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Introduction - Just a few questions
#1
Introduction - Just a few questions
Hello Everyone!

I have done all kinds of reading the last week and wow, I must say, this is such an awesome community.  I am brand new to CPAP therapy and I have a few questions.  First, let me start with an introduction:

I am a 38 year old male, 5'9" 240 lbs.  I am quite a bit overweight.  Moderate to heavy drinker.  No smoking.  No drugs.  Minimal exercise.  High Blood Pressure.

Medications:

Toprol XL 50mg daily- High Blood Pressure / Sinus Tachycardia
Lisinopril 20mg daily - High Blood Pressure 
Testosterone Cypionate injections - Low T
Anastrozole 1mg - Elevated estrogen from T injections

This whole sleep apnea concept has moved very quickly over the last 2 weeks.  It started with my girlfriend noticing very loud snoring and choking sounds.  I then downloaded the SnoreLab app to my iPhone to track some of the sounds she was hearing.  I didn't think much of it but her and I did some research and realized quickly that I needed to talk to someone about it.  It is unknown how long these symptoms have occured since her and I are both very "heavy" sleepers.  I decided to reach out to my doctor about this.  He is an internal medicine doctor and has diagnosed and treated the symptoms listed above.  I was told that this is outside his expertise and to find a sleep doctor.  I reached out to several in my area and the earliest appoint was available on February 5, 2020.  Around this time, we noticed that we had around $1200 in our FSA account and we have to spend it before the end of the year or it would be gone.  It does sound like a rushed approach I took to this, but I was kind of forced to given the time of year I found the symptoms.  

Even with the treatments above, I still feel so tired all of the time and I have a terrible time concentrating on anything.  So, I found a website that allowed me to do the WatchPAT home test.  I did this the first night available and it was found that I have severe apnea with AHI 41.5.  I have attached their report as well.  So, in order to spend that money, and speaking to their rep, I went with the ResMed AirSense 10 AutoSet with F20 full mask.  It will be here tomorrow (Monday).  The thing I find to be pretty weird about this experience, is that I still have not spoken to a doctor about any of this.  The rep did state in an email that, initially, the machine will be set at 4-20.  With all of that said, I have the following questions:

1)  The mentioned that the unit has a cell card and they can access my reports and make changes as needed.  I am not sure of the time period of this service.  Can the pressure settings be overwritten?  

2)  If so, what would be a good minimum pressure to start with?  Or should I just go with 4-20 until I can provide you all an Oscar report here in the next day or two?  From my research, I fully understand why such a low minimum setting is bad.

3)  I do not have a Rx pressure setting obviously, since I did not do any outpatient study.  Is this something I need to pursue?

4)  I do have a pretty bad cough from the Lisinopril, especially at night when I lay down.  How does the machine handle this?  

I am really looking forward to feeling better and getting some rest.  Any help you guys can provide will be greatly appreciated.  

-Chad


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#2
RE: Introduction - Just a few questions
G'day Chad. Welcome to Apnea Board.

First off, congratulations for recognising that apnea might be a problem, and taking decisive steps to confront it head-on. You have an excellent machine for treating normal obstructive apnea, and we'll be able to help you tune it in once you provide some OSCAR pages. I've included some links below to assist you, and give you some "homework".

In answer to your questions above:

1. Your machine has a built-in cellular phone connection to Resmed's cloud service, which your supplier can access. They can monitor your progress, get reports and make changes to your machine's settings, all remotely. You may also have access to Resmed's MyAir service, which will give you a bit of information and a lot of "gee whiz you're doing so great!" type of stuff. You should talk to your supplier about what is included in their service and for how long. They can change settings remotely, but personally I would not be comfortable with that. If they're prepared to act as a qualified advisor that's great, but you want to keep control i your own hands.

2. I'd increase the start pressure to about 6 and see how you go from there. (See link below for clinical manual). And yes - get us some OSCAR charts once you have things set up.

3. As I understand it you must be a licensed DME and have a prescription to sell a CPAP machine in the US. So I assume your supplier is a licensed DME and has procured a prescription on the basis of your sleep test. I'd ask them for a copy of that, which you will need later to purchase certain supplies (eg masks) or if you need a new / different machine at some stage.

4. Coughing into a mask can be unpleasant. It won't worry the machine at all, but you may find yourself waking up and removing the mask when the cough occurs. You might be better off with a nasal mask or nasal pillows, in which case the cough isn't confined to the mask. Again, this is probably one of those things you'll need to try and see how it goes.

