APAP or CPAP? Very confused

Luthie2006 wrote:Again, I don't know what I would do without all of you, and this is my first day on this site!!
The sleep clinician called me back, and as I stated in my last email, she agreed, that they are going to get zilch, zaddo, from my data card if I have the Escape!
She wholeheartedly agreed with this. She told me to bring in my Escape Auto machine tomorrow morning as I was going to do before, and she is ordering me a brand new S-9 AUTOSET machine which I will pick up tomorrow evening at 5:00 pm. I never EVER would have known this information that the Autoset was so much better if it was not for this website and I thank all of you so much!!! AND NOT ONLY THAT, she is going to tell the doctor that on all his orders from now on he should specifically write S-9 AUTOSET. And this is as large teaching hospital out of Chicago!! They assumed that everyone was getting the AUTOSET.
So you guys helped me, I contacted my sleep technician and she contacted the physician that on his orders it should state, AUTOSET, and now MORE PATIENTS will be helped by all of you! Thank you again. By the way, since I will receive no training on the AUTOSET, is it the same dials as the Escape? I will not have availability to be trained. They are going to set the pressure though on this one maybe a little higher and actually she even said it's almost a waste of time to download its card, but she will anyways because I have to bring it in to be exchanged. Thank you guys! Love you!

Just for the record, if the MD ordered the prescription for X-brand and model machine they have to provide only that machine. If the clinician just prescribes "cpap" or "auto cpap" or "bipap", etc., then the DME can provide whatever machine they choose that fits that description. It seems your MD failed to specify. It's more profitable for DMES to give you a cheaper machine since they get paid the same by the insurance company for a cheap machine or a more expensive machine of the same type.

But just because they buy a machine 'in bulk' doesn't make it a bad machine. The ResMeds are all very high quality, quiet machines with good reputations from most posters. The more basic model, even without data recording, could be just fine for certain patients. Your problem is you didn't seem to have a full, multi-lead sleep study (which can be done either in a lab, or at home by trained people. Better Sunrise Corp. does full home studies in Chicago area). So if you don't get a proper titration study, you may diagnose apnea, but wont know exactly what the machine needs to be set at. If you had a full titration done, you could very well get by living with a non-auto or a brick machine. Not ideal but it does work for many. You may need more, subsequent titration studies done later on, which will cost more money, and your therapy may not be as good, but certainly doable. An auto, data capable machine can act as a partial substitute for a titration study. Not ideal, but for some its enough.

Good you are now getting an auto-data machine. Although, beware, you may STILL need to get a proper titration study even with the more advanced machine, for the reasons stated above. You will learn, there are a lot of variables with X-PAP therapy. Just wait until you start venturing into mask purgatory....

No, I did NOT have to fight with anyone to get an exchange of machines. Actually the DME Purchasing Director said I should exchange it! So the last 2 weeks have been h---- for me sleeping at night. The physician is not sure what is going on but they feel I am awakening from the air pressure changing all the time.
They will try to read whatever is available to them on the data card (which I understand is not much), and just switch it out for me. What a revelation I learned today! Again, thank you all! Back to work now, only 3 more hours until I can go home and try and sleep for a little while, WITHOUT any masks or machines. Have to pack it up and bring it back tomorrow morning. Thank you again, all!

I also did NOT know that people cannot breath at "4" cm. That is what they the doctor wanted me to be set at, 4cm. I seemed to sleep ok with that pressure actually, but who knows what was happening to me in the middle of the night be awakened almost every hour and totally a basket-case today with lack of sleep for 2 weeks in a row! Since I had no sleep lab study in a lab, it was hard for the doctor to adjust the pressures and so he started at me at 4-20. Who knows how high it went up to in the middle of the night? And now that I know I didn't have a great machine (Escape auto) they cannot retrieve the information they wanted. So now it will be more guessing games even when I do exchange the Escape for the S-9 Autoset tomorrow morning. The doctor is going to set it who knows where based on who knows what? It's a shame, because I was getting very adjusted to the face mask (WISP) and chin strap. So we will see what pressure he sets the air on to start and what happens. I do have a feeling that he is going to increase it tomorrow when I pick up the machine at the hospital.

Luthie2006 wrote: So the top cadillac model is S-9 Autoset? Thank you again

Nah it is not even a Cadilac, it is just the version with the automatic transmission and cruise control.

