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No events with at-home titration.Why does pressure increase?
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jdip Offline

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Post: #41
RE: No events with at-home titration.Why does pressure increase?
Wow, lots of great replies. Thanks to you all. I have a question regarding the fixed CPAPs. If I get it from a DME do they generally "lock" the pressure setting so that only they can change it (and I can't?) or should I be able to change it. They wanted to sell me the fixed CPAP machines since my prescription had a fixed pressure listed. I don't put too much stock on that listed pressure since it was given during one poor night of sleep with an APAP (S9 Autoset), so I think I would prefer to get an APAP for more flexibility if it's needed.

If I did buy used/online, how would you guys recommend going about getting the right mask? It seems that if I go with a DME, they give me some sort of "comfort guarantee" in that if a mask doesn't work well for me, I can get it changed. If I was to just look at a list of them online, I wouldn't know where to start.

(05-06-2015 03:37 PM)zonk Wrote:  Been there, done that, I would get PRS1 Auto 560 from Supplier #2
"Suppliers List" link is at the top of the page

I was keeping an eye out on that site. Are you in Canada? And if so did you have to pay brokerage fees and duties?

(05-06-2015 08:04 PM)archangle Wrote:  Here in the US, you can often find good auto CPAP machines for $300 on Craigslist. I don't know how it is in Canada.

A number of people have gotten machines from US online CPAP sellers. Most of them won't ship outside the US, due to anti-competition restrictions from the manufacturers. Some people have had success with reshippers, or having the machine delivered to a friend in the US. I think some Canadians have also found it was worth their time to drive across the border and buy from a Craigslist buyer if they are close to the border.

There's a lot of info in my signature line at the bottom of the this post about which CPAP machines are good and which are bad.

Good luck.

There's a ton of used CPAPs on craigslist locally. I found an S9 Autoset with humidifier for $450 which is supposedly like new in condition. I'm a bit wary of going this route though since I don't really know the history of the machine and don't have any recourse if it stops working suddenly after purchase.

There's lots of good info in your sig. Will be reading that tomorrow.

(05-06-2015 08:36 PM)TyroneShoes Wrote:  I agree with the doc, but it seems like an APAP, or automatic CPAP, would be able to continue to titrate pressure and give a better result than a bricked CPAP.

Were it me, I would get that, set it to straight 9 for two weeks, and then loosen up the high and low ends and see what happens. And what I mean by that is that I would parse the data using SleepyHead every day, and if I had questions I would come here for answers.

So I would get an APAP that works with SH and reports RDI, and other than the tweaks I have mentioned, follow the Dr's orders.

If it turns out to help, it will still be the best investment you can make in your health. If it turns out not to work, you can unload it on Craig's or Ebay and recoup much of the investment.

...
So it appears that UARS is a kissing cousin to SA, with the distinction being that arousal sensitivity is higher.

I am also not clear on how it is "clear that I do not have sleep apnea". Do you have any data supporting that? an AHI, even from a one-night titration?

It seems that UARS arouses one before a blockage or partial blockage can be long enough to be considered an apnea, and if that will not desat you the way a longer, real apnea will, it still arouses you, which can have some of the same symptoms and dire consequences of SA. Otherwise, UARS is pretty close to SA, and could be considered "stealth SA" because apneas are not flagged.

That sounds like a really good approach for me to take with an APAP instead of CPAP. I may well follow that.

Yes, when I said that I don't have sleep apnea, I meant it in the technical sense that my AHI is 0 (as seen during my at-home screening test and my titration). From what I understand, UARS is on the same spectrum though but restriction in the airways causes arousals, disturbing sleep.

(05-06-2015 08:42 PM)AshSF Wrote:  As Zonk said, get a PRS1 60 series auto machine model No 560xx or561xx in international markets. This machine reports RERAs as well which is a better proxy for UARS.

In Resmed land, an "Airsense 10 Autoset for Her" model also reports RERAs.

