new to forum and thanks

[winknblinknnod]

For all the great tips and insights I've gotten lurking here for the last month! I just got my equipment at the end of April, it was such a whine fest I didn't dare post. I've resolved quite a few problems just by giving myself time to get used to the change.... they included a claustrophobia/anxiety attack during the titration study; at least one change in masks and another's been ordered; terrifying my new kitten, who has come around at last, although she insists on sleeping with one paw on the mask, keeping it and it's air flow at bay...Happily, the hubby has remained undisturbed by the change.

I still feel like there is lots to learn. And, I'm slowly starting to feel rested during the day again for the first time in years.

Worst problem now is that I tend to take the mask off around 3AM and turn the machine off in my sleep. Hoping that will stop on it's own.

Thanks!

[STEVIEW.]

I've only been using my machine for less than 2 weeks, and its really made a difference. Never realized I had a problem until my wife insisted that I see the doctor about my snoring (she just finished 6 month of chemo for breast cancer, so I feel really bad that I was keeping her up at night). He sent me to a sleep lab (I live just north of Toronto) and they found out that I have severe sleep apnea. Now I know why I sometime woke up gasping for air. The first night I used the machine (CPAP - Fisher & Paykel 604 - thank god the gov't up here pays for most of it!) my wife thought I was dead, I was so quiet. It's gone fairly easily, although some nights I have taken off the mask after about 5 hours (felt like I was suffocating, or the mask hurt my face). I am constantly adjusting the fit of the mask (Respironics Comfortclassic) trying for that magic fit, but still wake up looking like I went a couple of rounds with Mike Tyson! Last night, I lowered the temperature of the heated hose, and I slept better. I still feel sometimes that it is hard to exhale against the air-flow (set at 7), so I use the ramp feature and hope I fall asleep before it hits maximum.
Anyways, I'm really happy there is this website, and that I'm not alone.
Cheers, everyone.

[GoofyUT]

Steve-

When I started CPAP in the beginning of April, I was issued a Fisher & Paykel HC608, the same as you have except with automatic altiude adjustment. I thought that it was a GREAT CPAP, with outstanding humidification, the best you'll find, with its heated hose and its chip-controlled humidifier.

I became slightly discouraged because of the same kind of thing that you're reporting; That is, waking up in the middle of the night, feeling like I was suffocating, despite the fact that I was at a constant pressure of 10 cmh2O. I believed that it was because the hose was heating the air too much and I felt that it was stuffy, which woke me. I tried fooling with the comfort settings and the climate settings of the F&P, but could never find a combo that solved my early AM awakenings and still gave me adequate humidifcation.

I talked with my pulmonologist about this, and he ordered me a ResMed S8 Vantage APAP, whicjh I've been using since. I think that the humidifcation of the F&P was much better, but the humidification of the ResMed seems to have become OK as I've adjusted to it. I don't really experience "rain-out" with the S8, but there are certainly more droplets in the pillow sleeve of my Swift than I had with the F&P. And, I'm using AutoSet rather than CPAP, though loe and behold, my AutoSet is running at 10.0 just like my CPAP did, 95% of the time.

Anyhow, I hope that things are working out OK for you. I just wanted to let you know that, though I think that the Fisher & Paykel CPAP is top-notch, I too had problems with what I believe was the heated hose heating the air enough so that it felt uncomfortable and woke me.

Best of luck to you!!!!!!!!!!

Chuck

[STEVIEW]

Thanks for the reply, Chuck. Actually, last night I had my best night yet. I also tried lowering the temperature on the humidifier, and it made a big difference. I also loosened the straps on the mask, and I think I FINALLY have them right! I've also noticed one other thing since I started with the CPAP - I don't get up during the night for a bathroom break. I wonder if anybody else has noticed this? Between my deeper sleep and less interruptions to get up, I'm starting to feel much better (especially since I usually only get 6 hrs of sleep per night.) I also take medication for high blood pressure, and I wonder if I will see changes in my blood pressure, now. Anybody else have input on this?
Thanks everybody - this is a great forum!

Steve.

[GoofyUT]

Congrats on your good night Stevev, and I'm sure that, now that you've got things dialed in, it'll be the first of many (though you'll have occasional stinkers from time to time, just to keep the adventure going)!!!!

Re: nocturnal trips to the can, yes, frequent awakenings to void are a cardinal symptom of OSA, as I understand it. Many of us awaken because of obstructive (or central) events and then tell ourselves that we have to go (to explain away the awakening). Most of us have found that one of the first things we notice as treatment starts working is that night-time bathroom trips diminish or disappear.

