Help! Specialist Rxed CPAP Pressure So High that AHI Went Up

Muse-Inc wrote:The question in my mind would have to be determined from your sleep study: which of the 2 pressure ranges 4-6 or 10-11 given all the info from all the data collected was actually the ideal pressure range?[

Thank you for pointing out the lower range. What factors are considered when determining the pressure? The sleep study "CPAP distribution summary" listed the minimim S2O2 percent to be between 90 and 92 at all pressure ranges between 4 and 13 and the sleep percentage to be 100% from 4 to 7 and at 10, but down to around 95% at 11 and 12. Per the summary, I only spent 5.6 minutes at pressure 13, yet am listed as having 21.4 AHI. at that pressure.

I have the manual that came with the CPAP equipment. Is there another manual that tells how to adjust the settings myself. Can anyone give me a clue where to find the software and whether I need a card reader for the Machine I have?

From past questions, it seems this machine is quite recent. A full description of the CPAP machine I have is at the link that is in my signature below.

Thank you to alll who have made suggestions.

jmelby wrote:I'm surprised to hear that your DME will not allow you to get another type of mask... my understanding is that is not a legal requirement and any xPAP prescription is good for any mask. In any case, it would be a good idea to ask your doctor to write the prescription to include "patient choice" for masks so you can choose what works best for you.

The prescription specifies "Medium OptiLife." There is a space on the form to check off "patient choice," but the sleep specialist did not check that. Since the OptiLife Mask is a nasal pillows mask, the DME rep said he could not change it to a full face mask without a doctor's recommendation due to liability issues. He did change me to a different nasal pillows mask when the Opti Life caused dental pain due to the position of a strap.

This brings up another question. If the power goes out when a person is asleep and using a full face mask, how does a person breathe? Since I can evidently stop breathing 67 times an hour without CPAP and never know I do it, I would not assume I would wake up if sound asleep when the pwoer went out. I do not have an electric generator or any sort of battery backup device and have not heard of any for this machine.

Thank you all for the helpful information and suggestions.

FFMs have an anti-suffocation valve that immediately opens letting in (and out) outside air. Get one of these, it wakes me up immediately: https://www.cpap.com/productpage/relian ... light.html

If you can afford it, go buy my mask the RespCare Hybrid, great mask and a lot of us here wear it:

Muse-Inc wrote:FFMs have an anti-suffocation valve that immediately opens letting in (and out) outside air. Get one of these, it wakes me up immediately:

If you can afford it, go buy my mask the RespCare Hybrid, great mask and a lot of us here wear it.

Thank you for this information. It alleviates my fear that of the power going off while wearing a full-face mask., in case the power goes out in the house while i am sound asleep.

The results of my doctor visit are that the M.D. that ordered the sleep test wrote a prescription for APAP with ranges of 4-8 or 10-12. He said he though APAP was better that CPAP. He also wrote a prescription for a full-face mask or mask of patient choice.

Before I went to this doctor, I realized I was missing a page of the sleep study that showed the charts for an hour while at pressure 11. I called the sleep center and asked them to fax that page to my doctor's office. By the time the sleep center secretary called me back, I had alread been to the doctor and was near the sleep center, so I stopped in there. The secretary checked the file and the emailed report from the sleep tech and didn't have the missing page either.

I told her the sleep specialist had not returned phone calls from me and the DME that started Dec. 18 that requested approval of a full-face mask and that I had been instead provided the Resmed Swift LT for Her after the prescribed OptiLife Mask caused pain from a crown, which seems to have been jarred loose by the use of the OptiLife mask due to a strap sitting right over the crown.

She checked her files and found where she had faxed two sleep specialists regarding the full face mask based on a voice mail message from me on Dec. 18 to the sleep center. She also found the faxed request from the DME for a switch to a full face mask to which the sleep specialists never responded. She called the DME and confirmed that they never heard back from the sleep specialists and had made additional follow-up phone calls to the doctor.

While I was at the sleep center, I left a copy of the new APAP and full-face mask prescriptions and said it would be nice if a sleep specialist looked at my sleep study and determined if the new prescriptions were appropriate before I went to the DME to get the settings changed and got a new mask, which will probably be at my own expense because my insurance only allows a new mask every three months.