A few other things to think about:
  • As far as I can see, your report doesn't specify if you had any central apnea. So for now we'll assume you have ordinary obstructive apnea and proceed on that basis. If centrals show up as an issue, that will be a matter for discussion then.
  • Your apnea is much worse when sleeping supine and on your left side, and very good when sleeping prone. If possible you should avoid lying on your back and left side - this will give your machine less work to do. It may also be the case that a soft cervical collar will help keep your neck in a slightly extended position which will help avoid airway collapse.
  • Some drugs including alcohol can make apnea worse. I'm not familiar with those you have listed so you should probably do some homework and ensure they're not going to make things worse - talk to your GP. You should also reduce alcohol in the evenings.
  • I'm guessing that the supplier will have set the ramp to 45. That means that the pressure builds up gradually over a 45 minute period. However you're starting at a low pressure anyway so the ramp isn't doing anything for you. On the other hand it prevents the machine diagnosing and treating apneas during that period. I'd turn the ramp off completely, but if you can't tolerate that set it to Auto.

Get OSCAR: https://www.sleepfiles.com/OSCAR/

Oscar help: http://www.apneaboard.com/wiki/index.php...OSCAR_Help

How to format and post Oscar charts: http://www.apneaboard.com/wiki/index.php...ganization

General beginners tips: http://www.apneaboard.com/wiki/index.php...re_success

All about masks: http://www.apneaboard.com/wiki/index.php/Mask_Primer

All about collars: http://www.apneaboard.com/wiki/index.php...cal_Collar

Clinician manuals: https://www.apneaboard.com/adjust-cpap-p...tup-manual
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#3
RE: Introduction - Just a few questions
"3) I do not have a Rx pressure setting obviously, since I did not do any outpatient study. Is this something I need to pursue?"

I went through a traditional 'sleep center' and my initial prescription ended up being 5-20cm, so your 'mail order' prescription is about the same for less $.
A titration study at the sleep center will cost $$.
As others have said 6 cmH20 is a good starting minimum for an adult.
After a few days of actual usage you will have enough OSCAR data to start making 'informed' adjustments to your minimum setting.
20 cmH20 works out to be about 1/4 psi...so we aren't talking about hazardous pressures.
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#4
RE: Introduction - Just a few questions
Thanks for the help!

What about EPR?  Should this be enables for someone with no results yet?  Or it also one of those things where we will just play around with it until we have verified results in Oscar?
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#5
RE: Introduction - Just a few questions
Thanks for the help!

What about EPR?  Should this be enables for someone with no results yet?  Or it also one of those things where we will just play around with it until we have verified results in Oscar?
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#6
RE: Introduction - Just a few questions
With a minimum pressure of 4cm, EPR (Exhale Pressure Relief) won’t do you any good.
As long as you aren’t showing an abundance of Clear Airway events, then EPR helps make therapy a little more comfortable.

Since your Sleep Study didn’t show CA’s, it’s probably safe to set your minimum pressure to 6cm with an EPR se at 2. At least until we can see some charts.
OpalRose
Apnea Board Administrator
www.ApneaBoard.com

OSCAR Chart Organization


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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#7
RE: Introduction - Just a few questions
We got your back Chad!!!
6-20 (or 4-20) is a good start, expect it to change for night 2.  As others have noted, a pressure of 4 is usually too low for most adults.
I do recommend no ramp, if you do need one we can add it back in.
EPR, will likely add it on night 2, either for therapy or comfort.  Note:  Min Pressure will be >= 4 + EPR
You do NOT need another sleep study right now.

Your OSCAR charts for night 1 and 2 will tell a lot.
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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#8
RE: Introduction - Just a few questions
(12-30-2019, 03:39 PM)bonjour Wrote: We got your back Chad!!!
6-20 (or 4-20) is a good start, expect it to change for night 2.  As others have noted, a pressure of 4 is usually too low for most adults.
I do recommend no ramp, if you do need one we can add it back in.
EPR, will likely add it on night 2, either for therapy or comfort.  Note:  Min Pressure will be >= 4 + EPR
You do NOT need another sleep study right now.

Your OSCAR charts for night 1 and 2 will tell a lot.

Can't wait!  Will report back tomorrow with night 1 chart.
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#9
RE: Introduction - Just a few questions
Hello, here are the OSCAR results from night 1.  I did wake up a few times due to the mask.  Nothing painful, just some getting used to.  Also, woke up one and felt like my mouth was a balloon haha.  I assume that is also some getting used to.  One thing I find concerning it that the machine did max out a few times at 20cm.  Is this something to be concerned about?


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#10
RE: Introduction - Just a few questions
Just realized the resolution of the last chart is probably hard to read if you don't have a 4k monitor.  Here is a smaller resolution.


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