CPAPtalk.com

Is deleting the "ramping" something we can do at ourselves or would I need to bring it to the DME to do so?

Fitness Seeker wrote:How do i know which S9 model i have? The unit itself doesn't say.

Right next to the power button, it should say "Escape, Elite, Escape Auto, or AutoSet." Let us know which one.

Is deleting the "ramping" something we can do at ourselves or would I need to bring it to the DME to do so?

Ramping is a patient comfort feature, as is humidity, and EPR (exhalation pressure relief). So you should be able to adjust those as you wish for your comfort. Some DME's, however, lock patients out of EVERYTHING, including the ability to adjust patient comfort features. Why do they do this??? Because they think that "patients" are too stupid to touch anything except the on/off button. Some DME's lock you out of being able to see your data as well.

Fiddle around with your machine buttons (you really CANNOT hurt anything--you can't change the pressure unless you specifically go into the clinician's mode) and see if you can find and adjust your ramp settings. If you can't, post here and someone with your model will be able to tell you what to do.

As you explore around this board, you'll see that most of us think it's a lot of horsehockey that only a clinician may change the therapy settings--people of even moderate intelligence like me can figure out how to adjust the therapy settings for optimal treatment, if they take the time to learn about their machine and treatment.

Yah...I got to switch masks. Pugsy, I think i have the same as your, a ResMed FX nasal pillows. I can't believe how much they charge for these things. They cost no more than a couple of bucks to manufacture! Anyway, this is the only one that comes in "petite" (XS). It's just like a hair/head band. Love it. I told the DME I'd like to lie down and just try it. I lay there for 15 min b4 they kicked me out. Boo. I thought i'd have a chance to try at least one other. I mean if you get charged for a "mask fitting/orientation" shouldn't you be trying on multiple ones? But I have confidence this one may work out. But seriously these manufacturers shd have us participate in focus groups so they can design better stuff.

Ok, looking fwd to better nights going forward.....

Ok Nite #3 on apap and 1st nite on the new ResMEd Fx Nasal pillows. The new mask is working much better, albeit still got up feeling a bit unfreshed...i'll keep trudging along...the AHI went back up but less than 1, which is good. I found that w/ this mask i tend to have to sleep on my back. When i turn (which is quite frequent) to the side the nasal pillows won't stay in well. Also, sometimes I put a "bone" pillow on my chest and lay the hose on that so give it some elevation.
At one point the nasal pillows slipped out and i was 'half awake' and stuffed them back into my nostrils.

@Pugsy, maybe you can give me some input on your experience w/ this mask.

Gosh, I have had none of the issues you speak of. I have never routed the hose over my head but a lot of people do and it may help with the dislodging that might come with tossing and turning. I have always been a huge tosser and turner due to back pain. I do now use the barrel cozy. I got it last winter yo help with rain out but I found that I like its softness enough to use it all the time. It may help with the stability somewhat. Hard for me to say because I have always had a very decent leak line anyway. I did try routing the hose over my head (metal headboard) but I didn't like it. Until I broke my wrist recently I was mostly side sleeper but with the cast on I seemed to stay on my back more.

If you think you like the FX well enough to use it a lot you might consider adding the barrel cozy. It may help stabilize things a bit. For sure it is quite soft and comfortable.
http://www.padacheek.com/PAC_SwiftFX.html

Like Pugsy, I use the Swift FX and I'm a side sleeper. I used to be very, very restless. As in tear up the whole bed at night in my sleep restless. On BiPAP I'm no where near as restless as I was. I've never had problems with leakage with the FX, although I know a lot of people do. Like Pugsy, I don't route the hose over my head. I tend to hug my hose under my upper arm---rather like it's a large stuffed toy snake. (It's a side benefit of a hose cozy.) I think part of getting the FX to work right is understanding just how loose it's designed to fit. Because once it's sufficiently loose, the pressure from the machine plasters those pillows right up against (NOT IN) your nostrils---or at least that's how it works for me.

Fitness Seeker wrote: At one point the nasal pillows slipped out and i was 'half awake' and stuffed them back into my nostrils.

