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First Checkup - What to Ask?
#1
We go in soon for the six week checkup with my husband's sleep doctor. For 32 days so far, his AHI is down from 15 untreated to 2.8 with the CPAP. His leaks are averaging .94. He sleeps at least 7 hours per night, sometimes 8, with the CPAP. And he definitely is more rested (and so am I because he no longer snores!)

What should we ask the doctor at this checkup?

Should we be shy about the fact that we have been peeking with Sleepyhead? I doubt he would care but would just as soon this not be controversial visit.

We also bought a Climateline hose due to rain out. I assume we should tell the doctor about that just in case he thinks that makes some sort of difference. We did not notice any change for the worse after changing the hose; if anything the AHI is now trending down.

Just want to be prepared for what to expect on a first checkup. Thanks!
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#2
Spouse,

I don't know your doctor. Some are incredibly cooperative and encourage you to monitor your treatment and communicate it with them. As we all know, there are some that think we're idiots and should do exactly what they say without question or information. I hope you have the former.

Print out what you can, take it with you, and share everything! By the way, from what you say the treatment is being very effective (congratulations!) and the only input from your doctor may be to just keep on doing what you're doing.

Sounds like you're doing well. Best of luck and

Sleep-well
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#3
Thank you. I thought those numbers all looked good but glad to hear it from someone like you!

I am the spouse fiddling with Sleepyhead and buying the new hose etc; my husband is the super compliant sleeper so I don't want to get him in trouble with his doctor! I just feel better knowing what is going on, and then reading all about it here whenever we have a question.

This forum is super helpful and I am so glad we joined.

(01-01-2013, 09:46 AM)jdireton Wrote: Spouse,

I don't know your doctor. Some are incredibly cooperative and encourage you to monitor your treatment and communicate it with them. As we all know, there are some that think we're idiots and should do exactly what they say without question or information. I hope you have the former.

Print out what you can, take it with you, and share everything! By the way, from what you say the treatment is being very effective (congratulations!) and the only input from your doctor may be to just keep on doing what you're doing.

Sounds like you're doing well. Best of luck and

Sleep-well

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#4
The Climateline is a comfort feature so the doc doesn't need to know.

Telling him you are using the software wouldn't hurt. It would tell you immediately if he is a good doc or a controlling doc.

And yeah, my bet is the doc is going to see "Keep doing what you're doing and see you in a year".
PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


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#5
Hi SPOUSE,
WELCOME! to the forum.!
Best of luck to you and your husband on the checkup.
I don't think you necessarily need to mention the climate line hose since it is a comfort thing. Hopefully, the Dr. is receptive to your husbands taking control of his CPAP therapy, I guess it couldn't hurt to mention about the software, not sure on that one.
trish6hundred
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#6
Thank you Paula. I appreciate your input!


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#7
Trish, thanks and Happy New Year!

(01-01-2013, 12:24 PM)trish6hundred Wrote: Hi SPOUSE,
WELCOME! to the forum.!
Best of luck to you and your husband on the checkup.
I don't think you necessarily need to mention the climate line hose since it is a comfort thing. Hopefully, the Dr. is receptive to your husbands taking control of his CPAP therapy, I guess it couldn't hurt to mention about the software, not sure on that one.

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#8
(01-01-2013, 09:35 AM)SPOUSE Wrote: We also bought a Climateline hose due to rain out. I assume we should tell the doctor about that just in case he thinks that makes some sort of difference. We did not notice any change for the worse after changing the hose; if anything the AHI is now trending down.

The machine should be set to the correct size hose, or the delivered pressure (especially during periods of high leakage) could be too high or too low. I think the hose diameter might only be setable using the Clinician's Menu.

The common ClimateLine hose is same diameter as the 15 mm SlimLine hose. The ClimateLineMAX is fatter, like the older standard 22 mm diameter hose. If your machine has been set correctly (whether by DME supplier or by you), no need to mention it to the doctor.

If you husband's CAI (Central Apnea Index stays less than his OAI (Obstructive Apnea Index) then I would think the pressure is probably not unsafely high.

If the AHI (total Apnea + Hypopnea Index) is less than 5 then I would think the pressure is probably not unsafely low.

Keep an eye on the data (at least weekly) to verify the AHI and CAI are staying low. If AHI suddenly gets worse, this might be from sleeping more often on his back or from a change in his medication.

Since your husband uses a fixed pressure level (not an Auto machine) I would suggest buying a wrist-mounted Pulse Oximeter if possible and monitoring his oxygen levels during sleep occasionally and especially whenever he is sick or has a change in medication. Using a Pulse-Ox is an important tool also for folks with Auto machines, but even more so if not using an automatically self-adjusting machine.

Take care,
--- Vaughn
Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
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#9
Vaughn, we have the ClimateLine (not the Max) and it is the same diameter as the slimline hose, so we are OK there.

Perhaps there will come a time when we don't look at the data every morning but I don't think that will be anytime soon! We do that right after getting up and it's fun so far. Kind of sets the mood for the day tho (like weighing).

His Obstructive Apneas have been only one or two per night lately. Clear airways have been more but CAs seem to be when there is a leak or when he turns over. I am a light sleeper so I take note of the time (mentally) if I wake up when there is a leak or when he turns over and it seems to correlate with the CAs as far as I can tell. I guess that is a question for the doctor.

We have a wrist oximeter but have been waiting to use it for fear of being freaked out by it and hoping to wait till the numbers settled to an even pace. In the last week the AHI has been 1.64 or lower so now may be the time to try the oximeter.

Thanks for your input!



(01-01-2013, 02:00 PM)vsheline Wrote:
(01-01-2013, 09:35 AM)SPOUSE Wrote: We also bought a Climateline hose due to rain out. I assume we should tell the doctor about that just in case he thinks that makes some sort of difference. We did not notice any change for the worse after changing the hose; if anything the AHI is now trending down.

The machine should be set to the correct size hose, or the delivered pressure (especially during periods of high leakage) could be too high or too low. I think the hose diameter might only be setable using the Clinician's Menu.

The common ClimateLine hose is same diameter as the 15 mm SlimLine hose. The ClimateLineMAX is fatter, like the older standard 22 mm diameter hose. If your machine has been set correctly (whether by DME supplier or by you), no need to mention it to the doctor.

If you husband's CAI (Central Apnea Index stays less than his OAI (Obstructive Apnea Index) then I would think the pressure is probably not unsafely high.

If the AHI (total Apnea + Hypopnea Index) is less than 5 then I would think the pressure is probably not unsafely low.

Keep an eye on the data (at least weekly) to verify the AHI and CAI are staying low. If AHI suddenly gets worse, this might be from sleeping more often on his back or from a change in his medication.

Since your husband uses a fixed pressure level (not an Auto machine) I would suggest buying a wrist-mounted Pulse Oximeter and monitoring his oxygen levels during sleep occasionally and especially whenever he is sick or has a change in medication.

Take care,
--- Vaughn

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#10
(01-01-2013, 09:35 AM)SPOUSE Wrote: His leaks are averaging .94.
whats median, 95% percentile and maximum leak

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