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Just titrated - few questions
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Paptillian Offline

Preferred Members-2

Posts: 474
Joined: Jun 2013

Machine: S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: H5i
CPAP Pressure: 4 - 10, EPR x2
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Pennsylvania, USA

Post: #21
RE: Just titrated - few questions
One more question in addition to my last post, please:

The test showed 44 spontaneous arousals, which I presume means they were not related to any kind of apnea. Is that seen often among OSA patients? The test did not show any leg movements or physiological distress. Mean oxygen saturation was in the 90's.
(This post was last modified: 06-19-2013 12:25 PM by Paptillian.)
06-19-2013 12:24 PM
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jgjones1972 Offline

Preferred Members-2

Posts: 516
Joined: Nov 2012

Machine: ResMed S9 AutoSet
Mask Type: Full face mask
Mask Make & Model: ResMed Quattro FX
Humidifier: ResMed H5i
CPAP Pressure: 18 - 20
CPAP Software: ResScan SleepyHead

Other Comments: CMS50I PulseOx

Sex: Male
Location: Ohio - USA

Post: #22
RE: Just titrated - few questions
Central Apneas during titration were likely PAP induced. It is a natural reaction to the increased air pressure, i.e. the pressure makes you have to exhale more forcefully so you also inhale more forcefully. This can cause mild hyperventilation until you get used to exhaling more forcefully and inhaling more softly. The body reacts to the hyperventilation by suspending breathing momentarily - this shows up as a Central Apnea. Temporary PAP induced CA is fairly common, hence the lack of concern and OSA diagnosis. Like I mentioned, this should subside as you acclimate.

Prescription is for a Medium Swift FX nasal pillows mask to be refilled every 3 months "pro re nata" for one year...means new mask up to once every 3 months as needed for a year. New headgear up to once every 6 months as needed for a year and new tubing up to one every month as needed for a year.

Spontaneous arousals could have just been from trying to sleep in a strange place with eyes on you while hooked up like a cyborg.

It's great you got the script for APAP...if you titrated at 5cmH2O then 4 - 10 seems like a pretty good starting point. Just make sure to get a fully data capable machine so you can keep an eye on where the pressures are going and adjust it over time to close in on a tighter range and/or to make sure your pressure needs aren't higher than shown in the lab titration and also to make sure those CAs subside with time, though the CA Index during lab titration isn't really high enough to be very concerned with.

Sleep-well
06-19-2013 06:00 PM
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Paptillian Offline

Preferred Members-2

Posts: 474
Joined: Jun 2013

Machine: S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: H5i
CPAP Pressure: 4 - 10, EPR x2
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Pennsylvania, USA

Post: #23
RE: Just titrated - few questions
Thank you sincerely, and for all the help everyone has given so far. I'm learning a ton here and really helped me to feel empowered when making decisions.

The doctor's receptionist called to confirm that I don't have CSA's as well, so you're spot on jgjones! She didn't leave a reason, but what you said sounds good to me. Smile

I spent some time today calling a couple local DMEs and running the numbers. For my specific insurance plan, it wasn't worth it. I would end up paying more through the DME. They also quoted a 1.5 to 2 week turnaround to get documents from the doctor, get the insurance auth., order the machine, etc.

Finally I put an order in with one of the suppliers on the list. Saved some money, got everything I wanted, and free overnight shipping and a promotional 30-day mask return period to boot. They even pre-set the machine to my prescribed pressure range. Should be here tomorrow!

Cool


Thanks
(This post was last modified: 06-19-2013 07:09 PM by Paptillian.)
06-19-2013 07:05 PM
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jgjones1972 Offline

Preferred Members-2

Posts: 516
Joined: Nov 2012

Machine: ResMed S9 AutoSet
Mask Type: Full face mask
Mask Make & Model: ResMed Quattro FX
Humidifier: ResMed H5i
CPAP Pressure: 18 - 20
CPAP Software: ResScan SleepyHead