Sounds like you may have the mask misfitted if you are stuffing the pillows into your nose. On the rare occasions when I do have to fiddle with this mask, the fiddling is best described as pulling the pillows AWAY from my nose and letting them gently fall back against my nostrils.

Janknitz has a pretty good step by step guide on how to fit the Swift FX on her blog at http://maskarrayed.wordpress.com/swift- ... ing-guide/

I am also a side-sleeper and use Swift FX. Learning/training yourself to position your head in the right place on your bed pillow will help you. You can also experiment with different types of pillows for your head. I find I have to lay my face on the very edge of the pillow. Also the cheek strap needs to go around my head about an inch above where the little bone juts out on the back of the head, and the top silicone one needs to be very loose for me. Also, a hose management system often helps to keep the nasal pillows in the right spot on your nostrils as you moved in sleep. If the mask moves in my nostrils, I can usually just reposition it, to let it fall against my nostrils without really awakening. If you get some Lansinoh for your nostrils, it is a little bit tacky in texture, and night help you to keep the nasal pillows in position where you want them. You can find it in the baby supply aisle of pharmacy and grocery stores, it is pure lanolin that nursing mothers use for their breasts. Ask the pharmacist to help you find it if necessary. Archangle usually chimes in with Lansinoh info if I mis-spell it. If you need more info about Lansinoh, you can probably do a search here for it. It is good for nasal sores and also for dry cracked heels, as well as chapped sore nursing breasts.
Welcome to the hosehead club, and keep on keeping at it, you WILL eventually be able to sleep with the mask on and also get adequate rest and feel so much better and be much more productive, & it will add years to your life. Ask any questions you need, people on this forum are from around the world and usually someone is here that can answer your questions. As for the ramp feature, you can have the DME turn that portion off if you are unable to do it yourself, if the DME has locked you out. I turned mine down from 20 minutes to 5 minutes, I felt like I was suffocating until I did that. I like 5 minutes, it is about right for me to be able to fall asleep and then get my prescribed pressure.

Update--it'll be 3 wks this Sun on apap. I'm still not having much improvement. In fact, I took the advice of using it for a couple hours at nite and have been yanking off the mask alot. This isn't good. I keep trying to trace the SOURCE of my problem:
a. mask?
b. pressure?
c. other?

I can't really pinpoint it as the mask seems ok (FX Swift nasal pillows).
I just can't FALL asleep.

I started back work today and I'm really concerned that it's taking a toll on me. AT this rate, I"d be fired sooner or later. Can't tell your employer you've just got to lie down to nap! I was off today , took my vehicle in for inspection, intended to attend a 3-hour class. however, i felt sooo sleepy i wish someone could drive me home and it was only 10 min local to get home. Immediately i jumped into bed and lay there, decided to plug up w/ the machine. AT this point it was obvious i was in severe sleep debt and that i SHOULD be able to fall asleep. Nope. I was plugged on the machine for ONE HOUR and couldn't fall asleep, even w/ the sleepiness that prevented me from doing the rest of my errands and attending a class I planned to take. So, after 1 hour, i yanked the mask off and lay there, eventually i did fall asleep (w/o the mask). Why does this happen?

I emailed the Sleep Clinic (I"m suppposed to go back for Follow up in 3 wks) to ask them if the apap machine ideal for me, b/c at an AWAKE Meeting the presenter told me (from the data on the sleep studies) that i was developing central apneas (4) from using the cpap. (i only had hypopnea events, 15.1 on the sleep study). But once cpap kicked in i had central apneas. So the presenter told me to inquire about other machines, ie bilevel, servo ventiliator, etc. When i brought this up on the email the sleep clinic told me "those machines' are for more "severe forms of apnea". Is this true? Sigh. They told me since I seem to "not tolerate CPAP" that i shd consider other alternatives, ie dental appliances.

Any input?

Fitness Seeker wrote: They told me since I seem to "not tolerate CPAP" that i shd consider other alternatives, ie dental appliances.

