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Newbie to the Board ... New Machine (I hope) ...
Hello out there.

Made my first post on the "Success" sticky, and thought it would be good to start a new thread. Here is an edited version of that post:


... back in 2009, while at the ENT doc with one of my kids, I asked for an appointment to address my snoring. I was tired all the time, driving home was a bit of a crapshoot as I'd be drowsy and fall asleep. Not good.

Some background ... I've always snored. I first noticed my snoring in college, when I weighed a measly 125 lb. When I got married, my wife jokingly mentioned how she wanted to smother me with a pillow because my snoring was so bad.

Anyhow, I finally decided to go for it. Visited the doc, who prescribed a sleep study. Did the study, they found I had something like (I forget the numbers) 17 "events" per hour where I didn't breathe for 45 seconds. That was a bit of a shocker. I received a Philips Respironics M series, which seemed to help my general fatigue. In 2010 the CPAP supplier called me to let me know I could get a new machine, which I did, a REMstar Plus with C-Flex (model 250). For a while my compliance waxed and waned, in the summer, when I was hot, I tended to avoid using the machine. In the winter, when it was cold, I'd always use it. That was then ... in the last year or so I've been much more diligent about using it. There are periods when I don't/can't use it ... like dry camping in my travel trailer ... and I definitely notice the negative impact on how I feel.

About a week ago I read an article that mentioned how regular CPAP users often need their machines adjusted to increase the pressure. Hrm. I dug around a bit and found this forum. It appears that my current device is not a data logging type (despite having an SD card), which is very disappointing to me. I was pleasantly surprised to learn about the data logging machines, the software available, and the user support community. Just fantastic.

I have a followup with the ENT on another issue, and I'm going to ask about the CPAP. If I can get a new device, I'd like a data logging model ... maybe even an auto-PAP.


So, before I goto the ENT (scheduled for 2 April), I'd like to rent a more modern machine to 1) try it, and 2) log some data. It's been recommended that I get a hold of the sleep study (that's in work, have a call in to the sleep clinic) ... and after reading about the newer machines, I guess I'd need that in order to configure a rental unit(?). I'd really like to rent before I visit the ENT so I can ask him to prescribe a nice machine. Thought on that? Should I pull the trigger on a rental unit today (without the lab report)? I read the "CPAP Machine Choices" sticky ... any thoughts on a starting point for a rental?

Thanks again for the help. I'm a bit stunned by the data logging piece, I really think it could help me optimize my therapy, which would be awesome.

Warm Regards-
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Have you read this material on machine choices: The Good; the Bad; and the Ugly: http://www.apneaboard.com/wiki/index.php...ne_Choices

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Yes, I've read that wiki.

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Dosco, my first choice would be a Resmed Airsense 10 Autoset, second choice would be the Philips Respironics Dreamstation Auto. Both are good full-data machines, with the edge going to Resmed for being faster to respond ahead of apnea events, and a better exhale relief method. Advantage to Philips if you plan to run a unit on battery power since it is 12 volts, while Resmed is 24 volts and requires proprietary adapters.

For setup, just set the minimum pressure 1 or 2 cm less than your CPAP pressure. So an auto range of 7-14 would probably be pretty good for you. You will know pretty quickly if hat needs any changes. You can also decide whether you like AFlex (Philips) or EPR (Resmed) by trying those settings.
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I would stick with either Philips respironics dreamstation line, or the resmed airsense 10 line.   Avoid the dreamstation cpap or airsense 10 cpap.  Both are bricks and will not provide you with the detailed data you are looking for.   Similarly, avoid the air start series by resmed for the same reasons.   

The auto versions of either are your best choices (the dreamstation auto and the air sense 10 auto set).  Auto will provide you with the freedom to set a range, and will treat you even when the conditions change.  They can also be run in straight CPAP mode.  You've probably already noticed that there are some strong opinions on both algorithms.  Both are excellent machines and will effectively treat obstructive apnea, but resmed devices are more aggressive.  This can be good or bad and like everything, YMMV.  

I personally went with the resmed - I found it slightly better with treating me, and preferred their expiratory relief (EPR) over PRs flex.  I have since switched to an Aircurve 10 vauto.  

Good luck!
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Thank you for the replies.

I called the ENT, and (not surprisingly) the patient assistant wasn't able to immediately pull up the records. I had the sleep study done in ~2009, and the ENT has gone through 2 IT systems since then (I've had to fill out the new patient forms twice since 2009). The person on the phone suggested I call the sleep clinic ... here we go. She told me to call back if I wasn't able to get any satisfaction from the sleep clinic.

