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Just titrated - few questions
#31
(06-14-2013, 10:54 AM)PaulaO2 Wrote:
(06-14-2013, 10:27 AM)Paptillian Wrote: 4. Will the doctor or insurance company be tracking my usage? Back in January I had heard something about 'compliance.' How do they check? How long do they check for? What are the compliance rules and what happens if I fail?

Nearly every insurance will do compliance checks. Usually this is for 3 months and you must use the machine for an average of at least 4 hrs per night. If you do not comply, they take back the machine.

This must depend on the insurance/doc. My machine supplier never checked unless I asked them. When I did ask them, it was clear I wasn't compliant a lot. Yet they still changed my mask, and I still have my machine. I ended up buying the thing though (rent to own maybe?), so if they want it they'll have to come get it out my cold, sleepless fingers.

The word "compliance" does sound a bit ominous, but it's widely used in medicine and isn't supposed to be a judgmental "Ve haf vays of making you Komlpy!!!" kinda thing. Still, Paula's observation may apply in your case. The aim is (or should be) to help you get to *be* compliant, rather than hang over your head as a "you'd better or else" threat. On some of your annoyances:

Quote:* mask puts pressure on my front teeth when resting on my face

Yep. I get that. Then I move a strap to fix the teeth thing, and it tries to blow my eyeballs out. Fix the eyeball hurricane and it makes a farting noise out the side of my right nostril. I could be a kids entertainer with this thing. Last night I got it the best yet, with an entire night *of nose breathing*! But I achieved it via straps so tight I had grooves on my cheek in the morning :-)

Quote:* tube tugs on mask, dragging it down and sometimes causing a leak

All the time. I just tighten the straps and take the face-grooving. Thank god I'm not pretty and care about how I look.

Quote:* dry mouth in the morning even though I think I kept my mouth shut

Oh gawd, yes! Although to be honest it mostly happens when I mouth breathe (a lot). I can wake up middle of the night with my mouth feeling like the bottom of a dead parrot's cage. Bottle of water on the nightstand is de rigeur.

Quote:* some facial marks from mask straps, but they fade quickly

Yep. Battle scars, dude; battle scars. Wear them with pride. Cool

Quote:* CLEANING EQUIPMENT IN THE MORNING WHILE ALREADY RUNNING LATE

Cleaning? Yeah, I really should do that... Vomit
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#32
I think overall I'm doing alright with it. It's been 3 nights now with CPAP and according to the data my average AHI is 1.56. Most of that seems to be due to the presence of 'open-airway' events, which to me look like central apneas. My sleep doctor confirmed that I don't have central apnea, only OSA. Others on here have commented that these are likely CPAP-induced CSA's. I'm very curious why they are happening and how to put a stop to them to bring my AHI down further.

Attached are screenshots of my first 3 nights. To me it looks as though my first night was the most erratic with pressure spikes kind of all over the place. By night three it seems to have settled down a bit and I have more regular pressure increases every hour or so (can I assume they correlate with REM sleep?).

The important thing, for me, is that there haven't been any recoded obstructive apneas over these three nights. Just a couple hypopneas, but no OSAs and my snoring seems to have been stopped.

I'm also attaching a detailed view of a couple of those open-airway/central events from the third night. Gotta figure out what these are and nip them in the bud.


Attached Files Thumbnail(s)
               
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#33
This is exactly what my DME did to me..gave me the oldest out of date machine they had..I learned it was an outdated machine only after having rented it then buying it after a year...When I asked them point blank why they didnt give me a newer model. (..they lied and made excuses tho finally one person did admit they always give out their oldest merchandise on the shelf first) ...

So good for you...you do not have to take whatever the DME wants to give you...you can buy your own machine then have the DME set it up for you then have your insurance reimburse you..or shop around for different DME who wont unload old outdated equipment on you
I don't believe anything I hear and only half of what I see
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#34
(06-23-2013, 11:42 AM)Paptillian Wrote: It's been 3 nights now with CPAP and according to the data my average AHI is 1.56.

That's well-nigh normal. What was your AHI when diagnosed?

(06-23-2013, 11:42 AM)Paptillian Wrote: Most of that seems to be due to the presence of 'open-airway' events, which to me look like central apneas. My sleep doctor confirmed that I don't have central apnea, only OSA. Others on here have commented that these are likely CPAP-induced CSA's. I'm very curious why they are happening and how to put a stop to them to bring my AHI down further.