So to Hyperlexis: So how do I get a titration study when I cannot sleep at a sleep lab? I did check out Better Sunrise Company in Chicago, and they mostly specialize for oral dental devices, although it did look like they also do for CPAP machines. I can't go that route; I know insurance won't cover that. My doctors felt that the in-home sleep study test that they gave me for 2 nights was sufficient at the time.

I agree with you, however, that they are just "guessing" at what my pressure should be at. That is why it is from 4-20. I am hoping with the newer machine, that they will adjust the pressure higher maybe than 4 and see. If not, and the increase of pressurized keeps me up every hour, then I quit! Unfortunate because I am doing very well with the mask and chin-strap.

You can adjust the pressure yourself - move the '4' to e.g. 6 or 7 or 8, and either leave the '20' where it is, or move it down to e.g. 15. And once you've got at least a week of low pressure readings of e.g. 9 or 12 or wherever your stats sit for 90/95% of the time, you'll have your titration, but of course continue to monitor for a longer time, or 3 x a week to be sure about the range. We can help you with the adjustment if you need it.

Luthie2006 wrote:So how do I get a titration study when I cannot sleep at a sleep lab?

Don't worry about an in lab titration study at this point. Worry about it later if the need arises. If you have plain jane OSA with no complicating factors there's a real good chance that things can get all sorted out by using the AutoSet's data.
Cross the "what if" bridge only if you need to.

Luthie2006 wrote:they are just "guessing" at what my pressure should be at. That is why it is from 4-20. I am hoping with the newer machine, that they will adjust the pressure higher maybe than 4 and see. If not, and the increase of pressurized keeps me up every hour, then I quit! Unfortunate because I am doing very well with the mask and chin-strap.

Again...let's get see what the machine is wanting to do in terms of pressure...you know it might not be the pressure changes that are waking you up. It might be sub optimal therapy itself meaning apnea events are causing the arousals because the minimum pressure of 4 is too low.
Not only is the 4 cm a bit suffocating...if your pressure needs are say 9 or 10 then it may take too long to get from 4 to 10 and the airway closes off and the apnea event itself is the disturbing factor and not so much the change in the pressure.
We won't know what the machine is doing until we see some data.
When I first started therapy we set my minimum pressure to 8 cm and had the apap max at 12 I think it was. My AHI was still around 10 with the 8 cm starting point and I was waking up like crazy and still feeling like crap. So I gradually worked up to the minimum of 10 cm and I think I just opened up the maximum because it wanted to go there sometimes.
My AHI dropped to 3...I started sleeping soundly and longer each night and the headaches went away and the nocturia went away and I actually felt better during the day...So I needed 10 cm minimum to give the machine a good head start to preventing the apnea events. The machine works best when in "prevent mode" instead of "fix it after the fact mode".
Besides...often when the minimum pressure is more optimally set...the machine doesn't go increasing the pressure nearly as much and often the max pressures seen will reduce.

Now I don't know what is going on in your situation but it wouldn't be impossible for the same thing to happen to you. We see it all the time. Them minimum pressure just doesn't give the machine a good enough head start. Maybe you need 7 cm..maybe more.. We won't know until we see some reports. The minimum pressure is the most critical pressure setting when using any auto adjusting pressure mode machine. It has to be high enough to give the machine a good head start to where it needs to be to prevent that airway collapse. It can't go from 4 to 10 in the blink of an eye...it doesn't do anything that fast. Unfortunately that is what some people think it can do but it can't.

So don't go down the "what if" road until you see what's going on and if we do find that you are sensitive to pressure changes...that's easily fixed by either a really tight apap range or just use cpap mode. You may or may not require a huge pressure difference for those REM related events.

In lab sleep study...worry about that later if we run into problems that can't be sorted out from what we see in terms of data on your report and how you feel.

Luthie2006 wrote:So to Hyperlexis: So how do I get a titration study when I cannot sleep at a sleep lab? I did check out Better Sunrise Company in Chicago, and they mostly specialize for oral dental devices, although it did look like they also do for CPAP machines. I can't go that route; I know insurance won't cover that. My doctors felt that the in-home sleep study test that they gave me for 2 nights was sufficient at the time.

I agree with you, however, that they are just "guessing" at what my pressure should be at. That is why it is from 4-20. I am hoping with the newer machine, that they will adjust the pressure higher maybe than 4 and see. If not, and the increase of pressurized keeps me up every hour, then I quit! Unfortunate because I am doing very well with the mask and chin-strap.

