I need a new sleep study to get a hybrid. What???

A thread, or even a wiki page, where one can document DME horror stories would not only be a good read for learning about idiots, but as a place where people can see what they are up against when dealing with DME's.

A place to post DME 'success stories' would also be nice because they *occasionally* happen.

In all truthfulness, you pressure needs do change slightly with a different mask, as masks introduce air differently, etc. Many users (myself included) do see a change in their AHI when switching masks. But is it significant to warrant a new sleep study/prescription? In most cases, it probably doesn't.

timbalionguy wrote:
In all truthfulness, you pressure needs do change slightly with a different mask, as masks introduce air differently, etc. Many users (myself included) do see a change in their AHI when switching masks. But is it significant to warrant a new sleep study/prescription? In most cases, it probably doesn't.

My cpap has a setting to tell it what kind of mask I'm using. Does that automatically adjust for the type of mask I'm using? If not and I see an increase in my AHI since I have a machine with data can't I just bump the pressure up a little at a time to compensate?

I guess maybe the issue is that technically my pressure is only supposed to be changed by physicians order. So I guess to be all legit if I have an increased AHI with a new mask then I would need a sleep study so the doctor could order an increased pressure.

If that is the case then what she said was honest.

As far as I know the only reason to set the mask in the machine is so that it can subtract out the normal vent (leak) rate from the reported leak rate. It won't compensate pressure.

Oscar: Please don't start the "am i allowed to change my own pressure" debate please do a search on the topic and post THERE, let's not kill the original spirit of THIS post (which is probably just as insane)
(just kidding, but no really let's not even go there!!!!!)

oscar98 wrote:My cpap has a setting to tell it what kind of mask I'm using. Does that automatically adjust for the type of mask I'm using?

I think so, if it works like the S9.

If not and I see an increase in my AHI since I have a machine with data can't I just bump the pressure up a little at a time to compensate?

If you see an increase in your AHI with one type of mask than another, unless you're leaking more with one type than the other, then you have to decide whether you think that you're truly having more events with that mask. What I would be inclined to do in that situation is to just compare AHIs within a mask-type. So if I had a higher AHI with a FFM than with pillows, if I wanted to stick with a FFM, I would just look at my AHIs on FFM (e.g., on this FFM at CPAP=8 for a week, I had an AHI of 2.5, whereas, on this FFM at CPAP=6 for a week, I had an AHI of 6.5) and not compare it across mask-types. Does that make any sense?

I guess maybe the issue is that technically my pressure is only supposed to be changed by physicians order.

Technically all of our pressures are only supposed to be changed by physicians' orders.

So I guess to be all legit if I have an increased AHI with a new mask then I would need a sleep study so the doctor could order an increased pressure.

There can be changes in AHI due to type of mask, but in my opinion, if you're not leaking, I would view those as part of measurement error and not as evidence that your having more events (unless there is a reason to conclude you're having more events, such as you think the mask is pushing your jaw back and you're obstructing more, or whatever).

It is very hard for many of us to find a mask that works, and often many, many masks have to be tried. If we needed a new titration each time, that would be a disaster. During my titration, they switched me from one type of mask to another in the middle of the night because I was leaking with the first.

If that is the case then what she said was honest.

She doesn't know what she's talking about.

echo wrote: Oscar: Please don't start the "am i allowed to change my own pressure" debate please do a search on the topic and post THERE, let's not kill the original spirit of THIS post (which is probably just as insane)
(just kidding, but no really let's not even go there!!!!!)

I guess my sarcasm didn't shine through.
I guess a better way of putting it is that in my RT's world she can't just show up and adjust my pressure based on my data. She would need a prescription from the doctor based on sleep study result to do this. (is that not correct?)
However, what she can do and what I can do a machine I own sitting in the privacy of my own bedroom are two different things.

ps: thanks for explaining the mask setting thingy

oscar98 wrote: I guess my sarcasm didn't shine through.

guess not (my sarcasm sensor must not be "on" today!).