Other Comments: CMS50I PulseOx

Sex: Male
Location: Ohio - USA

Post: #24
RE: Just titrated - few questions
You might want to give your insurance company a call (Phone # should be on back of card labeled "benefit inquiries" or something like that). I called mine and they agreed to let me file claims on CPAP and supplies purchased from on-line suppliers. I scanned and e-mailed my Rx then scan and e-mail receipts and completed generic claim forms with codes (you can get the form and codes from several on-line suppliers) and they send me a reimbursement minus co-pays. If you have a really high deductible you might not get much, if anything, back yet; but, you will at least have met part of the deductible. I don't know how many insurance companies will agree to do this, but mine was happy to do it - they are saving money too. There must be a few other insurance companies that agree to do it also or so many on-line suppliers wouldn't post the generic claim form and codes.

It's worth a shot.
06-19-2013 07:52 PM
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Paptillian Offline

Preferred Members-2

Posts: 474
Joined: Jun 2013

Machine: S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: H5i
CPAP Pressure: 4 - 10, EPR x2
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Pennsylvania, USA

Post: #25
RE: Just titrated - few questions
(06-19-2013 07:52 PM)jgjones1972 Wrote:  If you have a really high deductible you might not get much, if anything, back yet; but, you will at least have met part of the deductible.
Yeah, unfortunately as my insurance company explained it the claim would be out-of-network and my deductible for that is almost all of the purchase price Sad I'd be eligible for 50% of maybe $200. Still worth a shot though if nothing else, as you said, to meet a deductible. I just have to get the authorization which, as one of the insurance reps told me, must come from a doctor (I can't do it myself). I called my doctor and they told me they can't do that; that the DME has to do it after getting my forms from the doctor. But... the online supplier is not a DME. Circular problem.

I'm gonna need some more caffeine and patience on the phone to figure this one out.
06-19-2013 08:05 PM
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jgjones1972 Offline

Preferred Members-2

Posts: 516
Joined: Nov 2012

Machine: ResMed S9 AutoSet
Mask Type: Full face mask
Mask Make & Model: ResMed Quattro FX
Humidifier: ResMed H5i
CPAP Pressure: 18 - 20
CPAP Software: ResScan SleepyHead

Other Comments: CMS50I PulseOx

Sex: Male
Location: Ohio - USA

Post: #26
RE: Just titrated - few questions
My insurance company accepted a copy of the Rx as authorization from my doctor. You never know what any given insurance company will do though and I think a lot of it just has to do with which claims rep. you talk to. Dont-know

In any case, things will probably go a lot smoother dealing with the on-line suppliers. I'm convinced that a large part of the CPAP compliance problem is the intolerable struggle inherent in dealing with some of these crooked, useless brick and mortar DMEs and the Respiratory Salesologists on staff. I almost gave up on PAP when I was just a couple months in because I figured it would be less painful to suffer with apnea and die early of a stroke or heart attack than to spend the rest of my life dealing with dishonest, corrupted crooks ...ok...deep breath...count to 10 - I don't think anyone here really wants to hear my DME rant again.
Oh-jeez


I've never had a problem with any of the on-line suppliers I've used and have found a few to be exceptionally helpful.
06-19-2013 08:36 PM
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Paptillian Offline

Preferred Members-2

Posts: 474
Joined: Jun 2013

Machine: S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: H5i
CPAP Pressure: 4 - 10, EPR x2
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Pennsylvania, USA

Post: #27
RE: Just titrated - few questions
(06-19-2013 08:36 PM)jgjones1972 Wrote:  [...] I think a lot of it just has to do with which claims rep. you talk to. Dont-know

That's been my experience exactly. I've written about my battles with insurance in another thread. To summarize, I've been fighting since January to get authorization for my titration. I'm at the point where I know them by name and I can tell from the moment they answer whether or not it's going to be a productive call.

On the plus side, I probably have enough credentials at this point to start an advocacy service for people with authorization rejections. Rolleyes Too-funny Oh-jeezCrying-into-tissue
06-19-2013 09:17 PM
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Paptillian Offline

Preferred Members-2

Posts: 474
Joined: Jun 2013

Machine: S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: H5i
CPAP Pressure: 4 - 10, EPR x2
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Pennsylvania, USA

Post: #28
Thumbsup Made it through the first night
I used my new machine at home for the first time last night. Thanks to everyone for helping to get me to this point in short order.

