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Jayjonbeach wrote:Hello all, 3rd night is in the books and my numbers appear to be improving. (and yes Emilia i registered just for you... ) YAY!!

So to anyone curious like other newbs, here is a run down of my numbers over the last 3 days.

Night one: CPAP mode, pressure 7, AHI 14.3, EPR=3. Night two: pressure 9, CPAP mode, AHI 12.5, EPR=off.

Night three: APAP mode, AHI 10 (AI 2.7, HI 8.3), Leaks 0.04, av pressure 11.2, EPR-off (thinking about putting this at 1). More Hypopneas than Apneas -- hence, the shallow breathing!

So, I do have a couple more questions.....

1. What is A-Flex, C-Flex and the difference? Flex has to do with the relief upon exhalation: A is when the machine is in Auto mode; C is when machine is in CPAP mode

2. Could leaks affect the AHI data? (I don't think so but would like clarification) Yep, from what I've read, leaks can skew your readings.

3. I wonder what is the advantage of CPAP over APAP if any? I did read a good thread/article on it somewhere but I would like to know what some long time users think. If APAP adjusts to your breathing, why even go back to CPAP? Will CPAP help reduce someone's AHI more than APAP? Not all insurances will approve the Auto machines. Mine won't unless it meets their medical necessity criteria. CPAP is a steady pressure, and for some folks, that is a best way to keep the airway open. Auto is a comfort factor, but it also allows those who have difficulty exhaling against a high pressure to get some relief.


I guess that is about it for now. One other thing I noticed last night, it seemed to me I was doing a lot of SHALLOW breathing, I wonder if I am one by nature and if this is also part of the reason I am always tired. I definitely want a copy of my sleep study to see what the numbers were (even if not fully meaningful because I only had 90 minutes of measurable sleep) and what my Oxygen Saturation level was. I am looking forward to renting an Oximeter to see where I stand now and where I will be in one month, I think Oxygen is critical to someone's well being and having OSA drops your levels which of course has the effect of making you horribly tired.

Overall I think I am adjusting well, my wife is not very keen about sleeping next to a "Machine" (yes she is poking fun and calling ME that) and truthfully I do feel a little like Darth (Luke, I am your father... ) but the mask is much more comfortable and much less obstructive to my sleep than I thought it would be.

Happy hosing to all of you out there.

Sounds like you are on your way to good sleep. Your numbers still need to come down, but these things take time and adjustments along the way. You have a very positive attitude so you will be successful!

Jayjon, sounds like you're on the right track now! Leaks can influence AHI, but your leak last night was not high enough for that to play a role in any apneas. The advantage of cpap over apap is that there is never an increase in pressure. Some people are quite sensitive to pressure changes and they've found a pressure level that stops events. Others aren't sensitive to the pressure changes or have a lot of variability in their events--for a variety of reasons--and do better on apap.

Is medical coverage the same in all of Canada? Several forum members have recently had more than one sleep study. I think it's sort of stupid to claim that one will provide all the data ever needed, but who knows why or how those decisions are made...

Jay, Since this is just guesswork right now to find your correct pressure, you should be doing a trial on auto for at least a few nights or even a week . As is said here many times, one night does not a trend make. Judging from just the one night on auto where your avg pressure was 11.2, you could set it from 10-13 or 10-14 and leave it like that for a few days and see where you land. The EPR is your choice, either Off or 1 whichever seems more comfortable at this point. My husband's breathing pattern did not match up with the Aflex or Cflex on our machine and disturbed him so we turned it off. What you're trying to accomplish at this early stage takes some patience but I think you're going to do fine with your great attitude.

All of these responses seem really helpful but please...call your physician and have him prescribe a range of pressures for you. I am the first person that will tell a patient to educate themselves and take an active role in their PAP therapy but do not continue to guess at what pressure or range of pressures you should use. If you actually are seeing a sleep physician, he or she has a rhyme to her reason. You have the right machine...the AutoPap...just the wrong setting. There are risks associated with making uneducated guesses at your pressure. You have a lot of questions about your therapy, and they are all valid, but you need to work with your PHYSICIAN for a valid starting point. Remember, that machine requires a prescription because it has the potential to treat you and make you feel better, but if abused it could actually harm you.

