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Please help!
#1
Hi everyone I am new to the forum and I really need help. To give some background info I have been cpaping for about 4 months now. I am 27 and weigh about 215 pounds and I believe I have had sleep apnea for much longer than just the past 4 months. The insurance that I have will not cover a sleep study so I am not officially diagnosed with sleep apnea but I am 99% sure that is what I have. About 4 months ago I bought a ResMed s9 Elite off craiglist that came with nasal pillows. When the mask stayed on all night I felt amazing the next day but the problem was that I always ripped the mask off during the night. So I recently bought a nasal mask off craigslist which for the past 4 nights has stayed on all night! The pressure has been pretty high though at between 17-19 which so when I wake up I still feel like complete crap. I have been getting really discouraged lately and it has been very hard to make it through each day and has been affecting my work and relationships. Im not sure what to do from here. What should I set my pressure at? Do I need an APAP or BIPAP? Is there another way to get diagnosed and titrated without spending a fortune? If anyone has any advice I would greatly appreciate it.

Sorry for the long post.
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#2
Hi strongman -- First thing: The Elite is a single fixed pressure machine. What is it currently set at? Also, what has your AHI been for the 4 months you've been using it, and what is the breakdown of event type (obstructive apnea, hypopnea, central apnea). What are your leak numbers like?

If you haven't been monitoring what's going on with your CPAP therapy using the available software, now is a good time to start. If you need help with downloading SleepyHead let us know. This would be a good idea before you consider the next step.

It's possible if you need a very high pressure that a bilevel machine would be the best choice -- but sometimes the problem is not that higher pressure is needed, but something else. Central apneas, for example, are not treated with pressure. And if leaks are not within acceptable levels then the therapy is compromised and the leaks need to be fixed before any pressure adjustments are made.

If you have plain old obstructive sleep apnea then you can usually titrate yourself with an auto-adjusting machine. If indeed you require very high pressures then that might mean a bilevel machine, but it's too soon to know if that's the case. First we need to figure out why you feel like crap, because it may not be your pressure settings at all.
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#3
(07-24-2015, 08:15 PM)strongman87 Wrote: The insurance that I have will not cover a sleep study so I am not officially diagnosed with sleep apnea but I am 99% sure that is what I have.

They might require an at-home test instead of a lab test, but I don't believe there are any current insurance policies that disallow all testing for sleep apnea. Have you rechecked lately and asked them to explain exactly what their policy is?

If you're in the US, you might want to contact your state's insurance commissioner.

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#4
Hi strongman87,
WELCOME! to the forum.!
Great suggestions so far.
Hang in there for more responses to your post.
Much success to you as you continue your CPAP therapy and fine tuning it.
trish6hundred
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#5
Hi strongman87,
Yes, please double check with your insurance. They should at least cover a home test or as Terry said, they may require a home test first. Also check with your doctor.

The thing is you are just guessing at your therapy needs. We have very little to go on as far as advising you on pressure settings. The machine you have is a straight CPAP. If you had an auto CPAP, then you could, at least self titrate yourself.
Now there is nothing wrong with your machine, but if you could download the sleepyhead software then we could see a breakdown of your apnea events.
Without that information, there is no way to see what is going on and why you feel like crap.
Good luck Wink

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#6
Thanks for responding!!
The AHI is always below 6 usually between 1-2. My pressure right now is 18 which i think is actually way too high. I don't know the event time and it doesn't leak at all. I have downloaded sleepyhead but i don't know how to use it so i don't. My main problem (i think) was that i kept ripping the mask off during sleep but now i have this mask that stays on so i think i just need to get the pressure figured out. I actually think the pressure is set so high that it was keeping me from breathing right. I do think that an APAP would be better but i just can't afford it. I was going to get an at home sleep test but the doctor said I need to get a test in the doctor's office which is like 800$. I guess I should call my insurance company and see what they can do.

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#7
Definitely worth checking with your insurance about what your plan covers. There may be sleep study options other than what your doctor is recommending -- only your insurance company can tell you what they will cover if there are.

Is the pressure set at 18 because that's where it was when you bought the machine, or did you set it yourself?
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#8
I'm going to call my insurance company tomorrow and see what they can do for me. The pressure is set so high because I thought maybe if I raised the pressure I would sleep better but I was wrong. It actually forced air down my throat and made me burp. I'm going to turn the pressure down to like 12 tonight and see if that helps.
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#9
When you go the DIY route you really need to be willing to download the software and learn about what you're doing and what the machine is doing. The data from the machine's SD card can (and should) be used to guide any pressure adjustments. Diagnosing and treating sleep apnea is not just a matter of hooking yourself up to a CPAP machine and "dial winging." You actually have a good machine and while it's not an APAP (best for self-titrating), it is a full data machine.

If learning about the software and how to self-titrate is not something you want to do then it would be best to let your doctor guide the process -- hopefully you'll find out that your insurance will cover diagnostic testing. A sleep study could confirm the diagnosis of obstructive sleep apnea, and might also turn up other information that could help explain your tiredness.



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#10
You do not need APAP, but it sure is a great tool for getting your pressure right and keeping it right throughout the night. You can only know if you need BI-PAP if you have a sleep study.

You can titrate yourself with a fixed CPAP, but it is just a lot harder; like trying to eat soup with a fork. And it takes a long time. You can try a pressure for a couple of weeks, then try a slightly lower or higher pressure for a couple of weeks, and so on, and settle on a fixed pressure eventually based on what your AHI breakdown is. If the numbers go down with a different pressure, that is probably a change in the right direction. So it is still titration and you can still find the best pressure for you, it just takes a very long time to get it dialed in. An APAP does most of this work for you, and much quicker.

Of course in the case of CPAP, you are making all of the decisions on pressure yourself, and you have to have some data to base that on, so you will need to get SleepyHead or equivalent software working and peruse the forum to learn how to parse the data.

Actually, that AHI is pretty low, so maybe you should stay with a pressure close to what you already have.
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