BTW I have no idea if your machine "adjusts for the mask" so go by what other (more knowledgeable) people here say

RE: RT's situation, I think you nailed it. (Edit: though prescription change not necessarily stemming from a sleep study; doctor could change the prescription based on CPAP data alone).

oscar98 wrote:I guess a better way of putting it is that in my RT's world she can't just show up and adjust my pressure based on my data.

OK, that part IS true, I think. They do need a prescription from the doctor. I don't think DMEs look at and interpret the data (beyond compliance), but not sure how many doctors do either!

SleepingUgly wrote:

oscar98 wrote:I guess a better way of putting it is that in my RT's world she can't just show up and adjust my pressure based on my data.

OK, that part IS true, I think. They do need a prescription from the doctor. I don't think DMEs look at and interpret the data (beyond compliance), but not sure how many doctors do either!

My doctor claims the data is inaccurate and therefore useless. I however, completely disagree with him because I can see a direct correlation between how I feel and what the data says. The two days I woke up this week feeling like I had been hit by a truck I took a quick look at the data and new immediately why I felt so bad.

The RT claims to understand the data but has yet to prove it. After I've had this machine a little longer I will download the reports and take them in to see if she can help me make sense of it all. Hopefully that will answer more questions then it creates.

oscar98 wrote:My doctor claims the data is inaccurate and therefore useless. I however, completely disagree with him because I can see a direct correlation between how I feel and what the data says. The two days I woke up this week feeling like I had been hit by a truck I took a quick look at the data and new immediately why I felt so bad.

My doctor claims that APAPs are useless because they "respond too slowly to events". Hmm guess she hasn't quite figure out that they don't jump up to stop apnea's but look at preceding breathing patterns. She hasn't commented on the data itself, I didn't go that far in the discussion, figured I better stop before I popped a gasket

Wouldn't it be nice if these dr's had sleep apnea as well and had to live with a data'less machine.

I don't know what doctor it was but when I was arguing with my previous DME about getting a machine with data she told me the only time they had ever sold one was to a doctor who had sleep apnea and specifically requested it and he paid extra out of pocket to get it. So data obviously meant something to at least one doctor.

echo wrote:My doctor claims that APAPs are useless because they "respond too slowly to events".

I wouldn't agree that they are USELESS, but I have heard things from reliable sources that are consistent with the notion that at wide open ranges, they tend to have difficulty keeping up and therefore many tend toward pressures that are too low. That's part of the rationale for setting narrow ranges.

I have had some sleep doctors with apnea, and they do not scrutinize my downloads the way we do. I can't say with certainty, but I'm pretty sure they don't scrutinize their own downloads the way we do. So why the disparity between how much value we place on the details and how much they place? Interesting question, in my mind.

Listen, I just gotta chime in here on APAPs being slow to adjust pressure: if it detects those breathing artifacts that are deemeded precursors to apnea, it increases pressure and I think rapidly. When I hit the switch to go to initial APAP pressure from the 'mask fit' feature, I usually breathe in & hold my breath, then exhale when it switches. Some nights, my AutoSet 'thinks' this is a precursor and increases the pressure 2 cmH2O with each breath...that's pretty durn quick.

If you set the initial APAP pressure too low and your overnight numbers are consistently lousy, then you probably need to tweak slowly to find the optimal initial pressure.

While my number are pretty good, I've increased my initial pressure to see if it might improve my many nightly wakeups...I'm beginning to think my every hypop is causing an arousal/wakeup .

As to different pressures for a hybrid-style FFM -- your DME is mis-informed, an idiot, or trying to bamboozle you...take your pick. Both hybrid styles are FFM and most who try them like 'em -- they fit quite differently from each other ( I can't make the Liberty not leak) so ya gotta find the one that fits your facial anatomy best and then get the right size of oral cushion and pillows and the straps adjusted just right.

The RespCare Hybrid vents more than the ResMed masks. I use the MIR FULL setting and expect a little leak -- I always use the 'mask fit' feature to ensure an excellent fit and turn the 'mask off' alarm "on" to ensure I adjust anything if something goes awry...once I pulled the hose off the mask, must not have had it attached well

Good luck with whichever mask you chose.