "whenever I needed it". We shall see.

Captain,

I just asked Emipire Bluecross the same question about how often I can get a new mask, and they wrote back the same thing. So I asked if I could buy one myself and send in the receipt or if it had to be through a prescription. I also told them I knew of a great site (this one) where I could get it probably for half of what the DME would bill the insurance company for if I did it on my own. Waiting to see their reply.

So as for a new type mask, have you thought about a nasal pillow interface, like the Swift or Breeze? There is a lot of info about them both on this site if you use the "search" feature on the top of the page. I personally couldn't use the Breeze and now only use the Swift, but people swear by both. Depends who you talk to.

Make sure before you get this machine that you really don't want the auto feature. It might be a good thing to have, even if you use it now or not. You never know how things can change in the future and you may want it then. I don't doubt the Remstar Plus is a good machine, but if you're getting one now, why not get one that has it all? Mine does both, but I use it at straight pressure right now. But I have switched off and on and like having the option to do so.

One last thing. Does this machine have software capabilities? I would never get another machine without it. I would really consider that when you get the new one. So much to be learned from your data and such a great way to take control of what is going on with your condition.

Well, let me know what you end up doing. I wish you best of luck with whatever you decide. Just make sure you do your homework and don't settle for something you really don't want just because they're the DME will make out better if you do. Do what will be best for you.

Sleepless on LI wrote:The PB 420e is a great machine, from what I've heard on this site. There are a couple of differences, though. One is, I don't think it has the Cflex, but I'm not positive on that.

I agree; it is a wonderful machine. No, the 420E doesn't have CFLEX. However I think that I've verified that it does respond to an exhalation and stops "pumping" as hard. If it didn't there would be a pressure spike as the exhalation added to the output of the machine.

Note that this is not the same as CFLEX but (I'm guessing based on some recent looks at old CPAP machines) a significant step up from nothing at all.

Also, the software has to be uploaded to your computer from the actual machine with a cord, not through a card reader like the Remstar Auto w Cflex has.

True. Thankfully the machine is small and light.

Sleepless on LI wrote:As many of them there pesky critters as it takes...and shame on you for even joking about adorable little baby bunnies. Bad, bad Bill.

I had a great nights sleep last night and just couldn't resist. Heh heh.

After using the very latest ideas for afixing the hose of the Swift I was finally able to use my favorite sleep position for the first time in 3 weeks. Wonderful!

Only problem is the Swift has developed a whistle on exhalation. It didn't bother me but my wife complained of my "nose whistle" this morning. Seems that as I get better she is developing sleep deprivation symptoms !

Bill,

Amy (Yawn) told me that's how she knows her Swift is leaking, it whistles. Beware, too, of broken short tube assemblies. Mine broke in two places in the past two weeks. Crazy glue helped one and now crazy glue and duct tape on the other. However, since the second break, I haven't seen 18-19 leak rates again, although the line is perfectly straight across the graph showing the leaks, which I think would mean it's a constant leak, not from moving around and leaking, and my mouth is taped securely, so it's not mouth breathing. That would definitely show, anyway, as ups and downs if I were.

Glad you had a good night's sleep that night. Last night was pretty much better for me. Getting used to the new hose position and I love it. Not more interference with a hose across me in the down position and not a worry about it being under the face, thanks to Tridens. We owe him one for that.

Lori,
I just got a call from the original DME and he seems more willing to work with me than he was this morning. He said he would talk with the REMstar rep about getting a better deal on the APAP version. He also said the same thing I've read about the CPAP being better for those with hypopneas, so I guess I'll just get the REMstar Plus for now. After my sleep study with CPAP next month I'll see how it does and ask if the APAP would do any better for me. I think right now I'm just renting the machine anyway, so I should be able to change if needed.

I'm a little hesitant on trying nasal pillows since I know how sensitive my nose is. I may end up trying them if I can't find a mask that suits me.

I don't think the REMstar Plus has software capabilities.