Better Sunrise does sleep testing at home, including titration studies. They are accredited and they do full, multi-lead studies. Much more sophisticated than do it yourself home tests. They send a tech to the house to set up the equipment and wire you up, and set up masks and a test cpap machine and a remote video camera. They then have a separate MD read the study and recommend pressures, etc. They don't specialize in one device, dental or cpap, or the other as far as I know. All I know is they are the only place in the area I found that does a proper study in a home setting (they did my diagnostic test, Merit did my titration test in their lab.) So as long as Better Sunrise can test you properly, that's all that matters. Your MD will determine later whether you need a cpap or other treatment type like a dental thing. The testing itself, however, is agnostic.

Luthie2006 wrote:So to Hyperlexis: So how do I get a titration study when I cannot sleep at a sleep lab? I did check out Better Sunrise Company in Chicago, and they mostly specialize for oral dental devices, although it did look like they also do for CPAP machines. I can't go that route; I know insurance won't cover that. My doctors felt that the in-home sleep study test that they gave me for 2 nights was sufficient at the time.

I agree with you, however, that they are just "guessing" at what my pressure should be at. That is why it is from 4-20. I am hoping with the newer machine, that they will adjust the pressure higher maybe than 4 and see. If not, and the increase of pressurized keeps me up every hour, then I quit! Unfortunate because I am doing very well with the mask and chin-strap.

Luthie2006:

Why can't you sleep at a lab? You had a bad experience at one years ago? I was tested at one last week which was hospital based and I couldn't have asked for a nicer private room with my own private bath and shower; my only complaint was the mattress on the bed was too soft; I sleep on a super firm mattress on my bed here at home. I return to the lab next week for my titration where I hope to find out after that test is done and scored by the lab's doctor if my pressure has increased much past my current straight CPAP pressure of 18cm. There is no way I could start out on a pressure of 4cm; no way.


Stevoreno_55
MS Gulf Coast
05/30/14

Pugsy: And everyone else: Again I so appreciate all your advice. You are all so experienced! I actually went very early this morning and dropped off my
brand new Res Med Escape machine back to the hospital and we are going to do a switch-out later. I am going to pick up a brand new Res Med Autoset machine. I feel like an idiot! I do my "homework" on everything and was focused more on the homework on masks. I did NOT know that machines vary so much with data cards! Even my sleep clinician was surprised and upset that I got the Escape model because she said of all people, she needs to have more precise information from the data card for the physician, and my bringing it in this morning she said and picking up the Autoset after work, is like starting all over from "scratch." The physician will give her instructions as to what to set the machine at because I am up every hour or so with it just staring at my pillow for no "apparent" reason.
As to the person who wrote (I am so sorry, I forgot their screen-name) as to why I can't do a hospital study: I went last summer and had a super nice tech. I never have insomnia falling asleep, but I could not get to sleep no matter what. The hook ups all over me and wires, and being watched on a video made me feel creepy. She was very sweet. What I did NOT like it was a communal bathroom for one person; but she always checked to see if someone was in there and would walk me with the wires hanging all over. I slept for 90 minutes total out of 8 hours and supposedly I went through all the stages of sleep and it was determined that I DID NOT HAVE sleep apnea.
I went to a new doctor (my current one) and he said that 90 minutes of sleep in a hospital sleep-lab is not enough to determine sleep apnea or not, and it is very obvious that I won't do well with another expensive hospital study (it was proven by me unfortunately) He said that they have been having very good luck with their newer in-home sleep study by a very reputable company. My insurance paid for it, and I was trained on how to hook it up with a 24-hour call number from my personal sleep clinician, and if I had any questions to call her personally on her cell day or night. They were smart and let me keep it for 2 days overnight, and I got 4 hours of sleep the first night (in my own bed) and 6 the second night. I did call her about the cannula that was bothering me on my face and she told me how to adjust it. Of course it does not show as much as an in-hospital lab would and there is obviously no EEG connection. My physician was ok with that and this is how my results were interpreted at the hospital. I can't wait to go after work to pick up my new Autoset. And it is because of Pugsy and all others on here that showed me what to look for. As far as pressures, the doctor is going to set it today, to what I have no idea.

My only concern about the pressure settings right now is that the minimum starting pressure be comfortable for you while awake. Lots of times techs and doctors just start out with the 4 cm minimum because they assume it will be "easier" for the patient but instead it often creates a suffocation feeling. No we won't suffocate at that low of a pressure but it can sure feel like it and feeling like it can disturb sleep....can't sleep so great if we feel like we have a pillow over our face.
So when you get your machine....test it out there is you can to make sure you are okay with whatever it is set to start out at and if you aren't okay with it...have them change it right then and there.