Regarding your blood pressure, increases in blood-pressure secondary to the OSA are another cardinal symptom (again, as I understand it) and are related to the adrenalin surges that your body will produce to get you breathing again after an apnoeic event. Therefore, as the events decrease and stop, your body doesn't need to produce these boluses of adrenalin,and so, your blood pressure will decrease. Mine sure did. I was diagnosed with OSA after a split night study during my last night in the hospital after my first (and hopefully last) heart attack on March 31st. Last evening I had my pressure checked two minutes after heavy exercise in my cardiac rehab program and it was 106/72. So, yes, it does work in decreasing blood pressure for many folks.

Congrats again, and make sure to keep us posted as to how its going!

Chuck

[Guest]

another rank newbie question: what does "AHI" stand for?

[Bingo]

AHI = Apnea Hypopnea Index.

It is the number of Apnea Events (Central, Obstructive and Mixed) added to the number of Hypopnea Events (Central, Obstructive and Mixed) divided by the number of minutes you slept.

EDIT= Oh, and doing it this way you also need to multiply by 60 since this gives you a range in MINUTES and not hours, which you need.

Bingo

_________________

CPAPopedia Keywords Contained In This Post (Click For Definition): AHI, Hypopnea

[GoofyUT]

Apnea-Hypopnea Index (AHI)

# of Apneas + # of hypopneas/total hours/60

It'll give you a rough indication of the number of events (apneas and hypopneas) that you'll experience in an hour.

There's also AI, which is the Apnea Index. Same formula, just with apneas only; and, HI, which is the hypopnea index, for hypopneas only.

AHIs less than 5 are considered to be normal.

Chuck

[winknblinknnod]

Ok, that must be the "11" they told me about, as the doc stated anything over 5 was considered OSA and I am a mild case. (the above was my question, had forgotten to signin)

[GoofyUT]

Well, 11 may be your titrated pressure. Generally, you need to have more than 20 events per hour to qualify for treatment under Medicare rules, which are the rules that most insurance companies follow.

Chuck

[winknblinknnod]

I know my machine is set on a pressure of 7. One of the things I have had problems with the lack of information coming from the doctor, I had to ask the tech what my oxygenation % was (down to 86% for 7 minutes during the four hour sleep study) and I had to check with my sister who's a nurse to see what they want oxy sat at (over 90% at all times).

I am definitely a mild case but I got treatment because my husband was hearing me stop breathing at night, along with horrific snoring. I think the doctor stated "you wake yourself up 11 times an hour". It was enough to make me groggy and unable to focus a good part of the day. Insurance is covering 80%.

I already had a follow up dr visit and he wouldn't switch the machine to anything other than this basic one, which I believe does not give me any info on what's happening at night, only reports via a memory card that it is in use and how many hours per day.

[Guest]

Well, 11 may be your titrated pressure. Generally, you need to have more than 20 events per hour to qualify for treatment under Medicare rules, which are the rules that most insurance companies follow.

Chuck

Just as an FYI - this changed a while ago - I think it was a little over a year ago now.

It USED to be a patient had to have an AHI of 30 or more with a minimum of 2 hours of recorded SLEEP time.

However, it was changed (Again I think a little over a year ago) to new guidelines:

INITIAL COVERAGE:
A single level continuous positive airway pressure (CPAP) device (E0601) is covered if the patient has a diagnosis of obstructive sleep apnea (OSA) documented by an attended, facility-based polysomnogram and meets either of the following criteria (1 or 2):

1) The AHI is greater than or equal to 15 events per hour; or,
2) The AHI is from 5 to 14 events per hour with documented symptoms of:
a) Excessive daytime sleepiness, impaired cognition, mood disorders, or insomnia; or,
b) Hypertension, ischemic heart disease, or history of stroke.
If a continuous positive airway pressure device (E0601) is provided and the criteria above have not been met, it will be denied as not medically necessary.

For the purpose of this policy, polysomnographic studies must be performed in a facility based sleep study laboratory, and not in the home or in a mobile facility. These labs must be qualified providers of Medicare services and comply with all applicable state regulatory requirements.

For the purpose of this policy, polysomnographic studies must not be performed by a DME supplier. This prohibition does not extend to the results of studies conducted by hospitals certified to do such tests.

If there is discontinuation of usage of an E0601 device at any time, the supplier is expected to ascertain this, and stop billing for the equipment and related accessories and supplies.

Hope that helps clear it up a bit.

Bingo

[GoofyUT]

Thanks so much for the update! (Wonder what'll be next year.....With the Deficit Reduction Act, it'll probably go to >300/hr!)

Anyway, thanks again.

Chuck

[snoregirl]

To stevie

I also used to get up to use the bathroom 2 to 3 times a night, I am now down to zero!!