In my distant memory, there was a significant amount of time before I adjusted to this treatment. Parts of the problem were too low of a ramp, too low of a pressure, fighting with the mask(s), interference by limb movements, and a brain conditioned to whacked out sleep patterns. The fact that I did eventually adjust and relearn how to sleep makes me just want to scream to read that those you count on to guide you would think that you could even begin to know at this point that you won't be able to tolerate cpap. The only issue you report is not being able to fall asleep. What they should have done is #1 Ask about any mask issues, #2 Consider if you are using the ramp and it's too low for you and keeping you in a state of alert, #3 Affirm through your data that your treatment is therapeutic and that your pressures are at optimum effectiveness for you. Maybe your pressure range starts too low, which could also affect your ability to fall asleep, and #4 Consider trying you at a fixed pressure to see if it helps. They have not even begun to try to help you make this work. Shame on them! And once they have done due diligence, maybe a sleep aid on a temporary basis would be merited. I wouldn't suggest that at first because you don't want to mask a problem.

It might help you to google sleep hygiene and diligently apply those principles that are conducive to sleep to give yourself a better chance at success. In my early times of cpap use, once things were working well, every night I went to bed thinking this might be the night I really sleep well. In spite of disappointments, I approached every night expectantly. I'll never forget the first time I woke from having slept deeper than I ever remember sleeping - it was better than... ummmm, chocolate. So worth the effort! I hope you soon have that pleasure.

I also use nasal pillows and am a side/stomach sleeper, and had a lot of trouble settling down and falling asleep in the beginning.

Following a suggestion from someone here, I started spending a few minutes sitting up in bed with the mask on and the machine running. I would, and still do, spend the time (one dvr'd episode of Jeopardy) every night adjusting and tweaking my mask so that it was snug, but comfortable. I think this is what I'll be doing on a permanent basis.

Last weekend DH and I went camping in our pop-up and I didn't have my 'adjustment time', just put the mask on and lay down. I wasn't as comfy all night, and had more leaks than when I 'mess' with my mask.

The time spent before sleeping gives you time to relax, get used to breathing with the machine (without thinking about it) and get your mask adjusted. It might be worth trying and I would definitely ditch the ramp. Made me feel like I was suffocating.

Hang in there and do get the software - you'll be amazed at the difference therapy does for your apnea numbers - compare them to your sleep study results.

Cheers,
xena

Fitness Seeker wrote: Immediately i jumped into bed and lay there, decided to plug up w/ the machine. AT this point it was obvious i was in severe sleep debt and that i SHOULD be able to fall asleep. Nope. I was plugged on the machine for ONE HOUR and couldn't fall asleep, even w/ the sleepiness that prevented me from doing the rest of my errands and attending a class I planned to take.

I emailed the Sleep Clinic (I"m suppposed to go back for Follow up in 3 wks) to ask them if the apap machine ideal for me, b/c at an AWAKE Meeting the presenter told me (from the data on the sleep studies) that i was developing central apneas (4) from using the cpap. (i only had hypopnea events, 15.1 on the sleep study). But once cpap kicked in i had central apneas. So the presenter told me to inquire about other machines, ie bilevel, servo ventiliator, etc. When i brought this up on the email the sleep clinic told me "those machines' are for more "severe forms of apnea". Is this true? Sigh. They told me since I seem to "not tolerate CPAP" that i shd consider other alternatives, ie dental appliances.

Central apneas, bipap, etc. don't matter if you don't fall asleep.

Can you think of anything about the CPAP that is keeping you from falling asleep? Too much pressure, noise, the thing on your face, can't sit in a comfortable position, etc.? Are you simply thinking about it too much?

Dental appliances only work in a small percentage of people whose apnea is caused by the jaw being back. It's good if they work.

Try all the strange things. Sleep in a recliner, eat a big meal before sleep, turkey, milk, booze, don't eat for 6 hours before sleep, music, TV, melatonin, etc.

Fitness Seeker wrote:Update--it'll be 3 wks this Sun on apap. I'm still not having much improvement. In fact, I took the advice of using it for a couple hours at nite and have been yanking off the mask alot.

