(05-03-2012 01:30 PM)Not Sleeping Well Wrote: 1. Two weeks is generally the recommended minimum time to monitor a change for results. Is there an optimum time? I understand the longer the time the better, but I also realize there is a point of diminishing returns. So, is two weeks also a good length of time to monitor a change, or would say a month be better?
This would depend on the data you get. If you notice a change or any kind of pattern, then you would adjust the time accordingly. For example:
You lower the pressure to 10.5
By day ten, the AHI has not changed but a tenth of a point or two
You could decide to go ahead and drop to a pressure of 10
You lower the pressure to 10.5
By day ten, the AHI has gone from .2 to 6
You would definitely want to raise the pressure back to 11.
Quote:2. When this all started I knew nothing about CPAP and APAP. I agree that based on my desires and me being able to tell that some nights are better than others that it might be nice if I had an APAP instead. I plan to bring this up with my doctor (probably my family doctor as I am pretty sure I am firing the pulmonogist). Does anybody have any suggestions to help me convince the doctor that APAP is the way to go?
If your insurance paid for the current machine, they are not going to pay for another one for probably 5 yrs. If, however, the machine is still a "rental", they may switch the rental to an APAP. As for the validation, tell your GP about how weight loss often changes the pressure needed and an APAP would show this as well as automatically adjust.
Quote:3. One other question. Starting with my pressure of 11 and 230 day average AHI 0f 0.5. Does it matter what direction I adjust to start with? My hope would be to maybe not need the machine with continued weight loss. I realize that may not happen, but that is my hope. Would it be okay to adjust down to see how I do?
If your AHI is that good (and it is very, very good) you could justifiably go down in pressure by a half point at a time. Or you could leave it alone. It is working and why fix something that isn't broken? Many people would love to have an AHI that low.
Quote:Paula, I'm a little lost here. I would definitely keep records of my changes for myself. Are you also suggesting I send my hand written records or spreadsheet to my doctor and employer? All my employer wants is a compliance report generated by the machine. They also have asked for a sample of the data. I get the feeling though that my check ups with them will now be less frequent. I basically think they wanted to see that I would establish a pattern of using my machine and I get the feeling they are now pretty much satisfied. That being said, I expect to occasionally have to turn in additional compliance reports. As for sending my downloaded data to my doctor, today was the first day they even mentioned I should be sending it to them, but I definitely will. Are you also suggesting I send them a copy of my personal record of changes?
No, and you answered my question. They (the employer) want machine generated data so that is what you should give them. You could use a highlighter and mark the numbers they are looking for (hrs and AHI).
IF you are going to be mucking with the pressure, then you definitely want to keep records for yourself. It can be a simple notepad by the bed where you keep track of the day you moved the pressure and from what to what you changed it to. For example:
5/3/12 - moved from 11 to 10.5; next change to be 5/17
It would be too easy to forget when you changed it and to what.
It is always a good idea to keep track of doc appts and the outcome and the decisions and whatever. I have multiple issues and I keep an updated text file of dates of diagnosis, test dates, what we tried, what worked, what didn't, etc. This came in very handy recently when I went to a new doc and handed him the file. He was able to see immediately what medications I had used and what did not work. There is no way I would have accurately remembered all that and was able to avoid wasting both our times re-trying something. Instead, he narrowed down our choices tremendously.
The best case scenario is for you to settle things with your sleep doc or to find another one. While we advocate patient empowerment, we also advocate seeing your doc on a regular basis.