Captain,

When I had my first sleep study done, before the second where I was titrated, it only showed four+ hypops per hour but 14+ PLMD events, so that totaled 19 awakenings per hour. The other problem was, my oxygen desaturations were classified as moderate. I think that's probably why the put me on the CPAP as the apnea was zero and the hypops were very low, but my oxygen wasn't good.

As far as the Remstars, I had a basic one for the first one and a half months, till they bought me my Remstar Auto. I know you said your doctor thinks straight CPAP works better on hypops, and he may have something since I keep my high and low numbers with the auto the same, the 10 I was titrated at, mainly because I like the graphs auto prints out which CPAP doesn't, and my hypops usually are at zero or very low with an occasional apnea or two. Hence, my 0.2-0.5 usual AHI. And if you're renting the machine, you wouldn't be able to use the software to your advantage because you wouldn't be able to play around with the pressure settings without your DME knowing you did, plus you'd have to buy software for a machine you don't even own yet.

As far as getting a mask, if you don't mouth breathe, I would rethink a nasal pillow interface. I think they are the most comfortable and least restricting when you sleep. Do a search by a keyword and see what people have to say about them. So far, it is my favorite and I would never go back to a mask again. I do have a mouth breathing issue, but there is tape and I ordered Dr. Sue's device which is on its way to me as of yesterday which supposedly stops mouth breathing all together. In the meanwhile, the Tegaderm patches are doing a great job.

Let me know how you make out and what you end up doing.

Also, I guess the Activa mask is out. I went to the website and put in my measurements and it said the Activa wouldn't work.

I wouldn't be so sure the Activa wouldn't work for a person based on "measurements". For most masks, the mask fitting calculations on this site may be spot on, but the Activa has such a unique cushion design...I think I'd be inclined to try an Activa regardless of what the mask fitting page said.

Both the standard and shallow sizes of the Activa work for me. It's an unusually forgiving mask. The Activa seems to defy all logic when it comes to facial features that would cause other masks to not fit well - or to leak.

And on the subject of the Activa, the mask measurement guide on this site, for some reason, said my Activa should be a large. I don't have a large nose in any direction, so I didn't understand that one. The top of my standard was too close for comfort to the corners of my eyes as it is, so what would a large do for me except be more uncomfortable?

I have just joined this user group. I have been a cpap user for almost 7 years now. I have a Respironics ARIA LX and use a Respironics gel mask. I used my unit trouble free everyday and it lasted 4 years without any problems. I had it reworked and update about 2 years ago and have had no problems whatsoever.

Sleepless on LI wrote:Amy (Yawn) told me that's how she knows her Swift is leaking, it whistles.

That's what I figured, but I can't figure out where it is leaking. And only on exhale???

I guess the pressure spikes on exhalation. But why last night and never before? Grumble ...

Gonna take a close, careful look at it tonight and see if I can make it go away.

From what I've read around the net people with hypopnea problems may not benefit from the APAPs as much as other folks.

I had primarily hypopneas, tons of snoring, many flow limitations and a scattering of obstructives when I once did a "self-test" at home running my autopap on a straight pressure as low as it would go (4 high/4 low) all night. Set to a range of 9 - 15 the machine wards off most hypopneas just fine for me. My AHI is usually 1.x - often an AHI of 0.8, 0.6, that kind of thing. That's been true of all 3 major brands of autopap I've used. Autopap with the low set up at 9 seems to ward off most hypopneas fine for me.

I believe "-SWS" also mentioned in a post once that his OSA was hypopnea intensive and that autopap treats him very well. If anyone would understand from looking at his own data what machine he, himself, personally, should either avoid or use, -SWS would know.

As -SWS has said many times, not every brand of autopap will suit every person well; and for a few, no autopap can give them as effective treatment as another type of machine.

I've found, as quite a few others have, that bringing up the lower pressure on autopap to a number at, or close to, what would be the titrated pressure from a formal sleep study does the trick for me. Handles my hypopneas very well and gives me a very low AHI.