In my humble opinion, the person who told you to "use it for a couple of hours at nite" gave you very bad advice. Every single time you consciously go to sleep without the mask on your nose, you allow your unconscious mind to continue to believe that the mask is NOT the new reality of your life.

Your unconscious mind is acting like a stubborn little kid who's determined to have his own way by screaming NO! NO! NO! at the top of his lungs to his parents when they're making a reasonable request. And like the parent of a screaming two year old who ALWAYS gives in and lets the two year old have his way, by giving in and consciously allowing yourself the luxury of sleeping without the mask after wearing it for a couple of hours, you are letting your unconscious, resistant part of your mind win the battle of "do I really need to sleep with the hose tonight?" every single night.

Your conscious mind has to play the role of a GOOD parent: You are in control of this, not the CPAP and not your unconscious mind. And you are the one who must consciously decide to force your unconscious mind to accept that sleeping with the mask really is the new reality and that the mask isn't simply going to go away. In order to do this, you have to man up and admit to yourself: You are the one who must make the conscious decision to NOT allow yourself the luxury of falling asleep sans mask at night---no matter how tired you are during the daytime. (And yes, I know how hard that is---particularly when you've got a full time job.)

This isn't good. I keep trying to trace the SOURCE of my problem:
a. mask?
b. pressure?
c. other?

I can't really pinpoint it as the mask seems ok (FX Swift nasal pillows).
I just can't FALL asleep. (emphasis added)

I certainly can identify with your statement that you just can't fall asleep when you go to bed since that was one of my own critical problems during the first two months of therapy---before the insomnia started to morph into sleep continuance insomnia as well as bedtime insomnia.

But what you've written here just isn't good enough self analysis to help us help you solve your problems: No one but you can figure out why CPAP therapy is bothering you so much. Perhaps keeping a detailed log of your feelings and reactions to what's going on when you are trying to get to sleep would help.

Things to think about that may help you pinpoint the (multiple) sources of your problem(s):

• When do you put your equipment back together for the night? During the first couple of months, the very act of getting ready to mask up was like a triple shot of expresso for me: No matter how sleepy I was before putting the mask and machine back together for the night, the very act of reassembling the equipment would make me WIDE AWAKE even though I was physically exhausted. I learned that I had to put the mask and equipment together several hours before bedtime. I was washing my face right after supper time. But unfortunately I was also worrying and anticipating a nightly struggle to get to sleep every night. I'd strongly recommend that you get the equipment together well before bedtime and then take the time each night to do something FUN for yourself that gets your mind off the nightly struggle to just get to sleep.
  
  When you are lying awake with the mask on your nose, what do you notice bothering you? Catalog all the things you notice and write them down. And then rank them. To help you get started, here is the list of things that used to really, really get to me back in the dark days of Fall 2010 and kept feeding my insomnia monster well into the beginning of 2011:
  
  • Mask related problems: The mask made my nose itch or hurt. The spot on the frame where the backstrap comes in dug into my temple. The inability to turn over without worrying about dislodging the pillows was always there. The feeling of piggy nose when the mask wasn't just right. My hair being trapped by the mask straps. The nasal pillows barrel stuck to my upper lip in hot, humid weather. The total inability to sleep in the position I most wanted to (head buried into my hubby's armpit).
    
    Pressure related problems: Aerophagia---the feeling I'd swallowed a basketball. Air tickled the back of my throat. Air leaked into my mouth and created chipmunk cheeks. I had difficulty swallowing normally (I swallow saliva a lot since I seem to make a lot of saliva). And difficulty exhaling against the pressure. And difficulty trying to take deep, relaxing cleansing breaths which I'd previously used to settle myself down if I found myself anxious while in bed. The EPR's slight increase in pressure made it feel like the machine was rushing my inhales. Air blew into my eyes from my tear ducts. This was easy to spot because if I pressed a finger on the inside corner of my eye, the "leak" would immediately stop, but when I kept the finger over the corner of my eye, but did not press down on it, the "leak" would immediately come back.
    