Any other machine will give you less information and make it harder for you to diagnose or tweak therapy settings.

That's a great point regarding reporting RERAs. I would definitely prefer a machine that reports that, as just looking at AHI seems to be useless for me (it's at 0). Does the regular Airsense 10 Autoset not report them? I wonder why they chose to add the extra functionality to the "For Her" model.
05-06-2015 10:24 PM
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jdip Offline

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Post: #42
RE: No events with at-home titration.Why does pressure increase?
Another thing I'm worried about is if I buy an APAP, but end up needing a bi-level for compliance for example, I would be stuck with the APAP.
05-06-2015 10:37 PM
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TyroneShoes Offline

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Post: #43
RE: No events with at-home titration.Why does pressure increase?
Which is why you should have a PSG first, and have a competent sleep doc parse the results. They can then determine what you need.

If you are not covered, it's a bit of a Sophie's choice any way you slice it. An APAP is less costly than a PSG and an APAP, but an APAP alone is even more costly healthwise if that is not actually what you need, and you won't know without a PSG.

The good news is you are thinking through all the variables, and getting advice.
(This post was last modified: 05-09-2015 12:52 AM by TyroneShoes.)
05-09-2015 12:52 AM
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jdip Offline

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Post: #44
RE: No events with at-home titration.Why does pressure increase?
(05-09-2015 12:52 AM)TyroneShoes Wrote:  Which is why you should have a PSG first, and have a competent sleep doc parse the results. They can then determine what you need.

If you are not covered, it's a bit of a Sophie's choice any way you slice it. An APAP is less costly than a PSG and an APAP, but an APAP alone is even more costly healthwise if that is not actually what you need, and you won't know without a PSG.

The good news is you are thinking through all the variables, and getting advice.

I really appreciate the advice; thank you. I would love to find a doctor who is more knowledgeable about UARS, but I have no idea where to look. I've done some Google searches for my area, but found absolutely nothing.

I think I will take the jump and try the APAP first. I've waited many months to get a CPAP prescription (which I won't even need if I buy online from the US, which I will probably do...) and my quality of life is atrocious right now and I'm desperate for some relief. Hopefully a CPAP will give that to me. And if not, I guess I'll just sell the machine at a loss.
05-10-2015 12:11 AM
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vsheline Offline

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Post: #45
RE: No events with at-home titration.Why does pressure increase?
(05-10-2015 12:11 AM)jdip Wrote:  I would love to find a doctor who is more knowledgeable about UARS, but I have no idea where to look. I've done some Google searches for my area, but found absolutely nothing.

I think I will take the jump and try the APAP first. I've waited many months to get a CPAP prescription (which I won't even need if I buy online from the US, which I will probably do...) and my quality of life is atrocious right now and I'm desperate for some relief. Hopefully a CPAP will give that to me. And if not, I guess I'll just sell the machine at a loss.

Hi jdip,

The optimal treatment for UARS is usually bi-level, not fixed-pressure CPAP, and not APAP (auto-adjusting CPAP). Please read the article or talk from Dr Barry Krakow linked below.

I recommend obtaining a machine which reports RERA events, which all data-capable PRS1 (Philips Respironics System One) machines do. (The only ResMed machine which reports RERA events is the AirSense 10 AutoSet For Her.)

As an optimal solution, I recommend a used PRS1 BiPAP Auto with heated tube option. I think this would be the DS760 model in US, or DS761 in Canada.

