[Diagnosis] Study results and Comfort vs Treatment

[Sn00zeAlarm]

I finally got a sleep study with positive results, with the help of one Ambien tablet.

The average AHI over the 407 minutes of the test was 5.2, so I beat the threshold of 5. (yay) Of course, my peak AHI rate is higher than that because I know from my own SPO2 tests that it seems to happen only sometimes. My opinion is that it is more like 10 to 15 per hour, when it is happening. The REM latency was 200 minutes, so I did not start dreaming until halfway through the test. The Ambien may have had something to do with that?

15% of the time was in REM sleep and only 6% was awake, for a Sleep Efficiency of 93.9%. 15% seems low to me - average is 20%. Stage 2 was 54%.

There were 10 obstructive, 20 partial obstructive, 2 central, and 1 mixed apneas. The averge AHI during REM sleep was only 1.0, which I find puzzling. I had thought that the events were more when I *was* dreaming. All I have is the textual summary, so I do not know the correlation of the various events. The longest 'respiratory event' was 63 seconds long, which is sort of scary. The lowest observed SPO2 was 86%.

No cardiac arrhythmias.

So the next step is a CPAP titration study, which will be in a few weeks. We talked a bit about the different kinds of machines. His focus was more on which features deliver better results while I am more interested in the comfort features. I know I will want a heated humidified hose because in our cool bedroom I already get dry nasal passages sometimes. And since my apneas are not continuous, it seems to me like EPR would be a good idea. It did not sound like he was a big fan of autoset machines.

I have done positive pressure breathing during some altitude training at an Air Force base, and I can't imagine sleeping like that. I know CPAP machines are not *that* strong.... are they?

I gave him the speech about having the machine for some years and how it is better to have features you can turn off and on instead of having to trade in the whole thing. But I will expect we will get more into that after the titration study.

[eseedhouse]

I have done positive pressure breathing during some altitude training at an Air Force base, and I can't imagine sleeping like that. I know CPAP machines are not *that* strong.... are they?

The maximum pressure of most CPAP APAP or BIPAP machines is 20cm of water. 1 cm is almost exactly 1 millibar so 10 cm would be roughly 1% of normal sea level pressure. Even 20 cm is only about 2% of normal sea level pressure. So no, you aren't going to blow up like a balloon, in fact your normal machine can't provide enough pressure to do that, whereas your lungs and mouth can.

[trish6hundred]

Hi Sn00zeAlarm,
WELCOME! to the forum.!
Good luck to you at your CPAP titration.
Hang in there for more answers to your questions.

[Inspired]

Hi Snooze Alarm,
When I told the nurse that I wanted the Airsense 10 Auto her reply was that the doctor did not usually prefer that one for his patients. I just continued to be diplomatically persistant, and explained that I wanted it so I could see the data myself, and that since I planned to lose weight I wanted a machine that would enable treatment modifications as my weight changed, instead of having another sleep study every time I lost 10 more lbs (which I cannot afford). I got what I wanted.

It was my careful study of many posts on this forum that helped give me the courage to be assertive, and what to say that would be most acceptable. I know health providers are mostly trying to do their best, but it's YOU or YOUR insurance that pays for it, so you ought to be able to purchase what you want within reason.

One thing I learned on this forum is that DME companies get paid the same amount from Medicare no matter what machine they give you, so of course they want to give you a non-automated "brick", because that helps their bottom line. But insist on what is best for YOU.

[green wings]

I just started CPAP therapy a couple of months ago, so the initial comfort issues are still clear in my memory.

You definitely want to get a mask that feels as comfortable as possible. One thing to check is where the mask vents (air blowing at your eyes and lips can cause problems and is uncomfortable,) and if the vent is noisy.

As far as the pressure goes, it's not that much, but it was noticeable to me at first. The xPAP machines have "comfort features" that are helpful for new users.

One is the ramp feature that starts you off at a pressure lower than your prescribed treatment pressure when you first turn on the machine and gradually increases pressure.

My treatment pressure is low, only 7 cm, but at first I still used the ramp feature to start at 5 cm.

The other comfort feature adjusts the pressure when you are exhaling and has different names on different machines. On my machine, it's called C-Flex.

I started off with a C-Flex setting of 2 (2 cm H2O) but needed to increase it to 3 to be comfortable.

After about a month, I switched to no ramp and a C-Flex setting of 1.

I did find the pressure noticeable when I first started therapy, but it feels normal now.

Even at the very beginning of therapy, though, I would notice that my perception of how much pressure there was would vary. It might be very noticeable for ten minutes and then not noticeable at all, to the point where I would pull the mask away from my face to see if any air was coming through it.

I haven't used a positive pressure respirator like you mentioned, so I can't say how CPAP treatment compares.

I used to scuba dive, though, sometimes below 100' and I also used industrial respirators in fire training.

CPAP is nothing like either of those. I can completely forget that the CPAP pressure is there after a few minutes. There's none of that constantly being aware of my breathing and very little sound from the CPAP machine. I don't hear my breath in my ears like you do when scuba diving.

It's a very gentle pressure.

I usually play music for about 30-40 minutes until I fall asleep. The music means that I can't hear the CPAP machine at all.

