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Another newbie here. I had my sleep study back in Dec of 2013. I did the initial sleep study follow by the titration a week later. Due to the holidays I wasn't able to make a followup appointment until the end of January 2014. Due to my wife having back surgery around that time, the appointment fell off my radar and due to my own procrastination, I didn't make another followup.

1 1/2 years later my PCP, wife and ex-wife are on my case that I need to get my sleep in order, so I am following up like I should have a long time ago.

I've had trouble for quite a few years, but mostly blamed it on allergies. I joke around saying "If it's green and produces pollen, I'm allergic to it". My friends joke that I can fall asleep at the drop of a hat and I have often fallen asleep leaning against a wall waiting for someone. I have caught myself in that twilight area between sleep and fully awake, wondering what the loud buzz-saw noise was before realizing it was me snoring. So I was relived to find out that I have sleep apnea and there is something I can do about it. Now I need to actually do it. Cool

My study results were an AHI of 45 with an RDI of 47.5. The AHI was a mean of 9 apnea events to 36 hypopnea events per hour. The mean apnea/hypopnea length was 22.6 seconds with the longest being 57.3 seconds. This makes me wonder what the mean length is for those who have an AHI above 100?

My oxygen was at 90% or above 85% of the time, 88% or lower for 9.5% of the time with a low of 77%. Math tells me that I was at 89% for 5% of the time. :-)

The titration study tested my at 4/6/8/10/12 with being the least apnea/hypopnea events. 10 had me at 15 hypop & 7 apnea events. 12 had me at 1 hypop and 11 apnea events. My oxygen for the whole time was at 90% or above for 96% of the time an at 88% or below for 3% of the time. Much better that before. My overall apnea events seemed to go up slightly, but my hypopnea events were at 90% less events that the original study. I understand this is only one night across the whole gamut of pressures, and the OSA and CSA events are likely to go up until I get used to sleeping with a mask.

The recommendation is 12 cm with a c-flex setting of 3. The recommendation from the initial study suggests a RemStar Pro DS 450 with SD card reader and a Quattro Ultra (M) mask with humidifier. With my constant allergies, I'm usually pretty stuffed up, especially in the spring and fall, so I am starting with a FFM which makes sense to me. It looks like the DS 450 is a regular CPAP machine instead of an Auto. I'm going to push the DME for an auto but don't know what is actually written on the prescription. I'll have to go back to my doctor for a copy of it for my records. I asked the sleep doctor about the difference between auto and straight, and he said they want me on straight 12cm. If I can get an auto CPAP, I would still stay on the straight 12 for the initial 90 day trial, but would like the option for later down the road.

Looks like my insurance (UHC) works with neighborcare/rotech, so I'll see what I can get out of them. The sleep office said they would send the prescription over last friday, so If I don't hear from them by Wednesday, I'll be beating down their door. Laugh-a-lot

Overall, I am looking forward to better sleep.

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(06-13-2015, 09:05 PM)SleepyWabbit Wrote: The recommendation is 12 cm with a c-flex setting of 3. The recommendation from the initial study suggests a RemStar Pro DS 450 with SD card reader and a Quattro Ultra (M) mask with humidifier.
PRS1 60 series superseded 50 series
PRS Auto is also a fixed pressure machine, just like PRS1 Pro but also can be utilized in APAP mode whenever needed
Better future investment, who know what future holds

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Hi SleepyWabbit,
WELCOME! to the forum.!
It's good to hear that you are following up and getting started with CPAP therapy.
I would try for an APAP machine.
Hang in there for more responses to your post and much success to you as you start your CPAP journey.
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G'day SleepyWabbit, welcome to Apnea Board.

I agree with your idea of getting an auto machine. Although a lot of sleep docs prefer to have their patients on constant pressure, I think the auto machine gives you a lot more flexibility in your treatment. It can also adjust as necessary for different situations (eg sleeping on side or back) and as your needs change as you grow older. Finally, it's like having a titration study every night - the machine gives you a continuous indication of your therapy needs.
Apnea Board Moderator


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Welcome Sleepywabbit! You've come to the right place. These folks really know their stuff! I'm just going through the diagnostic phase now, but the help they've provided here has really informed me and greatly lowered my anxiety about it all.

Reformed CPAP Outlaw
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(06-13-2015, 10:32 PM)DeepBreathing Wrote: ...a lot of sleep docs prefer to have their patients on constant pressure...

And why do we think they even do that? This is a question I expected to have an answer to by now, but I don't. I agree with you and all of your arguments about APAP, and its enormous benefits over CPAP.