Kock yourself out, but I wouldn't worry about that 1.56. Your sleep study would have spotted CPAP-induced centrals and, had they been significant enough, would have resulted in another study, to handle those.

Are you using a single pressure, or is it bi-level?

(06-23-2013, 11:42 AM)Paptillian Wrote: Gotta figure out what these are and nip them in the bud.

I don't think you do. Below 5 is normal. That said, if it's worrying you mention to your doc, and s/he may change the pressure. I reckon they'll tell you to wait a while though, because CPAP-induced centrals can go away as your body adjusts.

It's very similar to what happens if a diver hyperventilates to prepare for competitive breath holding -- named, of course, "apnea". Blood CO2 lowers, decreasing the brain's perception of need to breathe, so you can go longer without breathing. If the CPAP machine spots that it yells "EVENT!", but it's not necessarily an issue.
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#35
I'd not worry about those CA events. Look at the duration and how many you have then compare to the OA events. Also look at what the pressure was at the time of the CA event. If they consistently and only happen when at the top range, then it may be perhaps kinda sorta be pressure related. My bet is that with time, their number decrease. I doubt there are very many of us with a diagnosis of OA who do not also have some CA events happening nearly every night.

Don't worry about fine tuning anything just yet. You need to collect a lot more data first. My suggestion to you is to use it for 3 months. Look at the data, note how you feel, look for trends and your "norm" range for stuff. You don't have to necessarily know what you are looking at, just what is "normal" for you so when something is different, you see it.

After 3 months, then evaluate how you are doing. You want that AHI below 5. Some folks keep tweaking to see if they can consistently get below 1. I'm not one of those folks. I know my norm is less than 2.5. I don't freak if it is higher for a night here and there.

PaulaO2
Apnea Board Moderator
www.ApneaBoard.com


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#36
@spdklls99 - I'm sorry to hear what the DME did to you. I would have been dealing with DMEs as well if my insurance coverage were better. As it turned out I would have been paying full price for the machine either way... so I took a gamble on not needing the DME. So far so good.

@onsonby & PaulaO2 - Thanks, I'll try to ignore those CSA's then Smile Paula, I'll keep your comments in mind after I collect more data to look at.

onsonby, I was diagnosed at 12.3 AHI. I'm pretty sure that it's normally a little higher because I did not sleep nearly as well / as long, or in the same position in the lab as I normally do.

It's not bi-level, just auto CPAP ranging from 4 - 10. However, I have EPR turned on so the pressure dips when I exhale. Despite having EPR I still struggle a bit in the beginning of the night to overcome the feeling of not being able to breath out through the mask. I don't know if that's normal or just an effect of having a low starting pressure.
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#37
(06-19-2013, 12:07 PM)Paptillian Wrote: First the good news: My AHI dropped from 12.3 (baseline established on 12/2012) to 0.6 during the overnight titration! The optimal pressure was just 5 cm H2O, but the doctor prescribed auto-CPAP with a range of 4 to 10 cm H20 and Pressure Relief = 2.

The bad news: My second sleep study conflicts with the first about my type of sleep apnea and I'm not sure which one to trust. The baseline study found only obstructive apnea which was really prevalent during REM. The second study (CPAP night) showed no obstructive events, but central events instead! I had 3 centrals and a couple hypopneas. The diagnoses however is still "obstructive sleep apnea." I'm not sure how to read this.

Is it that I had no obstructive events, or that they didn't occur because of the CPAP and my pressure being so close to the minimum? Why did central events suddenly start showing up on the CPAP study and not before? Should I be concerned about them, and is the doctor still right about prescribing Auto CPAP or am I better served by some kind of Bi-Level / VPAP or other machine?

(06-19-2013, 06:00 PM)jgjones1972 Wrote: 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.

Hi Paptillian,

Ditto what jgjones1972 said.


(06-23-2013, 11:42 AM)Paptillian Wrote: I think overall I'm doing alright with it. It's been 3 nights now with CPAP and according to the data my average AHI is 1.56. Most of that seems to be due to the presence of 'open-airway' events, which to me look like central apneas. My sleep doctor confirmed that I don't have central apnea, only OSA. Others on here have commented that these are likely CPAP-induced CSA's. I'm very curious why they are happening and how to put a stop to them to bring my AHI down further.
...
I'm also attaching a detailed view of a couple of those open-airway/central events from the third night. Gotta figure out what these are and nip them in the bud.

