[Treatment] Hi all! I just got my machine today, and have a few questions.

[teaganofthelizards]

Hi all!

After a few months of waiting, a diagnostic and titration study, and annoying the attending MD to actually get my script written, I finally picked up my machine today. 

I recently switched to a different primary care practice, and when the attending mentioned sleep apnea I thought there was no way that was what was causing my issues. 

Well, the first sleep study showed an AHI of 5, and am RDI of 26. I don't have the results from the second study, but I'm going to have to call and get them.

Apart from the waiting, the whole thing's been really easy. Slept like a log during the first sleep study, the second wasn't horrible, though I'll never do another one during the full moon. The mask is comfy, and I'm not remotely claustrophobic, though I didn't expect it'd be a problem. 

So, on to the questions. 

I've set most of the options to sane defaults that shouldn't cause issues and are comfortable (EPR off, no ramp, etc).

I've read both the patient and clinical manuals for my machine, and understood most of it. I'm a little confused what to set the temperature and humidity settings to, unless that's purely a preference thing.

Also, my script is for a fixed pressure, 8cmH2O. I figured I should probably wait a few days and see how it goes, but is there any harm in opening up the range to 8-15 or so just in case I need more?

 Also, should I expect any pushback from the attending when it comes to making my own changes? I'm not super happy with the doc as it is (she doesn't have the best bedside manner, and her office staff is kinda rude), but I also don't want to annoy them while insurance is still watching it so closely for compliance. 


Thanks for all the help guys. Even just reading has been incredibly helpful.

[HalfAsleep]

It sounds like you’re off to a really good start!

For starters, you lucked out with your CPAP.

Here are some practicalities to attend to straight away:

1. Go to the Options menu and choose About. These are the specs for your unit. Check that the machine has been used for 0 hours (or close enough). Except with your express permission, you don’t want to be issued a used machine.
2. Insert an SD card in the slot behind the little door above the air intake. Use a low GB card. Make sure it’s not locked before you insert it. It will record your sleep data.
3. Download and install SleepyHead.

I’m a newbie, so I can’t give you advice on numbers. However, I have had the same reluctance to dink around with pressure settings until I have my 30-day follow up. I am all about compliance for the first month; for me, that’s enough to handle, and I can’t see irking the docs right off the bat. After that, whatever...

For now, I would just set the humidifier to automatic. Same with the temp. You will soon find out what works for you! I soon found out it made me wheezy and I lost my voice. I ratcheted down a notch: problem solved.

[TASmart]

I would start at 8 to see how it goes for a few days, Too much newness makes it really hard to troubleshoot. I am one of the few who does better at fixed pressures, so as soon as I got to trying APAP I was happy I spent a few weeks at the prescribed temperature to see what my baseline looked like.

[chill]

Welcome.  It sounds like you are well on your way to success.

I also do better with CPAP, at least as far as I have experimented.  It can be very tempting when starting out to treat the machine settings like a TV remote control.  But it goes not work like that, the machine is strapped to you.  It is best to stay several days at a setting to see what the effect are and then make a change if you think it is warranted.  I make an exception for humidity and hose temperature settings.  Those depend on your nasal passages and the heat and humidity where you sleep.  Change the to suit your comfort.

With an AHI to RDI ratio like that, I'd be reading up on UARS.  It can be tricky to treat.  You will be your own best advocate.

[dracus]

Welcome aboard....Best to get sleephead set up before you mess around. I switched mine to auto after the first night. In my case I got my AHI down to less than 1 in the second night. It was pretty good the first night at prescirbed pressure.

I decided to leave EPR on 2, and set the lower limit to 2 below my prescirbed pressure and the upper limit to 15. The macine kept me pretty much at 10 which is just below my presribed level of (11).

My 2 cents on compliance is this:

Is my AHI down to treated levels? ( <5 )
Did I wear the mask for the right amount of time. (4+ hours)
Did I use the machine for the right number of days (21 days)

If the answer is three yess then your attending has nothing to say...Your insurance is NOT looking at your compliance daily values or whether you turned on auto or not. They may be asking after 3 months if you were compliant and if the treatment is working.

It's important to avocate for your own needs. The doctor works FOR you. It's their job to provide you with choices and it's up to you to make the descions as you feel,

[MitchS]

Welcome to the forum! It looks like you are off to a good start.

I use a fixed pressure, too. I’ve tried auto on my machine. There doesn’t really appear to be a difference in treatment between the two modes for me.

For now I would use the script settings. In the meantime, I would install SleepyHead and set it up so you can post some charts. We have some members on the board who are very good at helping optimize treatment. Follow the links in my signature for information on organizing SleepHead charts and posting your data.

Good luck on your new journey.

[teaganofthelizards]

Welcome aboard....Best to get sleephead set up before you mess around. I switched mine to auto after the first night. In my case I got my AHI down to less than 1 in the second night. It was pretty good the first night at prescirbed pressure.

I decided to leave EPR on 2, and  set the lower limit to 2 below my prescirbed pressure  and the upper limit to 15. The macine kept me pretty much at 10 which is just below my presribed level of (11).

My 2 cents on compliance is this:

Is my AHI down to treated levels? ( <5 )
Did I wear the mask for the right amount of time. (4+ hours)
Did I use the machine for the right number of days (21 days)

If the answer is three yess then your attending has nothing to say...Your insurance is NOT looking at your compliance daily values or whether you turned on auto or not. They may be asking after 3 months if you were compliant and if the treatment is working.

It's important to avocate for your own needs.  The doctor works FOR you. It's their job to provide you with choices and it's up to you to make the descions as you feel,

Sleepyhead's installed and set up correctly, and the data from my hour of watching TV imported correctly.

Insurance not looking at specifics makes sense. I'm the grand scheme of things, they only really care of I'm using it so they're not wasting money. 

I think your point about the doc working for me is the biggest part of the whole thing. No card was installed in the machine by default, which if I'm reading the manual correctly means that the only way to get any data off for the DME and provider is the cell connection, and the data they can pull from that is rather limited. 

In the grand scheme of things, I will be compliant, and if the doc doesn't like the changes I'm making, then they either need to get off thier butt and make them themselves, or shut up.

[Gideon]

Welcome to the forum.

While we tend to be data driven, the keys being AHI <5 (successfully treated by the Pros) and compliant (simply using the machine), the real key is that key Vulcan Science Academy question "How do you feel?".

Comfort drives compliance, and the numbers ensure the machine is doing it's job.

On data, Post in a single thread, that will preserve history.
post a copy of your Sleep Studies, all of them. These will tell us more than a verbal recounting what type of apneas occurred during them and frequently note abnormalities that may or may not impact your treatment.
and finally your daily charts which contain detail of what happened through the night, down to a breath by breath detail if necessary. Organization is important here as there are many more charts than are typically important. Even the sidebar data is important.

Don't hesitate to ask any questions you have about any of our responses. Our task is to relay our knowledge/experiences with apnea to better inform you.

The links in my signature all contain good info for you getting started.

Fred

[Mosquitobait]

Not seeing the RAW data, it's hard to recommend anything. If you have trouble falling asleep at 8, put your minimum at 6 and then see how it goes. Resmed machine does work quite well with hypopneas (which is why your RDI is high). The insurance company doesn't care what your settings are - they only care about AHI (and honestly, your doctor is no different, but that's another story).

FWIW, 4 & 5 are pediatric settings. Most adults have difficulty breathing at those levels, so 6 would be a minimum.

[trish6hundred]

Hi teaganofthelizards,
WELCOME! to the forum.!
It's great to hear that you are adjusting well to CPAP therapy.
Keep up the good work, hang in there for more responses to your post.