Treatment needed pressures are easily determined once you can sleep successfully with the machine and data is available to see what might need tweaking. Right now the primary goal is to get you to sleeping.
There are some logical steps to take and try should it be seen on the reports that the pressures are varying wildly which might be compounding the staying asleep problem. It's not difficult. Unless you have something else going on like PLMD there's a real good chance that suitable pressures can be isolated in just a few nights.
It took me 3 nights I think it was to get mine sorted out once I had access to the software reports. I did it myself and I was about as green of a newbie as they come. You have a sleep clinician who understands the importance of the data and I assume also understands the common sense things that can be done easily to optimize your therapy in short order.

You can look at your data after the first night if you wish. We can help you understand what you see. Since you seem to have a knowledgeable medical professional at your side....might as well let her do her job. So I don't want to cut her out of the picture but if we see something standing out then we can suggest more specifics about what to talk to her about.

TO PUGSY: Thank you so much again! The medical professionals I have are great, however, I like this site better. She is a CPAP user herself and so is my sleep physician who is in critical care medicine at the hospital. However, I don't like bothering them too often anyways because they have a zillion other patients. I am not the only one. Yes, it is important to get this right, and like an idiot (newbie greenhorn I am), I kept sleeping with this machine set at 4 for 2 weeks with virtually no sleep. I am not sure what she or the physician can read when they pull out the data card from The Escape machine this morning; but obviously not enough! I did sleep with it for 2 straight weeks and only pulled it off the first couple nights in the beginning. Not only do I have no idea what the numbers mean, but I have no idea on how to press what buttons. I didn't know how to on the Escape machine, and I don't on the new machine I am going to get after work. She will tell me what the doctor set it at. I think they are going to go up in pressure. I didn't feel that I was suffocating at all with a pressure of 4 during the past 2 weeks. (I use the WISP nasal mask) with a chin strap maybe because the air is still going out of my mouth? But at any rate, he is going to do some changes today on the new machine. Perhaps when I receive it, someone can tell me what "buttons" to press to even see numbers that I am supposed to look at. I know at the DME, the therapist did not want me "touching" anything and to just click it on, and off, and showed me how to turn on the humidifer, how to clean it, etc. I was afraid that somehow I would adjust the pressure setting, so I never looked. I just pressed it on and off. And it was so much to take in at one sitting for 1 1/2 hours, that I was happy just to learn how to connect everything up. So maybe someone can tell me what buttons to press without disturbing my pressure button (my fear). I can be concerned on what the numbers mean later on. Thank you Pugsy and everyone!!
Luthie 2006 (I am female) and also I am not quite sure how to change that on my profile?

Luthie2006 wrote: I know at the DME, the therapist did not want me "touching" anything and to just click it on, and off, and showed me how to turn on the humidifer, how to clean it, etc. I was afraid that somehow I would adjust the pressure setting, so I never looked. I just pressed it on and off. And it was so much to take in at one sitting for 1 1/2 hours, that I was happy just to learn how to connect everything up. So maybe someone can tell me what buttons to press without disturbing my pressure button (my fear).

The machines are designed so that it would be very hard to change the pressure accidentally by pushing a button. At most, you might hit a button for the ramp setting. Once you have the machine, someone can point you to the clinician's manual if you actually do want to alter your pressure.

If there's stuff that didn't sink in in the hour and a half, just ask here. Someone will know.

Here's a link for the clinician manual for the S9 Autoset so you can learn all the ultra secret how to do this or that.
http://www.apneuvereniging.nl/forum/pdf ... manual.pdf
and here's a video showing and explaining
http://www.cpaplibrary.com/machines.html
Even if you make a mistake with pushing the buttons it's not the end of the world and easily fixed.

To change your profile to add female to it...
from the User Control Panel link at top left....click on Profile tab...then you will be on the "edit profile" page and scroll all the way to the bottom to see selection for male or female...mark it and don't forget to click on "submit" or it won't stick.

Might also want to watch the ResScan video as it will give you an idea what your machine can do.
http://montfordhouse.com/cpap/resscan_tutorial/ Tutorial
Send me a PM if you want ResScan. SleepyHead information is in my signature line

Thanks Pugsy: I will attempt to do this on my lunch hour or at home later. Thank you so much!