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Getting a machine advice
#11
RE: Getting a machine advice
I almost forgot, we have a Wiki for Dealing with a DME http://www.apneaboard.com/wiki/index.php...with_a_DME
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#12
RE: Getting a machine advice
When I acquired my machine several years ago, I had already decided I wanted a Resmed S9 Autoset.  When I spoke with the DME person, I was told that the prescription needed to specify a pressure range to dispense an Auto-adjust machine.  I don't think that requirement is different now.  Fortunately, I was able to get my PCP to change the prescription to a pressure range, and I got the right unit.

Good luck to you, and don't let them tell you no . . .
A.Becker
PAPing in NE Ohio, with a pack of Cairn terriers
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#13
RE: Getting a machine advice
I had advised the DME that I wanted a Resmed machine.  Due to the virus scare they delivered a box in my driveway.  When I picked it up and opened it I discovered that they had delivered a Phillips.  Based on the advice from this forum, I called the DME and advised them that they had delivered the wrong machine.  I told them that I had not used it and that they could pick it up or I could drop it off at their facility.  They had delivered the Phillips Dreamstation based on an erroneous reading of my doctors script.  Bottom line, they came and picked up the  Dreamstation and left a new Resmed machine.  I let them know politely that I did not intend to use the Phillips Dreamstation and that was the end of the discussion.  In the end, they  were happy to provide the machine that I was going to be happy with.
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#14
RE: Getting a machine advice
Thank you for all the advice thus far.

I am going to call the DME today I will let you know how that goes.  Now onto masks.

Given the state of the Coronavirus.  I don't want to go into the supplier if I don't have to (and they may not want me going in either)

My old mask was a Fisher and Paykel Zest nasal mask standard size.

I didn't mind the mask itself but I was not a huge fan of the straps.  The were very difficult to grip to readjust.

Any recommendations on something similar?

I know it is a feel thing and will be difficult over messaging like this, but any help is appreciated.
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#15
RE: Getting a machine advice
So I received a copy of my sleep study and it looks like they want me at a pressure of 8.

Looking at all the info, at a pressure of 8 in 123 mins I had:
0 - Obstructive Apnea
1 - Central Apnea
0 - Mixed Apnea
0 - Hyp w/ Dessat.
17 - Hyp w/ Arousal

For totals of:
AHI - 0.9
RDI - 16.8

I see the big difference between AHI and RDI is the addition of the Hypopneas w/Arousal.

Can someone shed some light on this?  I know from looking through all my other sleep studies the Hypopneas w/Arousal were by far the highest number on all the other studies as well.  I have an idea of what that means, I assume that a Hypopnea w/Arousal is that my breathing slows down, doesn't completely stop and I jerk awake before dessat. occurs.

I guess a couple questions I have are:
Are these events just as detrimental to good quality sleep as all the other events?
Why don't they include these events in the AHI, why make a separate category for it?
When I get setup with a machine will OSCAR be able to track these events as well?

Thank you,
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#16
RE: Getting a machine advice
Seeing the full study would be very helpful. I'm going to assume this was a titration test, and not the diagnostic. The question is what happened at the different pressures tried, and whether the results make sense in the context of a titration protocol. The fact you have one central and everything else is hypopnea, tells us you may benefit from the EPR feature of the Resmed device rather than a Philips. It may also mean you will have some more treatment emergent central apnea, and I strongly suspect this is the more likely outcome. Your titration actually reveals that you did not achieve efficacy with this CPAP titration and that your AHI remains near 17 events per hour. They are screwing around with the technicality that a hypopnea does not count if it does not cause a desaturation of 3-4% in your SpO2. The reality is you failed to demonstrate efficacy with your titration test and you should ask your doctor how he expects that CPAP pressure at 8.0 is going to change that. With 17 or more events per hour, you might not have severe oxygen desaturation, but your sleep quality is going to suck! The events will still be there. I can guarantee you will ultimately fail CPAP at these settings. My recommendation does not change what you have been advised earlier and the Resmed still affords your best shot at efficacy, however you should ask your doctor why this high event rate is acceptable and poses any hope of success.

If this was your diagnostic sleep test, and they are guessing CPAP pressure of 8.0 is what you need, that is a guess, and you should ask for an Auto CPAP and a range of pressure to try for self-titration. I'm sorry, but I'm very unclear on what your test status actually is. With hypopnea, most people need some pressure support or EPR to help with flow limitations and to avoid the respiratory effort related arousals (RERA), which again points to the Resmed Autoset. Do not try to take on the task of self-titration with a fixed pressure CPAP.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#17
RE: Getting a machine advice
Sleep Studies typically don't record Flow Limits.
The definition of a RERA is a series of Flow Limits followed by an arousal. You can think of hypopneas in this case as a significant Flow Limitation.

Why aren't these events a part of AHI.  The components of AHI were arbitrarily determined from the spectrum of obstructive events and Flow Limitations were considered insignificant.

So you have enough hypopneas to require treatment and significant flow limitations.  These are best treated with Pressure Support which is the difference between exhale and inhale pressures.

The best machine is a BiLevel, preferably the ResMed AirCurve 10 VAuto.  It is unlikely they will offer this machine
Instead they will most likely prescribe a CPAP.  You want specifically and only a ResMed machine because their implementation of EPR allows us to mimic pressure support, and specifically the ResMed AirSense 10 AutoSet.
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#18
RE: Getting a machine advice
Yes they are just as bad as other events. For me personally anyway. With those results you will definitely need a ResMed AirSense 10 AutoSet at the very least. I’m not sure why they don’t include them except to say it separates arousals from events.


OSCAR will do an excellent job keeping track of your sleep sessions and give you a ton of information. The experts here will help you adjust your therapy to your needs. You will benefit greatly by learning as much as you can about sleep apnea and the terms associated with it. Especially what the different charts mean in OSCAR. It will make things a lot easier for you. YouTube is an excellent resource for that. A guy who goes by the lanky lefty has a ton of very useful info for you to absorb. Doing so will help you understand why the experts are having you change things. Good luck and remember we’ve all been a newbie at this. The most important thing to remember is patience is KEY to pap success!
Download OSCAR <——— Click
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#19
RE: Getting a machine advice
When I replaced my Resmed S9 After five years I decided to try the Dream Station. After two weeks of crappy results I traded it for the Resmed A10 and have been satisfied ever since.
"Sometimes the magic works . . . and sometimes it doesn't" -- Chief Dan George in the movie Little Big Man
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#20
RE: Getting a machine advice
Thank you for your responses.  This was a CPAP titration study. I attached the rest of the graph if that is helpful.


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