So, what's the benefit of my having an autopap if I'm going to keep the lower pressure up near what I'd probably be if I were on a straight cpap machine? To me, it's the benefit of having a margin above -- an open space at the ceiling -- to take care of changing conditions that might require more pressure on any given night, or in the future.

If one thinks of autopap's benefits just as "how low can I go most of the night", then yes, it would seem like not "as much" benefit as people get from autopap who are able to set it practically wide open and do fine.

However, just because an autopap is capable of being set wide open, doesn't negate the overall benefit of having an autopap as opposed to a single straight pressure cpap, for people who find it works better for them with lower pressure raised to near titrated pressure, imho.

Example: Just the other night, the machine hit 14 briefly, which is most unusual. The night before that, and the night after, the highest it got was 11. It spends most of every night at 9 (the low I have set), occasionally 10, 11 or 12 for brief periods.

The AHI remained very low, even on the random night that went up to 14 for awhile. Whatever the machine was dealing with at that point, it was providing me treatment that allowed me to sleep obliviously, wake up feeling refreshed as usual, and see my usual low AHI.

Looking at that "14" night's data the next morning, the thought crossed my mind, "Gee, I'm glad I have an autopap." I could sleep peacefully through a night like that, even though hypopneas are the main component of my "events" when untreated.

RG,

I remember when I first got my auto, I tried it on the settings as set by the DME. Since I am a 10 cm, he put it on 5-15. It seemed with that wide a range, I was getting events all over the place, in the lower numbers AND in the 11 and 12 range, and with a relatively higher AHI, as I found out later. Then, at your suggestion, I brought the bottom number up and I even lowered the top number and seemed to zero in around the 10-11 range with events. Then when I tried to run either auto at 10-10 or straight CPAP at 10, my AHI was the best ever and I've kept it like that.

But, just for the experimentation of it all, I am going to keep my bottom number at the usual 10 tonight and bring the top number up to, say, 14 to see if anything happens. But it's almost like the higher I raise the top number, the more it seems I have events happen in the higher numbers. However, keeping it at a straight 10, my events lessen in frequency and my AHI's are at an all time low. But I an curious to see what will happen if I keep the low number at my titrated 10 and just give myself a little leeway to see what happens up to 14. This should be interesting. Any guesses?

This should be interesting. Any guesses?

heheh, well, my guess would be that at the same time you try that experiment, you'll also be trying out all of these things:

1. a new variation on how you use your mask and hose
2. a new pillow
3. a new way to apply Tegaderm
4. a new wine



Just kiddin' ya, SLI!! I know you know how to lab-rat. Yes, it will be interesting to see what you come up with, especially if you'll use the new settings for at least 3 nights in a row.

I picked "3" nights 'cause I don't think you'd be able to go longer without trying other things. You're a born lab rat. LOL!!

I picked "3" nights 'cause I don't think you'd be able to go longer without trying other things. You're a born lab rat. LOL!!

Now you're scaring me, RG. You know me a little too well. I woke up this morning and said, after looking at my results, "Well, I'll just go back to my straight 10 tonight." You knew what I was going to be thinking before I even thought it.

Here are the results after 9 hours of sleep. OAI 0.56, no hypops, two snores. Now, the apneas occured with .6 at 10 cms and 3.3 at 12. 12!!! I normally may be one or two apnea, no hypops and no snores at 10 straight. Is this drastic? No. But why would I need 12 last night? If my AHI stays lower at 10, why does this happen at 12? And all but one apnea, since they round up on this software, happened at 12. I don't understand, either, how it shows .6 at 10, round up to 1, and 3.3 at 12, round up to 4, with their AHI being a total of 0.56? Where does the 6 come in?

Anyway, it's not a drastic difference, I know. But I think my 10 was suiting me much better with lower apnea and zero snores. I'm not quite sure if I proved anything, or what it all means, but...I know, don't judge it on one night. You're right. But I have this overwhelming urge to return back to not fixing what isn't broken.