The 750 or 751 model is the "50 series" model which is nearly the same as its equivalent 60 series model but does not allow use of a heated tube. The heated tube is important in avoiding "rainout" (excessive condensation in the tube).

http://www.apneaboard.com/forums/Thread-...56#pid5556

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.
(This post was last modified: 05-10-2015 02:27 AM by vsheline.)
05-10-2015 01:42 AM
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jdip Offline

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Post: #46
RE: No events with at-home titration.Why does pressure increase?
Hi vsheline,

Thanks a lot for your advice. I have come across that article before and was thinking about bi-level. At the moment, I've only done an auto-titration (on an S9 AutoSet), and my doctor used that to prescribe me a fixed pressure (9 cm H2O). So I have no clue where I'd start if using a bi-level...
05-10-2015 03:00 PM
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Napmeister Offline

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Post: #47
RE: No events with at-home titration.Why does pressure increase?
I didn't read the whole thread so understand this is a long shot, if you happen to be in Sask. ... our machines are free through a program called SAIL. If I was to buy a used machine, Kijiji (similar to Craigslist) in Toronto sometimes has good prices.
(This post was last modified: 05-10-2015 03:29 PM by Napmeister.)
05-10-2015 03:28 PM
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jdip Offline

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Post: #48
RE: No events with at-home titration.Why does pressure increase?
(05-10-2015 03:28 PM)Napmeister Wrote:  I didn't read the whole thread so understand this is a long shot, if you happen to be in Sask. ... our machines are free through a program called SAIL. If I was to buy a used machine, Kijiji (similar to Craigslist) in Toronto sometimes has good prices.

Thanks, I appreciate the info. Unfortunately I don't live in Sask nor Toronto. I did see some ok deals on Kijiji Toronto but don't particularly trust buying and getting it shipped to me by random Kijiji posters. If nothing pops up locally in the next couple of days I'll probably go with Supplier #2.
05-10-2015 05:50 PM
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storywizard Online

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Post: #49
RE: No events with at-home titration.Why does pressure increase?
(05-10-2015 05:50 PM)jdip Wrote:  
(05-10-2015 03:28 PM)Napmeister Wrote:  I didn't read the whole thread so understand this is a long shot, if you happen to be in Sask. ... our machines are free through a program called SAIL. If I was to buy a used machine, Kijiji (similar to Craigslist) in Toronto sometimes has good prices.

Thanks, I appreciate the info. Unfortunately I don't live in Sask nor Toronto. I did see some ok deals on Kijiji Toronto but don't particularly trust buying and getting it shipped to me by random Kijiji posters. If nothing pops up locally in the next couple of days I'll probably go with Supplier #2.

Supplier #2 is great, all their machines are cleaned and sterilized...I have had a great customer experience with them, awaiting my ASV machine this week...

Good luck with the therapy...Sleep-well

Storywizard
05-10-2015 06:34 PM
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vsheline Offline

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Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
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Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

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Post: #50
RE: No events with at-home titration.Why does pressure increase?
Quote:I've only done an auto-titration (on an S9 AutoSet), and my doctor used that to prescribe me a fixed pressure (9 cm H2O). So I have no clue where I'd start if using a bi-level...

Hi jdip,

The "Auto" bi-level machines are all able to auto-adjust EPAP, so both ResMed and PRS1 bi-level machines do that. The PRS1 BiPAP Auto DS750/DS751 and DS760/DS761 (unlike ResMed Bi-level "S9 VPAP Auto" or the new AirCurve 10 Auto) can also slowly auto-adjust the Pressure Support to be just high enough to prevent Flow Limitation (UARS) and the resulting RERA events.

You could set a PRS1 BiPAP Auto machine to an EPAP of 9 and just let the machine auto-adjust the Pressure Support.

Or, you could let the PRS1 BiPAP Auto machine auto-adjust EPAP also. You would likely find that, with bi-level, you would be able to use an EPAP lower than 9, and every night the machine could do an auto-titration on both EPAP and Pressure Support. You could either leave machine in full auto mode or, after gathering a couple weeks of data, set a fixed EPAP and/or fixed PS, chosen based on the data gathered.

In addition, seems like you will need to email your doctor the article/talk by Dr Barry Krakow (or drop off a hard copy), to help your doctor understand that bi-level therapy is the way to go when treating UARS.

Also, please check your Private Messages.

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.
(This post was last modified: 05-11-2015 09:22 AM by vsheline.)
05-11-2015 08:31 AM
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