TendererCheese Therapy, Please Help

[Tenderercheese]

Good morning,

  I have been on a CPAP for 6 years now with mixed results.  I was originally diagnosed with a mild sleep apnea, about 7 an hour.  They gave me a Dreamstation and while my headaches went away, the apneas never have.  They are usually between 5-10.  I feel better than before but never wake refreshed.  We've played around with pressures but my doctor doesn't seem to care much as long as I feel better than before.  
  I purchased a new Apple Watch awhile back which I wear to bed.  It showed my blood oxygen level dropping below 90 percent occasionally while I slept.  This prompted me to do some research and download OSCAR.  I have upped my pressure which has caused my oxygen levels to stay above 95% but my apneas are still high.  
  I am an otherwise healthy 35 year old, 6ft 1" 185 lbs and run ultra marathons a couple times a year.  Below are some snapshots of my recent activity.  Any help would be much appreciated!

[factor]

First you know the Phillips ha recalled all their machines except for the Dreamstation 2? Look for the recall thread in the forum.

I am no expert but.
Looks like positional apnea to me. Which might be why you have the pressure so high.

Do you have a copy of your sleep study? If so post a redacted copy. Others will comment soon

[staceyburke]

The first thing - do you know that the machine you are using has been recalled? You should look at getting a new machine. 5 years is the time to get a new anyway. You should have owned this one for 6. ResMed S10 Autoset is the one you need. The number of events will be cut way down using this machine.

http://www.apneaboard.com/forums/Thread-...ion+recall

[Tenderercheese]

Yes I'm aware its been recalled.  I have registered it and am waiting to get a new one.  

I'll try to get my sleep study and post it.

[staceyburke]

Good! Please don’t get a dreamstation 2 - it will not help you as much as a ResMed autoset.

  Now about all we can do with the dreamstation is to raise the min pressure. Raise your min by 1. Your machine is slow to react to events and needs a head start to help your events. 

You can eliminate the v2 cart it does little with your therapy. It shows things as machine/tube noise and just clutters up the graph.

[Gideon]

I see some positional apnea but more of the typical problems a DS2 user has, more later.
Please inspect regularly for very small black specks in your tube or mask.

The DS algorithms respond slowly and need a head start requiring a higher min pressure.  You also have enough flow Limits, RERAs, and hypopneas that you could really benefit from a ResMed machine.  With your machine we need to raise the min pressure.  Your CA is running about 2, I'd like you to turn off flex to see if that helps.

So increase min pressure to 13 (maybe more later)
Turn off Flex (avoid CA events)
And try to use a thinner pillow to reduce any positional apnea.  Think 1 vs 2 pillows, thinner/flatter, less firm foam.

[Tenderercheese]

Thanks for the replies.

I have been checking for flakes and haven't found any yet.  My CPAP supplier also gave me a filter to instal between the mask and tube.

I just increased the pressure to 13 and removed the FLEX.  I'll sleep with a thiner pillow tonight.  

I have an appointment with my doctor in a couple weeks.  Typically can I just ask to be prescribed a Resmed or will I have to buy one out of pocket?  Are the differences that big that the insurance will cover it?  I have Bluecross.

[staceyburke]

Insurance should pay for it. The only reason the DME (supplier) tries to sell the dreamstation is it is cheaper to them. Making them more money.

If the Dr prescribe a ResMed only they have to give that one to you.

However, there are a lot of ResMed S10 models. It’s like saying you want a Ford. Is that a fusion, Lincoln, F150…

You want a ResMed S10 AUTOSET. Autoset is the key word.

[Gideon]

These are very unusual times.
It is unknown when Philips will provide a replacement or repair.
Philips has said do not use your device.

I suspect you may be able to get an early replacement as a result, but you will likely need a new prescription and your doc will need to formally justify it based on the above.

Neither the medical community nor your insurance consider a brand difference a sufficient reason to replace. IMHO going to ResMed it is.

Adding the inline filter will increase resistance and result in the need to return any device used with it. They are sensitive to moisture. It is possible a humidifier will clog them. An experiment to illustrate. Get a pair of blue jeans. Put a section over your mouth and breath thru them to establish a baseline. Then soak that section and try that again, much harder wasn't it. That is what happens when that inline filter gets damp.

Unless you doc feels you need an upgrade to a BiLevel (VAuto) you want the "equivalent" of what you have, the ResMed AirSense 10 AutoSet or AutoSet for Her, whichever is available.

[Tenderercheese]

One night with no FLEX and and 13 min pressure had better results!  Any suggestions on how to proceed from here?