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New to CPAP - seeking advice
#1
New to CPAP - seeking advice
My saga began some six weeks ago when I underwent an overnight sleep study at a local hospital. Since that time - silence from that provider and their sleep lab. So, last week I contacted a friend who is a doctor at the local VA hospital. He has reviewed my chart and will get me started next week with both the necessary prescription and an appointment with the VA Sleep Clinic to officially get things rolling.

I read comments from other members of this forum describing their particular APNEA characteristics as denoted in their sleep studies. I have attached my sleep study in hopes that someone more conversant in these things can tell me about my condition from a review of the two page document. Looking at the "Impression" paragraph these appear to be the findings:

1. It would seem I'm said to have "Moderate Obstructive Sleep Apnea".  OK, I get that but not sure what that entails in terms of treatment and recommended equipment.  
2. The study then goes on to say I have "Periodic Limb Movements in Sleep". I'm wondering how PLMV is relevant and/or if it is important?
3. The third impression says "Sleep apnea treated with CPAP @ 6cmH2O". I guess those are the settings they put into the machine I was coupled with during the session. It sounds like they had me on a  CPAP machine with added humidity. Am I correct in that?
4. The fourth impression was "Hypoxemia". I'm not sure what that tells me?

Their recommendation paragraph would seem to confirm my suspicions above as to the machine and recommended settings on that machine. They go on to suggest possible treatment of the PLMS.

My doctor has told me his prescription will be for an "autotitrating CPAP machine with mask, tubing, etc." He said he does not know the brands of equipment that are dispensed in the VA Sleep Clinic but says that if  I'm unhappy with their offerings, based upon knowledge gained on this website, he will do what he can to see that I get what I need. He goes on to say "Once your are using the CPAP every night and wake up with the mask still on every morning we'll do another over night oxygen measurement to see if the CPAP alone solved the low oxygen problem or it you need additional oxygen fed into the CPAP."

I believe I finally have a starting point thanks to this fine doc who has taken on my cause. I look forward to hearing from others as to what type of equipment I should ask for -assuming I even have a choice. Do people start out with a dehumidifier and heated tubing or does that come later if a need is shown? I know I need to get a so-called "smart" machine with an SD card in the memory slot. I am continuing to read the many posts in hopes that more and more of this will make sense to this newly diagnosed person.

I'm about to go merrily on my way into the VA sleep clinic but I hope to do so as a knowledgeable consumer. I appreciate any assistance that anyone can offer. Please see the attached and help me get a grasp on these things before my appointment with the technician in the VA clinic. I have not seen a bar graph like that which some have posted but I presume it exists somewhere in the sleep study. [attachment=5348]

Kind regards
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#2
RE: New to CPAP - seeking advice
I think your doctor is looking after you. My Reader's Digest version of the sleep study report would be as follows:

You have an apnea index in the 15 events per hour, which is the transition point from low to moderate on the scale, so say low moderate. They appear to have tested you at pressures of 4, 5, 6, and 7 cm of water pressure. You had no apnea events in the 4-6 range, but 5 at the 7 cm range. That is a bit strange that central apenas started to show up at 7 cm, but I wouldn't be too concerned about it for now.

They have prescribed an auto CPAP machine, which is good, but said to set it at a fixed 6 cm of water pressure. That probably will work well too. However if it were me, I would ask to have it set at 6 minimum and 8 maximum. It should treat you more reliably if you let the machine bump up a pressure a bit when it is needed. My person choice for an auto CPAP is the ResMed AirSense 10 AutoSet. It is very popular and has all the bells and whistles. That said your needs at this point are not high, and a lesser machine would probably work very well too. Insist on one that writes the data to a SD card, and you can read it in SleepyHead. That way you can monitor how well the machine is working for you, and you do not have to depend on doctors and sleep technicians to do it for you.

As for the Hypoxemia that is just low oxygen levels in the blood, and fairly normal for someone with apnea, as your breathing stops during the night and that drops oxygen levels. They are going to do follow up tests to verify it is improved with CPAP therapy.

As for the periodic limb movements in sleep, I don't know much about that. Restless Legs? Don't know. 

Hope that helps some.
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#3
RE: New to CPAP - seeking advice
Thanks Ron. That is all useful information for me. I'll add your note to my collection. I see you're a nasal pillow guy. That is what I used for my overnight sleep study and i guess it went well enough as I think the technician said I was not a mouth breather.  I also see you're a "preferred" member. How does one move from "member" to the higher level you seem to have achieved?
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#4
RE: New to CPAP - seeking advice
(04-15-2018, 11:16 AM)HD Fry Wrote: Thanks Ron. That is all useful information for me. I'll add your note to my collection. I see you're a nasal pillow guy. That is what I used for my overnight sleep study and i guess it went well enough as I think the technician said I was not a mouth breather.  I also see you're a "preferred" member. How does one move from "member" to the higher level you seem to have achieved?

I think the AirFit P10 is probably one of the most comfortable and least invasive masks available, if you don't mind part of it sticking into your nose. No, it does not seal against leaks the best, and because it is a nasal mask, opening your mouth can be a bit of a problem. I've tried the Mirage Quattro full face, and the Mirage FX nasal mask, and the P10 is easily the most tolerable for me. I suspect with your low treatment pressures it would be a very good choice for you to start with. If it doesn't work, ask for a different one.

