First post: Newbie looking for the big picture

First post after lots of lurking...I just got my report (clearly only part of it) - haven't discussed it with the Doc. He wants to prescribe a straight CPAP, so we'll have to straighten that out. I am "mild"- 12 AHI. Mostly hypopneas. Here is my question:

At the end of the day, the goal is, in the best of all worlds, high pulse ox + as close to 0 as you can get for AHI= a good night of sleep. Do I have that right?

Many thanks in advance for any input! Jean

You are on the right track. If you were to fall below 90% for blood oxygen you would have an issue that requires attention. If you were to go above 5 for AHI more work should be done to resolve the issues.

Good excuses for why you need an auto machine include that you have been told that you snore more when you lay certain ways and you believe your apnea is positional. In the short sleep study time you may not have been able to demonstrate that but you want a machine that can adapt to your changing needs. There are several others that I am sure people will contribute.

Thank you! Dr recommendation was very vague "like a Repironics Pro preferred". Sounds like a set up for Apria nightmares, where I need an Rx but not even an auth!

I haven't even started and I'm discouraged! I cannot even imagine why someone would order a straight CPAP these days.

Thanks for you kind words of support.

Your best bet would be to ask the doctor to list a specific machine in the RX. Resmed S9 AutoSet or Philips <insert appropriate model> 560 series.

If he asks why, say, it can work as a CPAP or as an APAP. Positional Obstructive Apneas warrant APAP. Also, tell you doctor that the S9 AutoSet (and S9 Elite) and PS <fill in the correct model numbers> provide full efficacy data, not just hours used and APIs. That might sway him/her.

Good luck, remember question everything, ESPECIALLY when dealing with Apria.

-tino

If your copay for insurance will exceed $400 for the machine, one option is to consider buying the machine yourself. You would still use your DME for supplies. You could produce reports to use for providing therapy information to your doctor or for discussion purposes there.

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Phillips/Respironics System One REMStar 60 Series Auto CPAP Machine - DS560. This is a new unit that has never been used. It is in perfect condition with the heated humidifier, humidifier tank, hose, power supply, SD card and travel case. The unit has never been exposed to a smoking environment. I will provide free shipping to a US address, or at cost shipping outside the US. References available upon request. $400

I agree with STL Mark, if you have to pay a ton of copay, consider just buying your own machine and use your insurance for masks. My machine is the IntelliPAP Standard Plus CPAP Machine with SmartFlex and you can get it with the humidifier for $470.00. I tried two other machines before I found this one and I won't go back. I actually usually by all my masks out of pocket too. It always seems like everytime I need one that I'm not even close to my deductible and I can get the same mask for less than half the price so I usually just buy it myself, but that's just me. I hate paying an exhorbant amount to a middle man that didn't do anything for the extra. He's not fitting me or helping me, he just pulls something off a shelf and charges the insurance double and a half. Part of which I end up paying anyway.

Diesel, does your machine have data capability? If your Intellipap Plus is the same as the Respironics Plus it doesn't.

Jeannh, if your Dr prefers Respironics brand I wouldn't argue with that, just try to insist on an Auto if possible, (560 model). Many patients here use that model. Your pressure needs may change in the future if you lose/gain weight, health issues occur,etc. If it's going through your insurance the Pro and Auto have the same payment code. The Auto can be used in either cpap or auto mode but cpap can't be used in auto. Good luck and keep us posted.

Yes my machine is data capable. I use to play with that a lot years ago, but not so much now. In fact I never use it. What I love about my machine is the smart flex, it makes it so much easier for me to breath out.

Jeannh wrote:First post after lots of lurking...I just got my report (clearly only part of it) - haven't discussed it with the Doc. He wants to prescribe a straight CPAP, so we'll have to straighten that out. I am "mild"- 12 AHI. Mostly hypopneas. Here is my question:

At the end of the day, the goal is, in the best of all worlds, high pulse ox + as close to 0 as you can get for AHI= a good night of sleep. Do I have that right?

Many thanks in advance for any input! Jean

I think the goal is to obtain the highest quality of healthy sleep possible.

AHI is a very crude measurement. There are many “micro events” that would never register that are important. There are many “breathing stability” events that can rob you of quality sleep.

Currently I am running with a seven day average AHI of 1.17 (SleepyHead). But I am dealing with some issues of breathing stability which I believe keep my sleep from being as restorative as it could be. There may be arousals from the extra respiratory effort. I think that my times of breathing a bit too much also frustrate circulation and metabolism.

I run with straight CPAP. I really do believe straight CPAP has the greatest overall potential for the highest quality of sleep simply because the body is not forced to deal with constantly changing pressures. You do have to monitor your data closely and respond to events with lifestyle or perhaps pressure changes or in my case the use of EERS[1] as needed.

Regarding pulse oximeter readings I think that a reading above 93% is likely good – but I also think that above 97% is bad. If you think about it there should be some deoxygenated blood cells registering simply from the metabolism going on. In my learning to breath eucapnically I have learned that for me with my pulse oximeter living at 2500' an SpO2 reading of 95% at my computer or 96% if doing moderate exercise (treadmill @ 70% MHR) results in the lowest heart rates and best over all feel. If I move into blood oxygen levels above that I get more and more symptoms of hyperventilation.

[1]: Gilmartin G, McGeehan B, Vigneault K, Daly RW, Manento M, Weiss JW, Thomas RJ.
Treatment of positive airway pressure treatment-associated respiratory instability with enhanced expiratory rebreathing space (EERS).
Source: J Clin Sleep Med. 2010 Dec 15;6(6):529-38. Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Link: http://www.ncbi.nlm.nih.gov/pubmed/21206741

[2]: Dynamic CO2 therapy in periodic breathing: a modeling study to determine optimal timing and dosage regimes
Yoseph Mebrate, Keith Willson, Charlotte H. Manisty, Resham Baruah, Jamil Mayet, Alun D. Hughes, Kim H. Parker and Darrel P. Francis
J Appl Physiol 107:696-706, 2009. First published 23 July 2009; doi: 10.1152/japplphysiol.90308.2008
Link: http://www.ncbi.nlm.nih.gov/pubmed/19628721

I think the goal is to obtain the highest quality of healthy sleep possible.

Makes sense. Thanks!

You can not only inform your doctor that all Auto machines will also run on CPAP,
but if appropriate, weight loss (or gain) of over 30 pounds may require an additional PSG,
but with an APAP, you can periodically let the machine test for a need for a pressure change
(under your doctor's direction)