[Diagnosis] What should my next steps be?

[Pet0r]

I have lurked for a while and just want to say thanks in advance for all the great advice the members here provide.

For many years now I've been snoring quite loudly and the only thing I could find that helped at all was a tongue retainer. I was using this and it was enough for me to fall asleep but it did not actually stop me snoring at all according to my wife. I've noticed in recent years that I can no longer fall asleep without the tongue retainer, if I try, I hear myself snore and get jerked awake again and again.

I figured that I should probably have a sleep study done of some kind, and so I ordered a WatchPAT test from Intus Healthcare (I'm in the UK), and I now have the results saying that I have moderate sleep apnea. It took me a very long time to fall asleep and sleep was particularly bad because I decided to not use my tongue retainer to try and ensure it would not affect the test.

I have read a lot about various subjects like UARS etc. and was wondering what you think my next steps should be. I have not spoken to an actual doctor about the issue yet and I guess that will be difficult due to COVID. As soon as I got my test results I was very interested in immediately ordering a CPAP machine at my own cost (and I am still fine with paying for it), but it feels like a huge mistake if my test results look like I actually need a BiPAP or something like that, so would love any feedback.

   
   

[SarcasticDave94]

Welcome to Apnea Board.

I guess I was hoping there'd be stats for the apnea event types. But I didn't see them, likely because of the test parameters in itself. Just going by what I see, I'd consider taking the proper steps to grab a ResMed AutoSet. I don't see anything specifically pointing to a need for a Bi-Level/VAuto or an ASV to deal with high CA. And again, this lack of info can be a tricky thing to navigate. I do say if the votes are in for a CPAP, an AutoSet by ResMed is the top pick. If a Bi-Level is called then VAuto is great, again a ResMed. The ASV is a specialized Central Apnea killer, and I don't see any evidence of needing it with what we've been presented. Let us see what others see and what advice comes up. I'm not at all certain what your steps are medically, if you need Doc to sign a script or if you just decide after tea to order up a shiny new CPAP and be done with it.

[Pet0r]

Thanks, I'm able to buy a ResMed AirSense 10 AutoSet without a prescription based on the result of this test, but if I needed something like a BiPAP I'd need a prescription. So my main concern was that I'd buy an APAP on my own dime and then if it turns out I needed something different I'd have to arrange returning that or selling it.

As you mentioned, will wait for some others to chime in as well, but I'm glad I asked because I was looking at a Phillips DreamStation so if the ResMed is a better choice that's good to know.

[staceyburke]

First I would suggest Supplier #2 from the supplier list at the top of this site. They WILL send internationally and you can buy used from them. I purchased mine used (1 month) for 70% of new on another sites. They also sell new. Great company.

BE SURE it is a ResMed airsense autoset (Cpap) or Aircurve ( bipap). NOT a Phillips dreamstation.

[Sleeprider]

The Airsense 10 Autoset acts as a bilevel with up to 3-cm of pressure support (EPR). I think it is very likely you will get the therapy and relief you need from this device. If it turns out you need a higher level of therapy, then we can cross that bridge when we reach it. Most people start with CPAP therapy, and those that manage to get the Autoset end up with a bilevel capable machine that relieves the flow limitations and hypopnea common with upper airway resistance. Once you begin therapy, we can assist you with optimizing settings and getting as comfortable as possible. The initial adaptation to therapy is more complicated because you not only need to get used to positive pressure, but also the mask interface. There is no way to predict if you need bilevel based on the test you posted, but most people get immediate and significant relief from the Resmed Autoset. Any improvement from something like the Aircurve 10 Vauto will be incremental, and by far the biggest difference will be just getting started. It's not a risk free decision, but it works more often than not. The Vauto provides a higher maximum pressure and more pressure support. I think the task at hand is to treat your AHI and RDI as best as possible with the Autoset, then advance to higher therapy if needed.

Our Supplier #2 has provided many CPAP and VPAP machines to members in Europe, Australia, Asia and even South America. You might want to look at their prices. I think they are selling the Autoset new for $539 U.S.D and the Vauto lightly used at $799 U.S.D. You may have import taxes and shipping in addition to that, but many can save from that source.

[OpalRose]

When I first looked at your report, I didn't see a breakdown of events, but went back and looked again.
From what I can see, I agree with others that a ResMed AirSense 10 AutoSet would be the best choice.

[SarcasticDave94]

OK there you go. I hope all the info helps cut through the murky CPAP world for you. Most PAP users need only a nice Auto CPAP like this AutoSet, and it should serve well. You can get the clinical manual in the above CPAP Setup Manual section to learn about the machine, what the settings are, and how to edit them. Download OSCAR and you can use an SD card of between 2-32GB to store data and to upload it to your PC. You can then take screenshots of this data and add it as an attachment here for us to review and help with pressure setting suggestions.

[Pet0r]

Thanks everyone for the advice. I decided to with Supplier #23 as they are the people who supplied my sleep test so it was eligible as proof with them quite easily, and they are UK based so shipping is faster and any warranty issues etc. will be easier.

I *should* receive all the equipment tomorrow, if not it will be Monday. Any first steps recommended during setup? I have read a bit about it and I suspect I want to turn on EPR via the Clinician's menu which looks very easy.

For reference I ordered the following:
- AirSense 10 AutoSet CPAP
- HumidAir Humidifier Water Chamber for AirSense 10
- Resmed AirSense 10 ClimateLine Air Heated Tube
- DreamWear Gel Nasal Pillows Mask - FitPack

I was going to order an AirFit P10 as my first mask to try but they did not have stock of it and advised it would be a 1 week wait time, so I decided to go with the DreamWear. They offer mask insurance for a nominal sum which I did pay for so if it's not a good fit for me I can return it up to 28 days later for a full refund.

[SarcasticDave94]

I'd say the only thing is to get OSCAR onto the computer and have it ready. Your PAP may not come with an SD card. You'd want/need one to work with OSCAR. It is a standard sized SD or SDHC with 2-32GB capacity, and any brand is good; the SD need not say ResMed. A digital camera store or electronics store is maybe your best bet.

Settings: you'll want mode of Auto, probably starting pressure 6 or 7 on the low side, upper side maybe 20 (it's likely to be needing less) just to have the OSCAR data tell you what the machine needs to address your events, with EPR on Full time setting of 2, humidifier and heated hose as you see fit maybe starting with Auto humidity at 4 and heated hose 75 degrees - humidity and hose temp will need adjusted to your preferences, and weather/seasonal changes may require adjustments.

Image of where SD goes on your PAP:

[Pet0r]

So my equipment arrived yesterday and last night was my first night using it. My mask fit is not great, I don't think there's any leaks but it was a little uncomfortable - I need the larger frame size, I ordered that and it should come tomorrow but will have to put up with that again tonight.

I didn't find much problematic, it took a while for me to fall asleep, and I also woke up early so I'm a bit tired today, but I attribute that to it just being the first night getting used to things. I also woke up once during the night, not sure why, and messed with my mask a little bit to try and get it a bit more comfortable. Overall, it was a positive (ha!) experience, I did not have any of my usual "snore and wake myself up as I'm falling asleep" problems at all, and I used SnoreLab to record my snoring and the loudest thing it recorded all night was just me moving around a little bit, a huge improvement.

I ended up going for 8 as the minimum pressure but with everything else as suggested above by Dave. I've attached my output from OSCAR, I removed a couple of sessions before and after my main sleeping where I was just getting used to the mask and adjusting the fit a bit.