[CPAP] Machine trial with Kaiser

[KKoelle]

My apologies for having  posted this message in another thread first.  I'm new here and just figured out how to start my own thread.  I did a 5 night trial with a loaner machine from Kaiser and I guess will be given a prescription for a machine soon but have some concerns: The watchpat study showed an AHI of 14.2, which given I have atrial fibrillation was deemed to be enough to need treatment. But it seems that more of my events are hypopnias and central apneas than obstructive apneas so I am wondering if the AirSense 10 is the right machine, or should I be on BiPAP?  Also, I had pain in my right ear from using the machine and it felt like the expiration pressure was uncomfortably high some of the time. (I felt like I was being blown up like a balloon).  I set the maximum pressure down to 15 because I was worried about the ear problem but I guess the machine never even went near that limit but still caused the ear pain.  Thanks, Karin
       

[KKoelle]

Here is  a hopefully more useful image of one of the nights with the trial AirSense 10 machine.  My biggest concerns in deciding wether it's a good idea for me to use this machine is wether it will cause central apneas to increase and also if the ear pain is normal and likely to resolve or if that is a deal breaker for using cpap.  It's a pretty steep learning curve to figure out what all this data means and I'm at the very beginning of the process but don't want to accept a machine that may not be right for me since I believe my medicare will only cover a machine every 5 years and I'm not clear if I will be given a machine by Kaiser (medicare advantage plan) or if it will be rented, so I'm wondering if I need to be sure to get the right machine the first time or if I'll have an opportunity to change machines if needed.
   

[Rich66]

I was with Medicare/Medicaid when I first started. I have ended up with an ASV machine, but first had to jump through the hoops. They didn't tell me the procedure or guidelines. But the first machine, I couldn't use it. So I had another in lab sleep study, then another machine. I couldn't use it, so another sleep study, another machine. It was the fourth machine that was the ASV and I could tell the difference. I think they have to prove the other machines won't work for the patient.
If you feel like you're being blown up like a balloon, yes, the pressure is too high. I am nowhere near what the doctor prescribed, but I am doing much better. And Medicare will make an exception to the 5 year rule. I started with Phillips Respironics, it started popping on me and that would wake me up. I sent it in for repairs 3 times, Medicare paid big money for the "loaner" machine I was given. After 2.5 years of Phillips, I switched to Resmed, Medicare paid for it all. And yes, I met compliance the whole way.

[KKoelle]

Thank you so much for your reply.  It’s comforting to know I won’t be locked into a particular machine if it doesn’t work for me just because I passed the initial trial period.  I have an appointment with a respiratory therapist this morning and will see what the next step is.  Unlike my partner who is with medicare/united healthcare and spent the night in the sleep lab and saw a doctor twice, I haven’t seen a doctor or a therapist yet.  I was just handed the machine to try for 5 nights without much instruction. If I hadn’t already been involved in my partner’s learning to use his machine I would have been completely clueless about the settings, mask fit, etc.  and I was fortunately able to use one of the masks that didn’t work for him so my compliance looks very good.

[Sleeprider]

Your results on the Autoset show a significant improvement in AHI over your WatchPat study. Neither of these approaches to diagnostics or titration are particularly good, but it's not too bad. I think if you are dispensed a Resmed Autoset, we can help you to optimize those results further. You were using a minimum pressure of 5 with EPR set at 3. To resolve more of the central events, we will likely turn down the EPR to a lower setting of 1 or 2 and increase the minimum to 6.0. That should stabilize pressure and result in even better results. Your summary shows most events are central or hypopnea and the detailed chart suggests your central events were expressed more profusely when pressure went up and EPR became greater. It's normal for CPAP to be used for initial therapy even when most events are central. For most insurance, you actually have to fail CPAP to progress to a more advanced PAP device.

[KKoelle]

Thanks so much for your detailed response- I feel better going into my appointment now and look forward to learning how to work with the settings.