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[Diagnosis] Finished the First Sleep Study: What questions to ask my ENT for the follow-up?
Hi Everyone,

I'm new here and, like most of you have probably experienced, am trying to wrap my brain around what the doctors are telling me now. I've never been in the best of shape and for years I attributed my daytime grogginess to being overweight. My dad has sleep apnea and a CPAP machine, but I figured I didn't have that problem because my wife never recounted stories the likes my mom told me where my dad would stop breathing in the middle of the night and loudly start gasping for air. I also never remembered waking up in the middle of the night short of breath or anything. When I went to an ENT with a case of tonsillitis he scoped my nose and informed me that I had a deviated septum and that the opening in the back of my throat was on the small side. That combined with my weight, he said, made him suspect that I was susceptible to sleep apnea as well. He prescribed a home test (the kind with the pulse monitor and the nose tubing) which I sent in only to find out that I had a (relatively) mild obstructive apnea event about every two minutes and that my blood oxygen was desaturated because of it. He then said I should go get a CPAP titration study done since it was nearly certain that I would need one going forward.

I had this study done last Friday and, as I was later told was somewhat typical, did NOT get much sleep that night. Maybe two hours if I was lucky. It's not that the CPAP bothered me per se, but I just could not fall asleep and when I did & woke up, I couldn't fall back asleep for a long time. It was as if I drank a caffeinated beverage in the late afternoon where I did not feel stimulated (in fact I felt very exhausted), but I just couldn't' fall asleep no matter how much I tried. The good news is that I was asleep just enough for them to get some good data which they'll be sending to my ENT in about a week's time.

So my question is: what questions should I ask or requests should I make when I have that follow-up visit to get a script for the CPAP (or Auto or Bi, not sure yet) machine and the mask? For example, I've seen a few suggestions here that I should ask for an AutoPAP machine even if only CPAP is recommended because I can set it to CPAP mode and the Auto machines record more useful data. Things like that. I know choosing a brand and model of machine/mask is another can of worms, but is there anything along those lines I should mention or request in my initial follow-up visit? BTW, as far as masks go, I tried the three types (nasal pillow, nasal mask, full face) and they ended up sticking with the full face because while I typically breathe through my nose, I'll sometimes take a big breath / yawn with my mouth, maybe due to my deviated septum and occasional stuffiness (once I was relaxed I breathe through my nose almost exclusively). The full face mask also prevented the strange phenomenon of the pressure exiting through my mouth whenever I yawned or talked, so maybe I'll stick with that for now. The other issue I ran into was the mask leaking when it rubbed against the pillow (I'm a side sleeper).

That's what I have for now. Any advice you can send my way would be much appreciated. I'm dreading the adjustment process that others have warned me about, but I hope that asking the right questions and requesting the right equipment that will give at least a little leg up.

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Welcome to Apnea Board StoopidMonkey81,
It sounds like you've done some research and that's a good start.

Be sure to call your insurance and get a list of DME providers. It's your choice who you want to use. Check around.

Also be sure you understand your coverage and what part you may have to pay. Don't believe anything a DME tells you. Your insurance pays the DME the same whether it's a CPAP or APAP.
The DME will make more profit by giving you a CPAP.

The first thing you should ask for and you have a right to, is a copy of your sleep study.
The next thing to ask for is a copy of your perscription.

Ask you ENT what your AHI number was, and the titrated pressure number.

If your Doctor recommends a straight CPAP machine, tell him you prefer an APAP machine. If he insists on a straight pressure setting, just tell him that an APAP will allow you to use a straight or variable pressure setting. You can change it at a later date if you have an APAP machine. You can't change it with a CPAP machine.

As far as the perscription goes, ask the doctor to write it as a Data Capable Auto CPAP Machine with heated humidifier and heated hose, and mask (patient choice).
It should also say Dispense as written.

As far as masks go, it is the hardest to find what is right for you. The DME should give you a 30 day trial on mask.

Hope I haven't overwhelmed you. I wish I had some of this information when I first started.

