Newly diagnosed severe CSA & OSA (AHI=108) seek advice

[SarcasticDave94]

Great thought there. To a great second half of the weekend

[Liteheart1]

Any input on what to ask sleep doctor at my meeting on Feb. 6th?

I had 2nd sleep study yesterday and while technician could not legally tell me results, listening between the lines it is clear that CPAP failed at the Medicare required pressure to control Central apnea AND that has sleep doc expected that the study could move to ASV titration. She is going over results with me late today and I expect will expedite Rx that would allow me to then get ResMed 10 ASV machine. Study was done with mask being Respironics Wisp.

?s I plan to ask:
1) What was AHI and other key statictics?
2) During ASV did it improve/reduce Centrals? What happened with OSA events?
3) Were there significant differences in events or pressure needed when side sleeping vs on back?
4) What are recommended pressures?
5) Any significant mask leaks?
6) Will she ask that machine be setup so that I can make slow changes to settings based on the data from Myair and/or OSCAR?

Thanks as usual ...

[Gideon]

1. Get a Full copy of your Sleep Study, for YOUR records.
2. go over these results with your doctor, take notes.
3-7 your 1-5
4. How do we go forward? What are your plans?

your # 6 6) Will she ask that machine be setup so that I can make slow changes to settings based on the data from Myair and/or OSCAR?
No she will not. At least it would be very unusual.
Once you know what machine you will be getting, request the manual here (the CPAP Setup button in the black banner

[Liteheart1]

Thanks @Bonjour for reference to article and answers to my questions.

[Sleeprider]

LIteheart1, you know the game on ASV approval with Medicare. I would not hesitate to discuss this with your doctor to let him know, you know. The point is, between the two of you, there should be a plan to expedite the path to the right therapy, and you will do your part to get there. Ask that the doctor do the same. Too often this process is frustrating for everyone involved. Ask him what needs done, and get a feel for the path forward. Express a preference for the Resmed Aircurve 10 ASV over the Philips BiPAP SV Auto. Keep us posted on how it goes.

[Liteheart1]

Picking up Eesmed 10 ASV Feb 13th. How should I take advantage of this 1st contact with DME especially with regard to  mask?

Only exp I’ve had is 2 sleep studies. Most mask exp so far is with Wisp which seemed to work very well during 2nd study and ASV Titrarion which for my CSA went from about 40 down to 2.6. I am side sleeper and per sleep study have a lot of leg movement but when I asked was told that there was no significant mask leakage with Wisp. I didn’t wake with nose or throat dryness and only slight nose indentation which went away fairly quickly. 

Are there other nasal masks I should audition? I definitely do have mouth breathing and during 2nd sleep study wore chin strap which I was fairly ok with. It was the chin strap style of a white cloth stretch strip that goes under chin and then up over head. Found that chin style more acceptable than the strap that actually goes around chin. I know that supplier 1 indicates their most popular nasal mask is Resp. Blue gel. I sleep quite warm and as we move into spring and summer expect I will prefer minimum stuff on face. While I’m doing exercises to encourage nose breathing chin strap might always be needed. Not sure if I tuck my chin but PSG tech did not indicate so. 

In first sleep study they moved me to FFM which I found a bit claustrophobic but I was dealing with the surprise of an unanricipated diagnosis of apnea and strange environment. Nonetheless I think I might prefer nasal mask with chin strap to FFM. never tried nasal pillow.

When people write here in wiki that DME gives 30 day trial on mask is that 30 days for each mask versus having just one 30 day period to try several masks and settle on one choice at end of 30 days? If the former then figuring out food mask for me is less urgent. As I wrote at least for 2nd study and titration the Wisp mask did great job with the ASV.

I started reading wiki on picking up machine including checking hours so you know it is actually new and etc. right now it is only the mask that I seek input about.

Sorry for such a long post but not sure what info you need to make a mask recommendation but realize ultimately one has to try a mask under pressure to feel whether it might have promise for yourself. My face is a bit on on the thin side and nostrils are normal or perhaps slightly narrow. Tech has rexommend d Wisp and except for FFM have had no other experience at all.   

As always much thanks.

[Sleeprider]

We have a very good Mask Primer wiki that is worth a read http://www.apneaboard.com/wiki/index.php...ask_Primer

The Primer covers most of the bases. You want a mask interface that fits and is comfortable for you. Take a look at the Primer and let's narrow your questions about masks down to whatever you still need to know.

[Plmnb]

...not sure what info you need to make a mask recommendation but realize ultimately one has to try a mask under pressure to feel whether it might have promise for yourself. My face is a bit on on the thin side and nostrils are normal or perhaps slightly narrow. Tech has rexommend d Wisp and except for FFM have had no other experience at all.   

Hello Liteheart1.

The right mask for you is part of the battle of conquering the apnea biz.  Trying the mask on under pressure is very important yes, but be sure to try it in the sitting up position AND the laying down position.  My DMD has no proper laying down trial area.  I told them this is ridiculous and then told them I'd lay on the floor, they were not pleased with that. so I proceeded to lay down as much as I could in the chair, still not the same). 

Also, I am a big proponent of the foam mask.  After a million different masks, nasal, hybrid and FFM and never being told there was a foam version it was FINALLY brought up as an option.  As a mouth breather who didn't want to try the techniques to avoid mouth breathing, and then finding the nasal masks useless for me, I tried the FFM again since they have come out with so may new and improved ones since my first therapy experience.  All except the foam mask leaked way too much, no matter how tight or loose I made them. So back I went to the DME.  When they ultimately had me try the foam mask I was almost in heaven.  The benefits for me are that I can avoid the slimy feel of the silicone(?), get a better seal, and mask doesn't move around so much.  I have the ResMed AirTouch F20.  See if you can try out this FFM when you try others.

I also found out recently that there are different head gear sizes available.  The starter kits usually come with a size that should work well with most everyone.  Of course I have to go be not an everyone.  Based on a post in a thread on here I contacted my DME and they are sending me the size small, a for her item, headgear.  I just can't pull the straps as far as they need to be.

Good luck in your experiences with your therapy.

Plmnb

[Liteheart1]

Thanks all. I did read the mask Wiki. At the moment my ?s are, however I'm in ball park of being set for pick up Resmed 10 ASV on Feb. 13th:
1) is 30 day mask trial that it seems DME offers 30 days for @ mask that you audition? versus a total of 30 days and you have to make a decision at end of that 30 days?

2) Any other masks to give a try for side sleeper with some mouth breathing who plans to wear chin strap?
I will as already suggested check ResMed AirTouch F20.

3) Will try masks under pressure and lying down? Why was it also suggested to try them sitting up?
I imagine that if doesn't leak sitting up AND no leak lying down that it might imply better fit?

Will be able to fill in more on my side bar profile soon.

[Gideon]

I hand fit any mask I am trying, no straps, if the mask contours do not come close to fitting my face there is no need to going any further. The initial fit I do is either standing or sitting. ALWAYS UNDER PRESSURE. If a mask makes the hand fit I adjust the straps to match the feel of the hand fit. The two most issues with a mask are it doesn't fit your face or it is too tight (which will cause leaks) The smaller the mask, assuming it fits, the fewer leakage problems you will have. That is pure physics.