I finally got a sleep study with positive results, with the help of one Ambien tablet.

The average AHI over the 407 minutes of the test was 5.2, so I beat the threshold of 5. (yay) Of course, my peak AHI rate is higher than that because I know from my own SPO2 tests that it seems to happen only sometimes. My opinion is that it is more like 10 to 15 per hour, when it is happening. The REM latency was 200 minutes, so I did not start dreaming until halfway through the test. The Ambien may have had something to do with that?

15% of the time was in REM sleep and only 6% was awake, for a Sleep Efficiency of 93.9%. 15% seems low to me - average is 20%. Stage 2 was 54%.

There were 10 obstructive, 20 partial obstructive, 2 central, and 1 mixed apneas. The averge AHI during REM sleep was only 1.0, which I find puzzling. I had thought that the events were more when I *was* dreaming. All I have is the textual summary, so I do not know the correlation of the various events. The longest 'respiratory event' was 63 seconds long, which is sort of scary. The lowest observed SPO2 was 86%.

No cardiac arrhythmias.

So the next step is a CPAP titration study, which will be in a few weeks. We talked a bit about the different kinds of machines. His focus was more on which features deliver better results while I am more interested in the comfort features. I know I will want a heated humidified hose because in our cool bedroom I already get dry nasal passages sometimes. And since my apneas are not continuous, it seems to me like EPR would be a good idea. It did not sound like he was a big fan of autoset machines.

I have done positive pressure breathing during some altitude training at an Air Force base, and I can't imagine sleeping like that. I know CPAP machines are not *that* strong.... are they?

I gave him the speech about having the machine for some years and how it is better to have features you can turn off and on instead of having to trade in the whole thing. But I will expect we will get more into that after the titration study.

[Sn00zeAlarm]

I had my titration study. It was with a Resmed P10 nasal pillow mask, and I went right to sleep with it, though initially it felt like I was not breathing out all the way. This was with the lab-type Philips machine, a sort of industrial-strength remotely controllable thing which is probably not representative of the home types.

No heated hose, but it did have a humidifer. The techs (who both used CPAP machines themselves, which was encouraging) said they always test with a humidifier because if you do the test without it, and want to add it later, they have to do the titration all over again!

There is a Matrix Medical DME office quite near me, and their online catalog does list some machines on the "good" list. Does anyone have experience with Matrix? The second choice, a bit farther away, is Apria, which I know to avoid. Insurance is Medicare plus a supplemental.

I see the doctor next week to go over the results and that is when he will write the prescription.

[bwexler]

Crapria has earned their nickname.
I don't know anything about Matrix.
I would always insist on both comfort AND treatment. After all discomfort will affect treatment.

[Mosquitobait]

So the next step is a CPAP titration study, which will be in a few weeks. We talked a bit about the different kinds of machines. His focus was more on which features deliver better results while I am more interested in the comfort features. I know I will want a heated humidified hose because in our cool bedroom I already get dry nasal passages sometimes. And since my apneas are not continuous, it seems to me like EPR would be a good idea. It did not sound like he was a big fan of autoset machines.

What features did he think delivered better results than a top-of-the-line machine? What exactly in your medical situation says that you can never use an auto-titrating machine? Is his issue that he wants you to use Respironics models because he has that software and not Resmed's? That's the driving force sometimes. Or is it just about auto-machines? Does he know that auto-machines can also be set to cpap mode?

So far, the only medical condition I've seen mentioned where an auto-titating machine cannot be used is someone with unstable blood pressure. The change in pressures can cause a worsening of the blood pressure. Some people DO do better with a straight pressure for comfort, but how would you know that unless you tried auto first? You might find it beneficial to switch between the two at different times of the year.

My doc gave me parameters of 8-12. If I needed higher than 12, then he wanted to know about that. Otherwise, fiddle away. MOST of my problems are with the masks, but that's a different story. I currently have my machine set from 9-11. Due to seasonal allergies, it spends most of the night near or at 11, so essentially it's acting as a ramping function and sticking to 11 all night. I also find that I change the EPR depending on the season. Currently, I have it at only 1. In the late Summer, I NEEDED it at 3.

Perhaps your doctor is annoyed with having a patient who is enthusiastic about working their own therapy. Some doctors want you just to follow their orders. Others are more flexible and give you parameters. He should be happy that you are involved in your own care since many, many people are not.

[Dawei]

When I was pushing for an APAP, my pulmonologist's primary concern appeared to be fear that the pt. would set the pressures too high and this would result in central apneas. When we talked about him writing a script for an APAP for me, I agreed to the idea that HE would set the pressure range, and that seemed to relieve his primary concern in writing the script. What I don't know is whether his reason for being reluctant to prescribe an APAP is typical of sleep docs, or just his own view.

David

[Sn00zeAlarm]

I got my prescription today. The Dr was quite knowledgable about the way DMEs operate. He said that there used to be good ones and bad ones, but these days there are just "bad" and "horrible". He knew Apria's reputation and luckily there is a pretty good DME very close by. He always requests full-data capable machines (*he* wants the data too!) with heated humidifiers. So no arguments on that score.

During the titration study they had me at 6cm with zero events. They had the CFlex setting at "3 out of 4".

I will be talking with the DME next week.