    Other problems: The Swift FX's exhaust flow was a huge irritant for me at the start and I still dislike it intensely. Chapped lips caused by the exhaust flow and minor leaks have remained serious on-going issues for me to deal with. Noise problems are significant for some people. For me, the conducted noise through the hose was a problem. Nasal congestion always seemed to magnify all my problems and so that was also an issue since I started CPAP during ragweed season, which is one of my two big allergy seasons. But my largest problem was the over all sense of sensory overload from the combination of the air tickling the back of my throat, the piggy nose sensations from the mask, the feeling of being trapped because I could not sleep the way I wanted to, and the fearsome exhaust flow from Swift FX that felt like a jet plane. A partial fix was getting a iHome for my iPod to play Gregorian chants all night long. That distracted me from the worse of sensory overload long enough to get to sleep once I started using the iHome/iPod combo. (I could not bear the thought of adding earbuds to my sleeping gear.) Solving the exhaust flow problem required sleeping in my hubby's warm fleece robe and lots and lots of chapstick. While I never had serious issues with them, other common problems include rainout and leaks. So do you wake up with water dripping into your nose? And how is the leak data? Any chance you've got problems with a dry mouth when you wake up? Or air from leaks causing you discomfort? Or too much fiddling with the mask to prevent/fix leaks causing you to have problems settling down enough to get to sleep?
  As my long list of things that used to (and in some cases still do) bother me indicates, it can take some time and effort and thought to identify and verbalize what specific kinds of things are really bugging you and preventing you from being able to fall alseep at the beginning of the night. But you need to take the time to identify the issues and verbalize them---even if they sound silly, stupid, weird or too trivial to count (like chapped lips). If you absolutely can't figure out any other place to start, go through my list and decide whether each of my problems is something you can identify with (Yes, that's something that bugs me too!) or doesn't seem to apply to you (No, that doesn't seem to happen to me, thank goodness.) Once you have your own list of issues, you have got to rank them in two different ways:
  
  • Most significant to least significant problems.
  • Easiest to hardest to fix problems
  You want to fix the easy problems first (because they're easy) and then start tackling the hard but most significant problems. And leave the less significant, but hard to solve problems for later.

And here's another long list of questions and suggestions concerning things you need to be consciously aware of in order to make a serious effort at solving your CPAP related issues in order to make CPAP work for you:

• How long to do you lie in bed fighting for sleep each night? If you can't fall asleep in a timely fashion, then you need to get out of bed. Yes, it's irritating. Yes, you feel like you'll get absolutely NO sleep at all. But the more you lie there awake and thinking about how much the machine is ruining your life, the worse it will be. Right after getting out of bed, it may help to write down exactly what things were bugging you to the point that you could not relax enough to get to sleep. But then focus on regrouping and settling down and getting sleepy enough to return to bed and mask back up and try, try again.
  
  What do you actually do when you find yourself not sleeping for what seems like hours on end? Worry about how little sleep you're getting? Focus on how uncomfortable you are? Try to lie absolutely still hoping that will help you fall alseep? Deep breathing or conscious relaxation techiniques (that seem to do no good)? Get out of bed and pace? Get out of bed and scream bloody curses at the machine and the injustice of having OSA? (That used to be one of my favorite counterproductive pastimes in the early dark days of my own adjustment.) Again, it may be that you need to get some of it out of your system by venting: So right after getting out of bed, it may help to write down exactly what things were bugging you to the point that you could not relax enough to get to sleep. But then you need to focus on regrouping and settling down and getting sleepy enough to return to bed and mask back up and try, try again.
  
  What do you do during the daytime to encourage yourself to become sleepy enough to get to sleep with the mask on your nose? Do you get regular exercise, but not too late at night? What kind of diet are you eating? Do you meditate or do yoga? Both will help you focus your energy on more positive things than fretting about the current lack of sleep. Do you get up at the same time every day regardless of how little sleep you get? Have you eliminated caffeine AND alcohol? And do you get outside for some NATURAL SUNLIGHT each day---preferably in the morning?
  