Suspect the member status is just based on the number of posts you make. I have issues getting my treatment right and seem to chase my tail a lot. That makes for many posts!! But, contributors here are very understanding and helpful. It is a good place to come for help during your initiation period to CPAP.
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#5
RE: New to CPAP - seeking advice
Thanks again Ron.
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#6
RE: New to CPAP - seeking advice
Welcome to the group HD Fry! Glad to hear you have a doc who's willing to take over and get things done for you. You will soon be on your way to better health!
APNEABOARD - A great place to be if you're a hosehead!!  Rolleyes  

-------------------------------------------------------------------------------------------------
EVERY ACCOMPLISHMENT BEGINS WITH THE DECISION TO TRY!
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#7
RE: New to CPAP - seeking advice
OK Cate. Encouragement appreciated!
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#8
RE: New to CPAP - seeking advice
(04-15-2018, 09:24 AM)HD Fry Wrote: My saga began some six weeks ago when I underwent an overnight sleep study at a local hospital. Since that time - silence from that provider and their sleep lab. So, last week I contacted a friend who is a doctor at the local VA hospital. He has reviewed my chart and will get me started next week with both the necessary prescription and an appointment with the VA Sleep Clinic to officially get things rolling.

I read comments from other members of this forum describing their particular APNEA characteristics as denoted in their sleep studies. I have attached my sleep study in hopes that someone more conversant in these things can tell me about my condition from a review of the two page document. Looking at the "Impression" paragraph these appear to be the findings:

1. It would seem I'm said to have "Moderate Obstructive Sleep Apnea".  OK, I get that but not sure what that entails in terms of treatment and recommended equipment.  
2. The study then goes on to say I have "Periodic Limb Movements in Sleep". I'm wondering how PLMV is relevant and/or if it is important?
3. The third impression says "Sleep apnea treated with CPAP @ 6cmH2O". I guess those are the settings they put into the machine I was coupled with during the session. It sounds like they had me on a  CPAP machine with added humidity. Am I correct in that?
4. The fourth impression was "Hypoxemia". I'm not sure what that tells me?

Their recommendation paragraph would seem to confirm my suspicions above as to the machine and recommended settings on that machine. They go on to suggest possible treatment of the PLMS.

My doctor has told me his prescription will be for an "autotitrating CPAP machine with mask, tubing, etc." He said he does not know the brands of equipment that are dispensed in the VA Sleep Clinic but says that if  I'm unhappy with their offerings, based upon knowledge gained on this website, he will do what he can to see that I get what I need. He goes on to say "Once your are using the CPAP every night and wake up with the mask still on every morning we'll do another over night oxygen measurement to see if the CPAP alone solved the low oxygen problem or it you need additional oxygen fed into the CPAP."

I believe I finally have a starting point thanks to this fine doc who has taken on my cause. I look forward to hearing from others as to what type of equipment I should ask for -assuming I even have a choice. Do people start out with a dehumidifier and heated tubing or does that come later if a need is shown? I know I need to get a so-called "smart" machine with an SD card in the memory slot. I am continuing to read the many posts in hopes that more and more of this will make sense to this newly diagnosed person.

I'm about to go merrily on my way into the VA sleep clinic but I hope to do so as a knowledgeable consumer. I appreciate any assistance that anyone can offer. Please see the attached and help me get a grasp on these things before my appointment with the technician in the VA clinic. I have not seen a bar graph like that which some have posted but I presume it exists somewhere in the sleep study. 

Kind regards

With regard to your doctor's prescription, it is mostly okay, however it would help if you specified Resmed Airsense 10 Autoset with heated humidifier and heated tubing.  The Resmed Airsense 10 Autoset is just the very best auto-titrating machine out there and can produce therapy like a bilevel with up to 3 cm of pressure support (exhale pressure relief) if needed.   This machine produces very good therapy and efficacy data which will allow you to see the results of the therapy and use that information to optimize it.

Your titration study suggests that you are treated at a very low pressure of 6-cm.  If you are like most people here, that may be a good start, but you will ultimately benefit from a higher pressure or auto-pressure.  Since "hypoxiemia" was identified during your study, the "Positive End Expiratory Pressure" (PEEP) can be used to treat hypoxia.  In simple terms that means a higher pressure may treat both apnea and the hypoxia.  Don't be surprised if you find a higher pressure more comfortable and effective.  We don't know if the hypoxia was resolved with CPAP pressure, but it can be improved with CPAP, and maintaining a higher PEEP.  An accessory you can use with the CPAP is a recording oximeter.  Many members here own an inexpensive oximeter like the CMS 50 F Wrist worn recording oximeter.  The data can work with the CPAP data to show your oxygen saturations levels through the night, and the relationship of that with apnea events or CPAP pressure.  Since hypoxemia is a concern, this inexpensive tool can help you to know if action should be taken or not.

The most important thing you can do at this time is to keep personal copies of the sleep reports and prescription for your future use and reference.  That is the best way to hedge against future sleep studies and to be able to continue your care, even if you eventually change doctors.
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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#9
RE: New to CPAP - seeking advice
Hi HD Fry, welcome to the Apnea Board.

Congrats on the road to better sleep, and by joining here, you will be well educated on how to be a very smart self-advocate in your CPAP therapy. Like others said, post data via SleepyHead and you will receive great advice from Sleeprider and other well-versed guru types. Follow through on the advice you get, great results are sure to follow. Best wishes on future success.

PS title status is dependent on time and helping others, etc. We likely have a description of criteria, I have forgotten the specifics, but there's a rumor that Coffee bribes help some....Smile

Coffee
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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