The doctor only guessed at the pressure I would need since no titration was done

I agree, it would be wonderful if he had a physician who could really dig in and help him, however,

It doesnt appear he is going to get another sleep study or titration study anytime soon..

Guessing at a range near what the doctor prescribed, because the first constant did not work, I think is prudent planning.

You could call your doctor and tell him youre trying to dial in your pressure to get his blessing I suppose.. I certainly have my
doctors blessing, but SHE knows I have been studying all this for months..

My doctor did not GUESS at a contant pressure, she sent me home with an autopap on a wide range for a week.

Im a shallow breather by nature, and I have found the epr settings very helpful as training wheels to get used to breathing against the pressure.
I have such a problem with it, I dont see me losing the training wheels anytime soon..

If you can get by without it thats always good, but if its a struggle for you, nice to know its there.

agree, it would be wonderful if he had a physician who could really dig in and help him, however,

It doesnt appear he is going to get another sleep study or titration study anytime soon..

Guessing at a range near what the doctor prescribed, because the first constant did not work, I think is prudent planning.

You could call your doctor and tell him youre trying to dial in your pressure to get his blessing I suppose.. I certainly have my
doctors blessing, but SHE knows I have been studying all this for months..

Remember...you don't need another sleep study to determine your optimal pressure, your autopap can help you with that. You DO need a definate range from your physician. You should reach out to your physician.

**definite*** sorry!

Obviously Jayjon is falling through the cracks with his Dr and the DME which is often the case we see here, hence all the helpful suggestions to get him on the right track. I don't see any "dramatic" recommendations given that would jeopardize his health, just a bit more educated "guesswork" than what he's been getting. Good luck Jayjon and keep us posted.

Hello again and once again thanks for the replys.

Unfortunately not such good news this time, a small bump in the road I suppose.

elena88 and Dori are on the right track here Sleepy, getting to see a doctor (especially a specialist) or even TALK to one here in Canada is like trying to make an appointment with Santa Claus, no kidding. Also I don't know if you caught it but the doctor DID recommend me a pressure of 7 which was really just a guess since no Titration was done, just a not so successful sleep study AND it appears the estimate of 7 was way off since I was SNORING with the mask on and the last 3 nights the pressure on Auto is way up from there.

Here are my numbers from night 4:

av pressure 13.2 (went up, probably not sleeping or breathing well, good thing I had the range up to 14, might go 15 max now)
AHI 11.3 (up from night before)
AI 3.9 (also quite an increase)
HI 7.4 (about the same)


So the good news is Saturday night with an AHI of 10 (not that great) and after I posted in the morning, I went out and felt GREAT most of the day. It was the best sleep I had since having the machine and was the most awake I have felt for a long time and it lasted most of the day. I wasn't full of energy (though I commented to my wife about kicking some guy in the head while driving, a sure sign I had some energy... ) but I actually felt rested, not fully maybe BUT some and some is a damn good start from the usual NONE!

So the bad news is last night I had trouble sealing leaks at first and I woke up once or twice with a leak too. Today I felt the usual crappy tired ALL day, more or less like I would without the machine, maybe the rise in the AI accounts for that not sure.

The other bad news is my nose is TOAST. I felt kind of embarrassed today walking around looking like rudeoff the red nosed raindeer (someone asked me about it too) and tonight I will sadly have to not use my machine as my nose needs to heal. I know, I know, I should try and find a way but I used a bandaid the last two nights, had the mask dialed out properly (no thanks to the dimwit technician who never showed me how to fit it or gave me instructions which is why I am the way I am now after two nights the wrong way) and it still made my nose worse since it was mush already. I also have it not that tight and that is why I had some small leaks around the eyes. My leak number never went up that much, I think to 0.1 from 0.04 but with the leaks I had it means I cant loosen the headgear anymore it seems or they will get worse (and they woke my wife up and she went to the couch which of course disturbed my sleep too)

So a mix of news, thanks again for all the help so far. I will go maskless tonight, grin and bear it tomorrow and get back in the saddle with hopefully some better numbers and better rest the next night. I would love to know what it feels like to be awake at work because I was getting very close to just quitting as I didn't like the job anyway and being tired while there makes it pure torture (especially because they keep it too warm too ).