I called the sleep clinic ... and got transferred to the main office. I left a message. After not hearing back for an hour-and-a-half, I called back and pressed "1" for billing. I spoke with the billing person, and she told me she'd look in the records archive. I'm guessing she was the 1-armed wallpaper hanger in the office, busy hanging wallpaper. She told me she'd call back in 15 minutes. I ran some errands and on the return trip she called me back (about 1 hour later). She wasn't able to find anything. We talked for awhile and she tried polling her database with some of my other information ... no joy. Argh.

I called the ENT back. I spoke to the same person again, and she said that she'd dredge through her office's archives, but she'd have to do so next week. I told her that would be fine.

I'm not surprised, but I have to say that this is super irritating. When I was in the military, I had 1 folder with all of my medical "stuff" over the years. A lesson for me ... I think I will be my advocate from now on, and maintain my own set of records.

In the meantime, I think the suggestion is that I could go out and immediately rent a unit on a test basis?

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Rentals are not commonly available, but you will need a prescription, or if your doctor's office has it on file, the DME can just get it faxed. My last supplier rented travel machines. I'm not sure about the auto CPAPs.
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Yeah...was looking at a rental website and I need a scrip.

Will have to work with the ENT. We'll see what happens.

The DME supplier, I've no idea who they are. I recall thinking they were fishy (no website, didn't leave a card, etc.) - icing on the cake was a guy from Virginia (next state over) showing up in his beemer - no card, no nothing, other than "here's your machine."

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Hi dosco,
WELCOME! to the forum.!
I wish you good luck as you continue your CPAP therapy and also with getting a new machine, and that you get the one you really want.
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Last week the ENT's patient coordinator, Danni, told me she would dredge through their archives. I called the ENT's office yesterday and spoke with Danni again to inquire about how the dredging was coming along, or if the dredging would happen later this week. She mentioned it was on her list and she'd get with me later this week. She called back about an hour later, and told me she'd found the sleep study. She faxed it to my office and I picked it up late in the evening (I was working offsite yesterday).


So I had 2 studies, an initial and a CPAP titration; the initial was done in December 2007 and the titration in Jan 2008.

Interpretation of initial study:

Quote:The total recording time for this polysomnogram was 434 minutes and the total sleep time was 409 minutes with a normal sleep efficiency of 96%. Sleep latency was normal at 7 minutes and REM latency was normal at 98 minutes. Sleep distribution was normal.

The overall Apnea Hypopnea Index (AHI) was 17/hr. REM AHI was 10/hr. NREM AHI was 19/hr. Supine AHI was 39/hr. There were 117 total events with 28 obstructive apneas, 3 mixed apneas, 86 hypopneas, and 0 central apneas. The mean duration of respiratory events was 22 seconds. The longest duration respiratory event was 45 seconds. The overall arousal index was 48. Mean oxygen saturation was 95% during REM and 94% during NREM. Moderate oxygen desaturations were associated with a nadir of 84%. Tracheal microphone monitoring revealed moderate snoring. ECG tracings revealed no ectopy. Periodic Limb Movements (PLM's) were noted with an index of 13.


Moderate Obstructive Sleep Apnea worse when supine
Mild Periodic Limb Movement Disorder (PLMD)

Interpretation of titration study:

Quote:The total recording time for this CPAP titration polysomnogram was 376 minutes and the total sleep time was 321 minutes with a normal sleep efficiency of 87%. Sleep latency was normal at 9 minutes and REM latency was normal at 111 minutes. Mean oxygen saturation was 97% during REM and 96% during NREM. At a pressure of 8cm H2O this patient's Apnea Hypopnea Index (AHI) was 0/hr. The patient tolerated CPAP therapy well and reported feeling more refreshed using CPAP. ECG tracings revealed no ectopy. PLM's not noted.


Moderate Obstructive Sleep Apnea with good response to CPAP Therapy

I also found a "Certificate of Medical Necessity" signed by my ENT ... it indicates the "length of need" as "lifetime" and it requests a CPAP (E0601) (other options were Bi-Level (E0470) and Bi-Level ST (E0471)). I'm not sure I can rent an auto-CPAP with this ... I'll contact a rental company and ask. On the upside the information is now in hand, and when I go to the ENT at the beginning of April for a followup on another issue, we can have a reasonable conversation about a new machine.

I look forward to any comments or suggestions from the Apnea Board community.

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