I told her the nasal pillows for the Resmed Swift LT were known by Resmed to be defective and they seemed to have collapsed after a few cleanings and I couldn't even get them to seat properly in my nose. I told her the only way I have been coping with the high pressure at night is to keep resetting the CPAP machine to ramp over and over to get the pressure down, then ditching the mask after a few hours of sleep because the pressure was too high and it was like having a vacuum cleaner hose blowing at full blast attached to my nose and I couldn't tolerate it. She was horrified.

Someone sent me a link to the Provider's Manual for the CPAP unit I have, so I may be able to figure out how to change the settings in the future. That person thought APAP without software was not a good idea. I may still let the DME make the setting changes, if the sleep specialist ever responds (or not), to keep the DME in the loop, since I am so new at this. I have business near the sleep specialist's office anyway. If I have questions about the CPAP machine, at least the DME is helpful, so long as I am not asking for something my prescription allows or that is within the scope of the patient's user's manual.

The sleep specialist's secretary said I also should have a prescription for a nasal mask, in case I wanted to use one of those. She said she would check with the sleep specialist to see if my current mask or a full-face mask or nasal mask were recommended for use with APAP. She said her husband has been on APAP with a pressure range of 5-20 and a nasal mask for 10 years and that worked well for him.

I asked about software availability for daily data on AHIs, etc. I think she added that to the questions for the sleep specialist.

She said she would call in the morning and try to get answers for me from the sleep specialists and let them know that they had dropped the ball on my treatment and I was suffering and irate as a result. She said the phantom sleep specialist is a "very nice guy." I told her he was on my *hit list for his failure to return phone calls and for basing his initial prescription for CPAP on an inadequate reading of the sleep study, which has turned me from being functional to being so tired that I am doing things that are dangerous to my health and those around me (such as a minor car accident and going to the grocery store, paying for food, and somehow leaving the food in the cart so I didn't bring it home). Fortunately, I only lost about $5 woth of food but I have never been prone to car accidents and forgetting to take purchases home with me. I am turning from being just a tired, functional person into a vegetable that is worse off than before the sleep study, thanks to lack of sleep due to CPAP treatment that is not working properly per the sleep speicalist's prescription.

So, I think I made clear that I was the sleep specialist's worst nightmare if he continues to ignore me. The sleep center secretary has been great and the DME had helped me every way they can that they legally can within the sleep specialist's prescription.

I tried again tonight to sleep with the current setting of the Swift LT for Her mask with the collapsed nasal pillows. I gave up after a few hours. I haven't put on the new nasal pillows. I am soooo tired. My cat does not approve of the current treatment and has meowed at me the last 2 nights until I took off the sleep mask and shut off he CPAP machine. I don't know if he is turning into a bossy feline "husband" or if he knows my CPAP treatment is wrong. He cuddles with me while i was CPAPing and never gave me a hard time about it before. He is like Sherlock Holmes. He has investigated the CPAP setup every night but suddenly he doesn't like it either. I have tried to keep using the CPAP and am not letting myself be bossed by a feline re: my CPAP treatment, but he seems to understand the problems better than my sleep specialist, at this point.

Any feedback on APAP would be appreciated. I am willing to take my chances on using it without software because my results with CPAP have been so disastrous so far.

Thank you to all who have offered comments, suggestions and support here. It means a lot to me to know I am not in this alone.

I think the raised pressure may have caused your mouth to open and therefore lose the air that should be going down, not out, and you may then be looking at having to get a full face mask, rather than just the nasal one you have now. I would definitely learn to adjust your pressure yourself (it's easy) and do a little experimentation, in increments tried for a few days each at a time, until you find the right setting. Too often non-sleep educated MD's overreact by bumping pressure upward when they don't otherwise know how to tweak things, and yours may be in that boat. The best thing you can do is to learn more (which you're obviously doing now) and to find out how dependent you are insurance-wise on sticking with the equipment and settings you have vs ones you choose.