Here is a link that can get you thinking about machine choices and what to avoid.


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Hi StoopidMonkey81,
WELCOME! to the forum.!
It’s great to hear that you want to take control of your therapy. You have a good attitude and that will go a long way.
Hang in there for more responses to your post and much success to you as you start your CPAP journey.
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Greetings and welcome!

Being able to sleep in a lab is difficult for some folks, so your experience in your own home in your own bed may be very different; try not to stress about the transition to an XPAP. I was just SO happy to be feeling better and waking more rested that I put up with the learning curve, but everyone is different.

Personally, I prefer nasal pillows - lighter, easier to wear and, though I am a side sleeper (most of the time) I rarely have problems with the nasal pillows.

My hubby also has a deviated septum and does MUCH better with the nasal pillows than he did with a nose mask. Also, he has a full beard and has no problem with either the nose mask or the nasal pillows.

He does use a chin strap, which helps with the occasional mouth exhalations.
Evpraxia in the Pacific Northwest USA
Diagnosed: 44 AHI when supine, O2 down to 82%
Treated since 20 Sept 2014:: 0.7 AHI, Settings 7-15, EPR on Full Time at Level 3
Better living through CPAP/APAP machines!
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BTW, can I actually ask my doctor to specify a specific model on the script? I read a suggestion elsewhere to get very specific on the script, such as:

1] ResMed AirSense™ 10 AutoSet with HumidAir™ Heated Humidifier
2] Patient access to Efficacy and Usage Data
3] ClimateLineAir™ Heated Tube
4] Filter
5] Mask of patient's choice
6] Pressure range between [x] and [y] (even if static CPAP recommended)
6] Dispense as written

Do doctors usually accommodate such a specific ask?
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A good doc that has your interests at heart won't care, but just beware, most are put off when you ask something specific.

Just be sure your asking, not telling. Smile
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Something to think about before having a rx be super specific is that you want a copy of the script, and you want to keep it - it is good forever if done correctly. mine looks like: (although it's been updated for pressure later)

[Image: 5ekX1l7.png]
هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
Tongue Suck Technique for prevention of mouth breathing:
  • Place your tongue behind your front teeth on the roof of your mouth
  • let your tongue fill the space between the upper molars
  • gently suck to form a light vacuum
Practising during the day can help you to keep it at night

هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه هههههه
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I had more events on my back than I did on my side. I used that as the basis to request an auto, and my clinician was very agreeable.

I believe a good doc will appreciate intelligent questions from someone who is interested in understanding his condition and therapy. If you have a doc who doesn't, I would expect a contentious relationship unless you're willing to just stfu and do as you're told.
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(10-31-2015, 02:51 PM)drtrech Wrote: I believe a good doc will appreciate intelligent questions from someone who is interested in understanding his condition and therapy. If you have a doc who doesn't, I would expect a contentious relationship unless you're willing to just stfu and do as you're told.

I'd like to think so too. Then again, this is my ENT and not a sleep specialist (as he's the one who wrote me the script for the study in the first place) so I'm not sure if I'll be continuing to see him going forward for therapy follow-ups. I'll find out later today.

As for the script, the thing I'm not sure about asking for (even though it's been suggested here) is to ask him to write a pressure range on the script even if the report calls for a straight CPAP pressure. If he agrees to write the model down (currently leaning towards the Resmed AirSense 10 AutoSet) along with the note about full efficacy data and "dispense as written", isn't that all I need to force the issue with a DME?
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Some doctors will write the titrated pressure on the script from the sleep study.
My doctor just wrote 9 on my script, and the DME gave me a straight pressure CPAP set at 9.

I then went back to my doctor, and asked for an Auto CPAP. He wrote a new script stating auto CPAP and left the pressure wide open at 4-20. Oh-jeez

The point is, know your titrated pressure. It's a starting point, and ask for a copy of your sleep study.

If your doc doesn't write a pressure range, the DME will leave it at default setting of 4-20, which you can change yourself. No big deal. We're here to help. Smile

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