  Have you considered a short course of prescription sleep medication? Because it could be that taking something like Ambien or Lunesta or Sonata for a short period of time might help you get over the hump that currently looks like a Mr. Everest sized mountain to you. It could be that you might be comfortable taking a sleep med every night for two or three weeks until you're no longer dreading bedtime quite so intensely. Or it could be that you might be more comfortable taking it on an "as needed basis"---perhaps only taking it the night AFTER you've had a particularly bad night to prevent two catastrophic nights in a row---for a much longer period of time. In either case, you need to talk to the doctor who prescribes the medicine about exactly how you will take it, how long you will take it, and what strategy will be used to wean you off the meds at the appropriate time.

Fitness Seeker wrote:I started back work today and I'm really concerned that it's taking a toll on me. AT this rate, I"d be fired sooner or later. Can't tell your employer you've just got to lie down to nap! I was off today , took my vehicle in for inspection, intended to attend a 3-hour class. however, i felt sooo sleepy i wish someone could drive me home and it was only 10 min local to get home.

Been there, done this. Only I do have the advantage of being a tenured college professor, so being fired is not a worry. However, yawning uncontrollably in a class that you're teaching and being somewhat concerned that you're going to fall asleep at the board (while teaching) is a novel, uncommon, and very uncomfortable feeling. And it did get that bad for me last fall.

Immediately i jumped into bed and lay there, decided to plug up w/ the machine. AT this point it was obvious i was in severe sleep debt and that i SHOULD be able to fall asleep. Nope. I was plugged on the machine for ONE HOUR and couldn't fall asleep, even w/ the sleepiness that prevented me from doing the rest of my errands and attending a class I planned to take. So, after 1 hour, i yanked the mask off and lay there, eventually i did fall asleep (w/o the mask). Why does this happen?

Because you keep choosing to yank the mask off and reward your unconscious mind and the childish part of your conscious mind by sleeping without the mask. So they continue to conspire to keep you awake every time you try fall asleep with the mask on your nose: They know they'll win if they keep you awake long enough; they know you eventually will consciously choose to take the mask off and consciously choose to go to sleep without the mask on.

Difficult as it sounds, when you couldn't get to sleep with the mask on, you should have just gotten up and sat up and forced yourself to stay awake until bedtime. Yes, you would not have gotten anything accomplished in that severe sleep deprived state. But it would have helped shut up the part of your mind and psyche that keeps screaming NO! NO! NO! to the idea of just going to sleep with the mask.

I emailed the Sleep Clinic (I"m suppposed to go back for Follow up in 3 wks) ...

Given your current severe difficulties, you need to demand to be seen much sooner than that follow up scheduled for 3 weeks from now. Call them and insist on talking to a doctor, nurse practitioner, or physician's assistant. Tell the receptionist/screener that you're experiencing so much sleep deprivation that you're starting to think about just quitting and that you need help immediately in trying to solve the most serious problem of not being able to get to sleep with the machine. Tell them that you are worried about being fired from your job. The message will get through and you'll get a call back from someone who really can talk to you about potential ways to fight the current insomnia medically---either through cognitive behavior therapy or prescription sleeping pills or both.

... to ask them if the apap machine ideal for me, b/c at an AWAKE Meeting the presenter told me (from the data on the sleep studies) that i was developing central apneas (4) from using the cpap. (i only had hypopnea events, 15.1 on the sleep study). But once cpap kicked in i had central apneas. So the presenter told me to inquire about other machines, ie bilevel, servo ventiliator, etc. When i brought this up on the email the sleep clinic told me "those machines' are for more "severe forms of apnea". Is this true? Sigh. They told me since I seem to "not tolerate CPAP" that i shd consider other alternatives, ie dental appliances.

Several comments:

1) What do you mean when you write "the presenter told me (from the data on the sleep studies) that i was developing central apneas (4) from using the cpap"? Does this mean that your CAI = 4 on the titration study? Or does it mean you had a total of 4 CA's on the titration study? Or does it mean that on some night with your machine you had a CAI = 4? Or does it mean your machine recorded a total of 4 CA's on some night? Because how significant this 4 is depends a whole lot on what the units for it are and where the 4 comes from.

