[Treatment] New Member - Please Critique My Treatment Plan

[LuminousOne]

Hello,

Background
I was diagnosed with OSA via a home test ordered by a sleep pulmonologist who my PCP referred me to. AHI -  19.1, with some severe O2 desats (70's, 80's). I had a tiration study which was inconclusive because I tapped out during the bipap portion (16/11) due to waking up with extreme aerophagia and the IP cutting off a good portion of my exhale. Note: During the 25 minutes at this setting, events were "0" in all categories and minimum 02 stat was 92. It would have helped if the sleep tech gave me recommendations which would help me deal with this or let me know that I needed to complete one more hour on the bipap, but that wasn't her style. The recommendation in the report was to complete a bi-pap titration due to sub-optimal titration OR an empiric trial of APAP with pressure range of 10-20. 
My PCP also referred me to an ENT who diagnosed enlarged turbinates, a septal deviation, 
and collapsed nasal valves. I will be having a radiofrequency turbinate reduction on Wednesday.
My dentist is making me a MAD to have on hand to use during brief naps, if the apap malfunctions, and while I am waiting to actually receive the machine. I get the MAD tomorrow.   

Plan (mine)
I go back to the sleep pulmonologist tomorrow. I will be adamant about receiving a prescription. I'm going to ask for an auto bipap (ResMed Air Curve) because it will cover higher pressures and will enhance comfort. I do not want to go through the standard DME's. There is a local stand-alone with great reviews and said to provide good support end education. They will help with mask selection and fitting. This will likely involve insurance, but I'm not giving up my choices or privacy (remote result viewing/programming). If this is not negotiable, I'll use them for mask fitting and initial supplies and then go to Lofta and self pay. I get a 25% discount on supplies (not the machine) at LOFTA being an RN.    

What do you think?

What do you think?

[Sleeprider]

You're on the right track. A prescription for a Resmed Vauto and self-titration would be a good bet we can get you dialed in pretty quickly. The need for high pressure and poor titration results are often the result of "positional apnea". https://www.apneaboard.com/wiki/index.ph...onal_Apnea

Read the wiki linked above to understand why very high pressure might not resolve apnea until positional issues are addressed. As long as you don't have significant central or complex apnea, we can help you to dial in any device, with preference to bilevel over CPAP.

[LuminousOne]

Thanks!

I thought it was positional, too. At least half of the time on bipap was supine, which I hate, or somewhat on my side with my chin tucked in. Neither is a good position for sleep apnea, I understand that they want to see results from the worst case scenario, but let's be reasonable. I had no central apnea or Cheyne-Stokes events.
The sleep tech was not helpful. She told me what she was doing but almost nothing to help me adapt to, and comply with, the test process. In retrospect, I think she should have had me take a break and walk around for a bit to relieve the aerophagia enough so I could continue, calm down, and finish the last round on bipap. I should have thought of counting during inspiration and expiration to adapt to the rhythm. Or, at least, popped a gas-ex. 

I don't know what I would do with our the help from people like you. This forum is excellent and the information is valid and scientifically based.

I have OSCAR downloaded and ready to go.

[Deborah K.]

Make sure you ask for the ResMed AirCurve 10 Vauto. That's the best.

[LuminousOne]

That's exactly the one I chose.

Thanks!