SleepyRT wrote: Remember...you don't need another sleep study to determine your optimal pressure, your autopap can help you with that. You DO need a definate range from your physician. You should reach out to your physician.

A doctor can no more guess at a "good range" for an APAP as he could guess at the ideal pressure. Any suggestion for a range would be based on either setting it to 4-20 (which is way too wide for most) or only GUESSING at a higher minimum pressure. Without a proper titration, no one can recommend an APAP range nor a fixed CPAP pressure.

jayjonbeach, if your mask is giving you serious problems on your nose bridge, it might be too small. In this case I would definitely reach out to whoever supplies you with your masks.

Stick a bandaid on your nose and tough out the night. You should not sleep without your machine. Then as soon as you can, get another mask. You might have to pony up the cost and order one from an online provider and pay out of pocket. Pay for expedited shipping if you have to. CPAP.com has a huge variety of masks and some guides to help you choose. Be sure you purchase return insurance, too.

If you can possibly keep your mouth closed with all the pressure, try a nasal pillow mask as that will take the pressure off the bridge of your nose.

SleepyRT wrote:All of these responses seem really helpful but please...call your physician and have him prescribe a range of pressures for you. I am the first person that will tell a patient to educate themselves and take an active role in their PAP therapy but do not continue to guess at what pressure or range of pressures you should use. If you actually are seeing a sleep physician, he or she has a rhyme to her reason. You have the right machine...the AutoPap...just the wrong setting. There are risks associated with making uneducated guesses at your pressure. You have a lot of questions about your therapy, and they are all valid, but you need to work with your PHYSICIAN for a valid starting point. Remember, that machine requires a prescription because it has the potential to treat you and make you feel better, but if abused it could actually harm you.

Hehe well its not like I didn't know the result!(see my post before this one) Today I called and asked for the specialist (who interpreted my sleep study results) and of course I was not allowed to talk to her. Not only that, I have to wait a month for an appointment and that is probably considered fast for a specialist here in Canada. No surprise here. So basically it was a waste of time calling except I got a good laugh telling the assistant that I adjusted the pressure on my machine.

"You're not allowed to adjust the pressure"
"Well at 7 I was SNORING with the mask on"
"Well you're not allowed to adjust the pressure"
"Well I DID!"
"......speechless....."

LMAO People and their rules, I have never been one to conform anyway.

The whole problem is I had sleep study to see IF I had OSA. Then the specialist prescribed a pressure she THOUGHT would work WITHOUT doing a titration. This might be because they changed the rules in my province and only allow one sleep study OR maybe this is the fandangled way they normally do things, which after learning more about OSA, seems pretty stupid. It seems to me that a second study should have been done with a CPAP machine where through the night they adjust the pressures and try to DETERMINE what pressure would be best from actual results.

Believe me when I say this coming from the Canadian Health System, does NOT surprise me in the slightest. \

Getting service from the companies that provide the machines is impossible to. Most have office hours requiring you to take time off work and trying to get questions answered on the phone is impossible, "You have to make an appointment with a Technician".

-----------------------------------

So last night was not good without my machine (thanks to the dimwit technician who did NOT show me how to properly fit the mask) and today I was my usual tired self at work like I have been for the last 20 years. My nose is not fully healed but much better than yesterday and tonight I will put on the bandaid and get back to hosing.

I am starting to think that a constant pressure might be best for me instead of the Autoset but alas it is far too early too tell. I think I will leave it alone for tonight set at min 8 - max 15 and see what kind of numbers I get in the morning.

Happy hosing out there.

If you could depend on the doctor or technician to really help, it would totally make sense to consult them. But they sent you home with a CPAP setting of 7 instead of a range for autotitration, and give you no guidance on how to use your machine or mask. Straight CPAP at 7 was just making you uncomfortable and almost guaranteeing your failure at CPAP. Sounds to me that you have to take charge of your own health in self-defense if nothing else. You are not doing this blindly--you are studying up and making careful decisions--and you are using the data to make sure you are not causing more problems than you are solving. I know the ideal would be to follow SleepyRT's recommendations, but this is not an ideal situation.

