newbie with ????'s

wow, what a great forum. Have been reading posts for a week and absorbing info. Sleep study in June, received loaner machine in July(is this unusual,the loaner part) never contacted by my doctor or sleep lab with one bit of info. RT who set me up with loaner gave me copy of my sleep study AHI 90.5, OS 56. her only comment on report was "that's pretty bad". this is the part where my wife and i freak out. I quess my first question is can my family practice MD handle this or do I need to look for a specialist? Would an ENT handle OSA cases? Wrestling my CPAP machine nightly, RT set it for 20cm. can only keep it on for about 2 hours(this includes a 45 minute ramp-up) I wake up in a panic and can't exhale. I'm not the type to panic. any suggestions?

Sleep medicine is a still-evolving specialty, and you'd probably be further ahead finding a physician who specializes in it if there's one available in your area. Otherwise, a pulmonologist would be closer than an ENT physician.

The RT probably can't/won't change your machine's settings without a change in your prescription, which typically takes another sleep study. Depending on the machine you've got, though, you may be able to adjust settings yourself. It's not something you want to go at willy-nilly, but more reading on the forum will help you understand the parameters you need to consider, the risks/benefits, and so forth.

I've read some posts here from people who've received loaner machines. In my case, I got what the DME called a rental, but it was really a rent-to-own type of arrangement. Each month a payment was made, partly by me and partly by my insurance company, until the machine was paid for. Supposedly, in the meantime, the machine could be returned any time, but I ran into a hassle from the DME when I tried to do that (I did it nonetheless, but it was nowhere near as cut and dried as simply returning a rental item should have been).

20 cm is pretty darn high. In fact can't get any higher on your CPAP. For high pressures like this sometimes a different type of xpap machine is easier to adjust to.

Which doctor got all this rolling for you to begin with? Don't put off too long telling him you are having trouble adjusting to the pressure if you continue to have problems.

thank you for your response! My family practice MD ordered the sleep study in May and I haven't heard form him since, tried to contact in June and was told they would get back to me. The sleep study center arranged my loaner machine and an RT spent 10 minutes fitting my mask and handed me a copy of my sleep study. That's the extent of my education from the pro's.

You don't mention it but are you using the EPR feature of your machine?

daddyshakesus wrote:My family practice MD ordered the sleep study in May and I haven't heard form him since, tried to contact in June and was told they would get back to me. The sleep study center arranged my loaner machine and an RT spent 10 minutes fitting my mask and handed me a copy of my sleep study. That's the extent of my education from the pro's.

Idiots. That is what I can type but not what I am thinking.

EPR (exhalation relief) may help you some but with that pressure it is going to be hard to adjust.

Check here for ResMed instructions on how to get into your machine and make sure EPR is set to 3 to give you a fighting chance against that hurricane of 20 cm.

http://www.cpap-supply.com/Articles.asp?ID=130

thanks again for the responses!! I have no idea what EPR is or what my setting is. My loaner is actually an S7 elite but i couldn't find it on the drop down list when i registered. I did not receive a book with my machine and when i contacted the RT who set me up with my problems she said i was not allowed to change settings and she would contact MD and get back with me. That was 7 days ago. So far this experience has been like landing on a carrier at night sitting in the rear facing jumpseat!

EPR is exhalation relief. Simply put the machine will reduce the pressure going in momentarily so that you don't have to try to exhale against the full brunt of the hurricane. It is a comfort only feature with variations from 1 to 3 meaning 1 cm , 2 cm or 3 cm reduction in pressure temporarily.

I am not familiar with the ResMed 7 at all. I do not know if it offers this feature. Someone else here on the forum will know.

It is a comfort setting. It should be something that you are allowed to have and change if need be.

The S7 Elite (which appears to be out of production) features:

Modular design, fits easily on a nightstand
Automatic altitude adjustment
Automatic international power converter
Ramp, Settling and SmartStart/Stop options
Compliance data available via LCD interface
Reports comprehensive clinical data accessible through AutoScan software
Large buttons and user-friendly patient menus
Includes premium travel case
Extremely reliable, high-quality device
High-tech sound baffling reduces noise dramatically

Manual Here: http://www.myresmed.com/Shared/StaticFi ... um-usa.pdf

As best I can tell this is a Compliance Data only macine. You want a Fully Data Capable Machine. So far I see nothing about EPR or pressure relief in the User manual, only ramping.

ETA: Clinicians manual here: http://www.internetage.ws/cpapdata/manu ... %20usa.pdf

Nothing about EPR or exhale pressure relief. WOW no wonder you're having a tough time, 20cm straight pressure. Can you take a look at your sleep study and determine if your titrated pressure was actually 20cm?

If your pressure is truely supposed to be 20... push them for a bi-level titration.

20 is the max that a CPAP or APAP can go.

You'll get more relief with your pressure if you go to a bi-level.

I think that the "Reports comprehensive clinical data available through AutoScan software" includes efficacy data.

Thanks again everyone, I am learning so much. Looking at my sleep study handout it looks like they took me up to 20cm over a 6 hour period and the best i did was an AHI of 70 and O2 of 68 at 20cm. For the final hour they tried to go from 20 to 25 and i couldn't sleep from the pressure. I quess i know why they loaned it to me, it's been discontinued, but it sure is quiet. It sounds like ocean waves as i fall asleep. I actually enjoy going to sleep with it on, but as soon as it gets to 20 cm after ramp up I wake up like someone has a hair dryer crammed down my throat. the manuals are an awesome find, thank you very much.

I'm getting angrier by the minute as I read about this shoddy treatment. I'm out of my league here but I'm hoping some the "pros" will jump in quickly and tell you what you have to do right now. I'm so glad you are going to be educated on this forum, and you will learn that most of us have been left to our own devices and had to learn everything we know right here. Shameful but true. Good luck and please keep us posted.

I am with Dori on this one...
P... poor in my opinion.

You need a BiPap at those pressures.

Does it happen to mention any central apnea events in your reports?

daddyshakesus wrote:Thanks again everyone, I am learning so much. Looking at my sleep study handout it looks like they took me up to 20cm over a 6 hour period and the best i did was an AHI of 70 and O2 of 68 at 20cm. For the final hour they tried to go from 20 to 25 and i couldn't sleep from the pressure. I quess i know why they loaned it to me, it's been discontinued, but it sure is quiet. It sounds like ocean waves as i fall asleep. I actually enjoy going to sleep with it on, but as soon as it gets to 20 cm after ramp up I wake up like someone has a hair dryer crammed down my throat. the manuals are an awesome find, thank you very much.

Something doesn't seem quite right here. Best AHI was 70 at 20 cm H2O? It sounds like you are getting really poor health care all around. You should have been followed up quickly with numbers like that. There is more going on here than meets the eye. You need a second opinion, or different doctor(s)