2) Insurance companies require you to "fail" CPAP/APAP before authorizing a switch to BiLevel or ASV. It could be that BiLevel may make you feel better---if your issues with tolerating CPAP/APAP have to do with pressure---i.e. not being able to breath out effectively even with EPR turned on or serious aerophagia issues that have not resolved even with attempts to address them with pressure adjustments, a switch to/from CPAP to APAP, and a change in masks, or simply being titrated at a very high pressure level. You might want to read this paper on Respironic's Bi-level Rescue Program and make a copy for the sleep doc/sleep center if you come to believe that a BiPAP might address some of your current problems with tolerating CPAP/APAP therapy. (I myself am on a BiPAP solely because issues that are talked about at in this paper---no history of centrals anywhere in my sleep studies, but I simply could not sleep with a CPAP/APAP and in terms of daytime functioning and symptoms, my OSA did not respond positively to CPAP/APAP, but rather got worse even though my treated AHI was well below 5.) ASV machines, on the other hand really are for people with diagnoses of central sleep apnea (CSA) or complex sleep apnea (CompSA), and unless your CAI number is great enough (I believe it has to be at least 5), you're not likely to be diagnosed with CSA or CompSA.

3) With a diagnostic AHI = 15.1 you are right at the cusp between mild and moderate sleep apnea. It could very well be that if you have very sound teeth AND if your OSA problem appears to be caused by your tongue falling back into your airway, that a dental appliance may work well enough to be considered effective. Be aware, however, that dental appliances have their own set of issues: Serious jaw pain and movement of the teeth do indeed cause many people to abandon the oral appliances. If you decide to try a dental appliance, you may run into problems getting the device covered by insurance. And, of course, the only way to tell if the device is really working is to have yet another full NPSG done in a sleep lab several weeks to a few months after you have the device fitted and fully adjusted to its final position.

Under the circumstances, my own personal advice to you (as another patient) would be this:

• First, work hard on sleeping with the CPAP every time you go to sleep. Until you quit the pattern of wearing the mask only a couple of hours a night before consciously yanking it off, it's impossible to tell if you will ever actually adjust to CPAP. You owe this much to yourself---that the trial on CPAP really is an honest trial on CPAP---i.e. a trial of full time use of CPAP and not a trial of part-time use of CPAP.
• Second I'd recommend giving yourself at least 8--12 weeks of full time use of CPAP before making any further decisions. It can easily take that long to really start sleeping comfortably with the machine. It can take even longer before you notice improvements in how you feel. But three solid months of full-time use of CPAP represents an honest, good-faith effort to make this therapy work for you.
• Third, start doing the legwork to properly evaluating whether you really and truly want to explore a oral (dental) appliance. That means you need to:
  
  • Contact the insurance company and seeing whether they will pay for an oral appliance for treating OSA and under what conditions they will pay for the device. (Some will, some won't, and many will---but only with some rather serious constraints and conditions.) It's also worth asking whether your insurance will cover future NPSG's used to determine whether the oral appliance is working as intended. And how often they'll cover a follow up NPSG to make sure the device continues to work as intended.
  • Get a list of several dentists certified by the American Academy of Dental Sleep Medicine so that you know the person making the appliance has some understanding of what they are doing.
  • Familiarize yourself with the wide range of types of oral appliances, how they appear to work, what they do to your jaw each night, their potential side effects (in terms of pain and dental problems), and the potential cost of each appliance.
  • And do some soul searching on whether you'd be happy with sleeping with such a device and whether you'd be happy measuring the day-to-day effectiveness of your therapy on nothing more than "how do you feel?" And also do some soul searching on how you would feel if you went through all of this, only to find out that a follow up sleep study shows that the device is NOT working---in the sense that it is not reducing your AHI down to less than 5. And do some soul searching about how you would feel if, several years down the road, you find out that your OSA has deteriorated and the oral appliance is no longer adequately treating it and you need to go back to trying to make xPAP work.
  Because in the end, those are the things you need to give serious thought to in order to decide whether you want to give up on CPAP (now) and try an oral appliance that may or may not work (now), and even if it works now, may or may not continue to work in the long term---as in 10 or 20 or 30 years.