Johnson and Johnson make a "finger and toe blister bandaid" that works great on sore noses and is just the right size. It is filled with a fluid for pressure absorption. Try that on your nose and wear your mask. If you look up REMzzzz, you will see a good soloution that gives you a little bit of padding and helps seal the mask. Some people here make their own out of old T-shirt materials. Also, our member PADACHEEK has anti leak straps and pads that help a lot. Check out padacheek.com. And you might just want to explore another mask. Check cpap.auction for really reasonable prices.

Give yourself several nights at the very reasonable pressure range you've set, and try to deal with any leaks that are caused by the mask. The results and pressures aren't very accurate if leaking is an issue.

I'd like to correct some statements I've read on this thread:
Using a machine set on constant pressure, and changing that fixed pressure based on results can sometime give you better information than a machine set on APAP. APAP's are not infallible, and for some breathing patterns, an APAP can zoom way up out control.

The doctor's decision to start conservatively makes sense. He has no diagnosis, because of an unsuccessful sleep study. He does think (guess) that you have OSA, he wants to help you, Jay, and he treads carefully. The first rule for doctors is "primum non nocere" meaning: "above all , do no harm". It would be far more irresponsible of any doc to blast an undiagnosed patient with pressure higher than 10 when the patients needs are not known, than it would be to start lower, and raise gradually. There are bad doctors, ignorant doctors and foolish doctors -- but not all of them are like that.

You're on the right track, Jay. Keep a log of how you feel, and of your results. If you're thinking of a machine to buy, go for an S9 -- with software it will show you snore data (the S8 will not). It will also distinguish the type of apneas that mean you need higher pressure (obstructive apneas) from those that don't (open airway apneas). The S8's handling of the difference between those 2 types leaves much to be desired - it simply raises pressure for any apnea below 10, and for no apnea above 10 - a reasonable rule based on statistics, but terrible if you happen to be a person who gets pressure induced apneas below 10, or obstructives above 10.

Snoring is a good reason to raise your minimal pressure, or to drop the amount of EPR. Otherwise, try to stick to a setting for a week or two -- your brain and body need to adjust to sleeping with the mask, you can't make decisions based on one night's results.

A battered nose needs time to heal -- and sometimes the only solution is a break from the pressure. A band aid -- even Micropore tape - may help to prevent some of the pressure sores, and it's important to avoid them.

Welcome to the forum, and good luck!

ozij wrote: The doctor's decision to start conservatively makes sense. He has no diagnosis, because of an unsuccessful sleep study. He does think (guess) that you have OSA, he wants to help you, Jay, and he treads carefully. The first rule for doctors is "primum non nocere" meaning: "above all , do no harm". It would be far more irresponsible of any doc to blast an undiagnosed patient with pressure higher than 10 when the patients needs are not known, than it would be to start lower, and raise gradually. There are bad doctors, ignorant doctors and foolish doctors -- but not all of them are like that.

You're on the right track, Jay. Keep a log of how you feel, and of your results. If you're thinking of a machine to buy, go for an S9 -- with software it will show you snore data (the S8 will not).

Thanks for the replies once again.

Yes I agree completely that given my chances that I fell into the low to moderate group and that no titration was done, starting at 7-8 made perfect sense. What did not was not having a titration and then NOT telling me how to do it myself! Without the forum and some guidance I would still be snoring at 7! The damn "Technician" who gave me this loaner machine did not even tell me about the EPR or what is was for!

So typical, get em in, get em out, next please, please pay your bill.....

Today I tried to call another company and got very little info but a lady did tell me that they do NOT have the S9 Autoset and only had the ELITE. Also, I would need a SPECIAL prescription for the Autoset and it was WAY more expensive?

This does not seem consistent with the pricing on cpap.com which shows it like 50 bucks more.

Man oh man someone has to quit their job and become a fulltime researcher to get anywhere these days I tell ya. I have no time during the day at work to call around for this stuff. I also need to know in Canada if someone should be "preapproved" for insurance purposes or not and if my wife quits here job in 3 weeks (which she will and she has the benefits and I don't) if I put the claim in before she quits will it still go through!? (government pays 780, insurance will pay the rest depending on company and this will be a 2000 bill up here in the "Great White North").

Thanks again for all the help thus far, would have been lost without it since service these days in most things is in the toilet.