It just seems like such a no-brainer. We know for a fact that what the optimum pressure for any individual patient will be is something that changes dynamically throughout the night due to sleep position and sleep stages. So it seems to make no sense to pick a fixed pressure that might be an average of what will be the optimum pressure and then never be quite right for a good part of the night.

Since an APAP can actually adapt to what those pressure needs change to throughout the night, it seems like a wonderful solution compared to a fixed blower.

So what are these docs thinking?

Is it possible that this is just legacy-holdover from when a xPAP could not do anything other than a fixed pressure? And that some docs are just stuck in the past with their thinking? Are they carrying flip-phones and pagers? Wearing bell-bottoms? Using dictaphones and typewriters? Butter churns? It's 2015, and we've had APAP for some time now. WTF?

I don't understand why the major manufacturers don't just stop making these brick CPAPs, and make APAP (which can be configured as CPAP) the basic machine in their product lines.
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I too have allergies and am often very congested even out of allergy season. The pressure from cpap actually opens up my sinuses at night and makes it easier to breath. Also you can get a micro filter for your machine which supposedly filters out allergens. Cpap has helped me with this aspect of my life.

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I have allergies but probably not to the extent that you do. I often have stuffed up nose and just recovered from an ear infection that was at my mastoid bone (I hope I have gotten rid of the infection). It was misdiagnosed a long time. Okay, back what I really want to say.

FFM's leak a lot and are not all that comfortable for most of us. There are some that feel they need the FFM. Have you thought of trying a nasal mask that is similar to a FFM but the mouth is not covered and there is less facial area covered? If you decide to try that, then you can consider going with nasal pillows if you choose to.

I had several years of miserable experiences with FFM and was on the verge of quitting when I had a sleep study manager bring a whole lot of masks to me about a month before my sleep study and when I chose one, he would hook it up to the machine in the sleep lab and let me lay down and see what it felt like. I choose the wisp and I was also given a chin strap just in case and I used those to acclimate to the mask/strap prior to my sleep study. I still use the wisp mask but no longer need the chin strap most of the time. I have one just in case I need it again.

Hope this helps and that you are able to find what works for you. There is a link here with info on machine types that you may want to look for because there has been a lot of changes since your sleep study.

The first time I was diagnosed with OSA, I got a PR machine and I shelved it pretty quickly. I did not have the knowledge I should have and of course I was not educated and didn't know how to educate myself at that time (it was in 1995 or 1996). Because of this forum, I have learned a lot (I have not learned the ins and outs of vpap machines yet though).

There are good people here that will help you as much as they can. Best info I can offer is be your own advocate, be proactive in your treatment and come here and ask for help if you need to. The DME's, RT's, etc. top priority is not your health and well-being; it is their bottom line in profits, etc. YMMV and this is just my thoughts and opinions. You decide.
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Welcome SleepyWabbit,
Please do not accept a machine that is not a fully data capable auto CPAP!
Call your doctor now, and have him send a script to the DME stating exactly what you want. Also be sure you have a humidifier with heated hose.

Don't wait for the DME to call you. They are going to give you a "brick" as we call it here. They like to pawn off older machines. You have a right to the latest machine out there regardless of insurance, which by the way, they pay the DME the same for a CPAP or an Auto CPAP

Inform your doctor that you will keep it on the straight setting he wants, but you don't know what your future needs will be, and an APAP just makes sense.

I've been through this nonsense with Doc's and DME's. It's harder to get it changed once they give you a brick.

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Thanks for all the tips. I'm looking forward to seeing what the filters can do for allergens in the air to include cat hair and 2nd hand smoke. My wife smokes so I'm looking forward to seeing if/what the filters do for it. She keeps it in the other room but I can still smell/taste it in the air when she lights up. She has tried to quit for both her health and ours (me and step-son) but has been unsuccessful. I think part of it is she is disabled with a bad back and nerve damage. The smoking has some sort of effect on her brain that helps with the pain. The human brain is a complicated thing. It's why we love the calming effect that pets have on us.

When I did the sleep study, they fitted me with both nasal and FFM. The FFM just felt more comfortable. I was stuffed up as usual and the air from nasal mask just went in and followed the path of least resistance right out my mouth. I was also sporting a goatee at the time and she suggested the FFM worked better with facial hair. I'm not writing the nasal masks off, but think I will be better off with the FFM for the 90 day trial and I can play with things afterwards. If this helps clear up my sinuses like I've heard from other users, then a nasal mask may be an option down the road. Of course if I have issues with the FFM, I will defiantly try other masks. I've been dealing with daytime sleepiness and other health effects long enough that I'm not going to give up on this treatment easily.
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