I-love-Apnea-Board

Checked my results this morning on the S9:
Hours used: 8.5
AHI: 1.0
AI: 0.8
CAI: 0.8
Leak rate: 3L/min
Mask fit: good (Mr. Green smiley guy)
Pressure: 8

I was titrated at a pressure setting of 5 in the lab but the machine figured me for an 8 last night (my range is set to 4-10, EPR=2, no ramp).

I felt good when I went to bed; very relaxed and able to breathe well once the machine was on and the mask was adjusted. When the pressure is off, it's very difficult to breathe through the mask. When it's on and the mask fits well, it's paradise. So effortless.

I did not feel like I slept well, despite breathing like I've never breathed before. Hopefully that was due to me just being aware of my situation and will subside. I feel like I was awake/conscious the whole night, even though I'm probably not. Also, I'm usually a stomach sleeper but I tried sleeping on my back and sides last night. After a while my legs start to get uncomfortable and I need to switch positions. Not sure why that happens to me, but the sleep study did not show any concerns of RLS. Finally I ended up on my stomach and amazingly the mask did not come off.

I woke up this morning feeling like someone hit me with a ton of bricks. I felt tired, but in a different way than usual. Instead of yawning, my eyes just feel droopy and I need a nap. It's been getting better throughout the day, though. I think maybe my body is making up on lost sleep. Dont-know

Some annoyances:
* felt my throat start to close up at one point while sleeping on back; machine adjusted pressure but not immediately
* mask puts pressure on my front teeth when resting on my face
* nostrils get a little sore at night
* tube tugs on mask, dragging it down and sometimes causing a leak
* dry mouth in the morning even though I think I kept my mouth shut
* some facial marks from mask straps, but they fade quickly
* CLEANING EQUIPMENT IN THE MORNING WHILE ALREADY RUNNING LATE

Some positives:
* S9 is super quiet; wife is happy!
* felt amazing while laying in bed and just breathing... effortlessly.
* wife reports not noticing any snoring last night

Next steps for me are to look into getting one of the software packages, either ResScan or SleepyHead. Also going to monitor my blood pressure to see if I notice any benefits.
(This post was last modified: 06-21-2013 12:50 PM by Paptillian.)
06-21-2013 12:47 PM
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Paptillian Offline

Preferred Members-2

Posts: 474
Joined: Jun 2013

Machine: S9 AutoSet
Mask Type: Nasal pillows
Mask Make & Model: Swift FX
Humidifier: H5i
CPAP Pressure: 4 - 10, EPR x2
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Pennsylvania, USA

Post: #29
RE: Just titrated - few questions
Oh yeah, forgot to mention that my cheeks blow up like a balloon sometimes until I let the pressure out Smile That's kind of fun.
(This post was last modified: 06-21-2013 12:59 PM by Paptillian.)
06-21-2013 12:59 PM
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trish6hundred Offline

Advisory Members

Posts: 6,446
Joined: May 2012

Machine: Resmed S9 AutoSet for Her
Mask Type: Full face mask
Mask Make & Model: Fisher & Paykel Simplus
Humidifier: H5i Heated Humidifier
CPAP Pressure: 10 - 7-20 Cm H2O
CPAP Software: Not using software

Other Comments: I started CPAP in 2008. Totally blind since birth.

Sex: Female
Location: Missouri, USA

Post: #30
RE: Just titrated - few questions
Hi Paptillian,
GREAT to hear how well you are doing with your new machine. If you find that your nostriles are sore, get some HPA Lanolin. You can find it in the baby isle of most stores, just put a "LITTLE" bit on a q-tip and swav it into your nostriles and that should help with the irritation and you might get a better seal which would be a great benefit.
If you find that you are mouth breathing, you could try a chinstrap and see if that helps you.
CONGRATULATIONS on your new machine and of course, keep us posted on how you go, and feel free to ask as many questions as you need to.

trish6hundred
06-22-2013 10:59 PM
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