(06-23-2013, 01:24 PM)onsonby Wrote:
(06-23-2013, 11:42 AM)Paptillian Wrote: Most of that seems to be due to the presence of 'open-airway' events, which to me look like central apneas. My sleep doctor confirmed that I don't have central apnea, only OSA. Others on here have commented that these are likely CPAP-induced CSA's. I'm very curious why they are happening and how to put a stop to them to bring my AHI down further.

Kock yourself out, but I wouldn't worry about that 1.56. Your sleep study would have spotted CPAP-induced centrals and, had they been significant enough, would have resulted in another study, to handle those. ...

(06-23-2013, 11:42 AM)Paptillian Wrote: Gotta figure out what these are and nip them in the bud.

I don't think you do. Below 5 is normal. That said, if it's worrying you mention to your doc, and s/he may change the pressure. I reckon they'll tell you to wait a while though, because CPAP-induced centrals can go away as your body adjusts.

Again, ditto what onsonby wrote.

It is not that the CA events appearing in your data are not "real" CA events or do not potentially affect your blood oxygen level, it is just that a few CA events are not considered a problem if they are of short duration (less than 30 seconds, I think), and especially not of concern in the first few weeks/months of treatment.

I think Medicare in U.S. will not accept a diagnosis of CSA unless the CAI (central apnea index) is 5 or higher all by itself. This is not to say your doctor might not be happy to provide you with a prescription for a bi-level or ASV machine (if the CA events you are seeing don't go away on their own during the first few months of treatment), this is only to say having a few CA events is widely considered normal and a more expensive machine to eliminate them completely would likely not be reimbursable. Normal does not mean harmless or fine, in this context it only means "not warranting reimbursement".

That said, reducing EPR to 1 for a week and then turning EPR off will sometimes decrease or eliminate the CAI, but I suggest holding off trying that for several weeks to allow yourself to become more used to PAP treatment, because most people find EPR makes PAP treatment much more comfortable.

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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#38
(06-23-2013, 02:53 PM)Paptillian Wrote: onsonby, I was diagnosed at 12.3 AHI. I'm pretty sure that it's normally a little higher because I did not sleep nearly as well / as long, or in the same position in the lab as I normally do.

Quite possibly -- for my sleep study I slept like a ... well, something that never sleeps. My diagnosis -- AHI=90+. Basically it's like I'm sleeping with my head in a bucket of water and every so often I pull my head out and gasp for breath :-)
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#39
(06-23-2013, 03:32 PM)vsheline Wrote: That said, reducing EPR to 1 for a week and then turning EPR off will sometimes decrease or eliminate the CAI, but I suggest holding off trying that for several weeks to allow yourself to become more used to PAP treatment, because most people find EPR makes PAP treatment much more comfortable.

Even with EPR I'm finding it hard to exhale through the nasal pillows until I settle down in bed or a while. I feel like I have to really "push" the air out and I think it makes me breathe harder. My starting pressure is only 4 cmH2O, so I can only imagine what some of you with high pressures have learned to cope with.

Thankfully though once I fall asleep it doesn't seem to be as much of an issue. When I wake up in the morning it doesn't feel as difficult to breathe as it does when I'm first getting into bed. I can see how some folks would have trouble with the initial resistance of the mask and air pressure. It's an almost suffocating kind of feeling. You just have to trust that nothing is going to happen to you and let yourself go.

I'm rambling again... Smile

(06-23-2013, 03:46 PM)onsonby Wrote: Quite possibly -- for my sleep study I slept like a ... well, something that never sleeps. My diagnosis -- AHI=90+. Basically it's like I'm sleeping with my head in a bucket of water and every so often I pull my head out and gasp for breath :-)

Sad Glad you found salvation through CPAP. I suspect that as I age I'll need higher pressures, but I'm hopeful that I still have a chance to help keep it in check by losing weight.
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#40
(06-23-2013, 05:35 PM)Paptillian Wrote: Even with EPR I'm finding it hard to exhale through the nasal pillows ...

For the most part, nasal pillows will feel like it takes more effort to exhale. You might be tempted to think "but it's the same pressure regardless of the mask type", but that is ignoring a significant fact. That is only true if you are not trying to exhale a volume of air.

Nasal pillow masks tend to have a much smaller "buffer" volume than other types of masks. Hence, to exhale the same volume of air, you have to blow with a higher pressure than with nasal or full face masks. Think of it as trying to add more air into a small balloon vs trying to add more air into your bedroom. The same volume of air will significantly increase the pressure in the balloon, but I doubt you could measure the pressure increase in the room.
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