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APAP pressure higher than CPAP
#11
Thank you everyone for your input. I used sleepyhead when I got home from work yesterday. I didn't fully understand it all, however I did find out that the "19" I was referring to was the highest my pressure went to. My median pressure was only 12.

Also after looking at it, I have started the process of decreasing my auto range. I'll do it slowly over the next couple of weeks.
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#12
Don't rush your pressure adjustments. Change it one night, then leave it for 4-7 days. Slow and steady. You are not in a race (as you know after 3 years of this!)
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#13
(05-27-2015, 02:57 PM)Mikaimee Wrote: Also after looking at it, I have started the process of decreasing my auto range. I'll do it slowly over the next couple of weeks.

It's helpful to raise the lower limit up to where it's going to need to be anyway, but I'd probably leave the upper limit alone for now, since the machine won't use it unless it needs it.

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#14
I would have to agree with Terry that the machine is likely better than the sleep study, based upon my recent experience.

After 9 years on a CPAP set at 13 as determined from my initial set of sleep studies, it was time for a new machine. DME stated that my insurance would not pay for a new machine unless I got a new sleep study. Not only that, they said they would not do it all in one night. I am hooked on the CPAP, so the first night was terrible to just prove I still have sleep apnea (only thing new was now I have severe apnea rather than moderate). The next night's study showed my pressure was to be set at 8 and the sleep lab's doctor sent a prescription to my DME for a fixed setting. Fortunately my ENT doctor wrote another prescription and set it to a variable of 4 - 18. I have used to Resmed 10 Autoset now for 2 nights and the report says the pressure have been around 14. So, not only do I believe that the sleep study was unnecessary, I think the results were likely wrong and cost the insurance company over $5000. Will be interested to see what my ENT will say when I return to him next month with a month's worth of data from the APAP.
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#15
(05-28-2015, 11:29 AM)kepSleep Wrote: I would have to agree with Terry that the machine is likely better than the sleep study, based upon my recent experience.

After 9 years on a CPAP set at 13 as determined from my initial set of sleep studies, it was time for a new machine. DME stated that my insurance would not pay for a new machine unless I got a new sleep study. Not only that, they said they would not do it all in one night. I am hooked on the CPAP, so the first night was terrible to just prove I still have sleep apnea (only thing new was now I have severe apnea rather than moderate). The next night's study showed my pressure was to be set at 8 and the sleep lab's doctor sent a prescription to my DME for a fixed setting. Fortunately my ENT doctor wrote another prescription and set it to a variable of 4 - 18. I have used to Resmed 10 Autoset now for 2 nights and the report says the pressure have been around 14. So, not only do I believe that the sleep study was unnecessary, I think the results were likely wrong and cost the insurance company over $5000. Will be interested to see what my ENT will say when I return to him next month with a month's worth of data from the APAP.

It seems that if one relies on AUTO modes that average pressure may be a good indicator of clearance of events but may be insufficient re oxygen sats/desats.

That was an issue for me. YMMV.

I place reliance on the Clinical Guidelines. To 'Cliff Note" Clinical Guidelines in a sentence: Optimal pressure assures RDI <5 while supine in REM with minimum Sp02 >90% with acceptable leaks and acceptable spontaneous arousals.

As I recall, my RDI was <5 as low as 8 or 9cm during the lab titration but oxygen levels did not pass muster until titrated to 12cm.

Original cardio script for Auto 6-15cm was a mistake, but more likely resulted in newbie Compliance than straight 12cm. The average pressure settled around 6 or 7cm-inadequate for 02 sats but AHI's were very good.

If you might post your lab titration it might be informative. I don't understand the discrepancy- doesn't make sense.
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#16
(05-28-2015, 11:29 AM)kepSleep Wrote: DME stated that my insurance would not pay for a new machine unless I got a new sleep study. Not only that, they said they would not do it all in one night. I am hooked on the CPAP, so the first night was terrible to just prove I still have sleep apnea (only thing new was now I have severe apnea rather than moderate). The next night's study showed my pressure was to be set at 8 and the sleep lab's doctor sent a prescription to my DME for a fixed setting. Fortunately my ENT doctor wrote another prescription and set it to a variable of 4 - 18. I have used to Resmed 10 Autoset now for 2 nights and the report says the pressure have been around 14. So, not only do I believe that the sleep study was unnecessary, I think the results were likely wrong and cost the insurance company over $5000.

While I think sleep studies are valuable for diagnosing difficult problems, I think they're being over-used now just to keep the labs busy.

I have a copy of the order for my machine from the pulmonologist and will never set foot in a lab again, unless I develop something strange that really requires a lab.

The next machine I buy will be with the card that says "Visa" on it. For the out of pocket difference between online and my insurance co-pay, I'll just buy the thing and be done with it.

My time is worth more than the cost savings. Taking off several mornings to go to the doc's office to demonstrate "compliance" for the insurance company, and paying the stupid "rental" bill every month is infuriating and it's not going to happen again.



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