Questions about re-starting therapy, researching before doctor visit

[Sleeprider]

Current price on Amazon for a new Philips Respironics Dreamstation Auto DSX500T11 with heated humidifier and heated hose on Amazon is $365+$4.99 shipping. The seller, Total Health CPAP and Supplies has 5 in stock, so if you're happy with the results of the machine you're using, this one should make you ecstatic. All 5-star reviews for the vendor and a very good price.

[CrazyDreamer]

I'm not happy with the machine I've used the past two nights but I've used an old mask and at pressures I don't think were right.  I was very happy with the sleep I got during the last 4 hours of my sleep study and the Respironcs Pico mask seemed comfortable.

As mentioned in post #20, I lucked out and got squeezed in at my doctor's office this afternoon where I happened to be driving by anyways.

My apnea seems pretty simple (obstructive only) and the study found it disappeared at a fixed setting of 7.0.  The doctor said I did not need an automatic CPAP and that many people don't.  I told him I thought I had read of benefits of some of these more advanced machines but he said many patients do worse with them.  

He said that their prices were pretty similar to what I could find online and that the modest additional cost was offset by the convenience by being able to get easy machine replacements if something is wrong.  I don't believe their costs are really as modest as he claimed and he may not really know since that is not really his line of work but diagnosing patients.  I told him I had used my dad's old Respironics AutoOne the past two nights and that it seemed okay without a humidifier and he said it was fine to use that machine if I wanted to give it a shot.  I thought "why not" if I only need a fixed pressure.  I decided to just buy a Respironics Pico mask from my doctor and give the AutoOne a try tonight at 7.0.  I was charged $142 but got a free hose.  I figured even if it was double what I could get elsewhere it was better to have it in my hands now and possibly sleep better tonight (my face hurts after using my old mask for 2 nights).

I had contacted Total Health CPAP and Supplies by phone contact through Amazon earlier in the day (inquiring about a ResMed Airsense 10 AutoSet) and they happened to call me back as I was walking out my doctor's office.  I told him I'd try the old AutoOne for two nights and then decide.  He said that he was the largest buyer of the ResMed Airsense 10 AutoSet on the east coast, buying 1,500 of them at a time(!!!!!).  He said that the Amazon sales is a more recent avenue of sales and he only lists them at night and weekends but they've been in business for 27 years, etc.

I did not leave with a prescription since I can order a machine without it and plan on trying the AutoOne for a night or two.  But what do you think about using this machine and at a fixed setting of 7???

My sleep study was not dictated yet but I think the information below is everything I need anyways.

[Sleeprider]

I think you should get a prescription, just for your records. It gives you a record you can use if and when you need it. Otherwise, I would not buy the doctor's machines, and I would definitely buy an auto CPAP which can be used in either fixed CPAP mode or Auto. The big advantage being full data and lots of flexibility, compared to a fixed CPAP which may not even have data.

You seem to titrate at 7.0, and if you get an auto CPAP I would run it at minimum 7.0 and maximum 11.0 and make changes if needed as you go. The pressure flexibility is especially important if you use exhale relief pressure (EPR) on the Resmed, which can drop EPAP pressure by up to 3 cm. No one is the same night to night or year to year, so auto has its place. There are a few people, espcially those with complex apnea and centrals that really do better on fixed pressure. If I'm choosing a machine for myself and can find a good deal, first choice is the Resmed Airsense 10 Autoset. Second choice, considerably behind that is the Dreamstation. I think you would experience an epiphany using a new Autoset over your current borrowed machine.

[CrazyDreamer]

I ordered a ResMed AirSense 10 AutoSet and it should arrive sometime next week. In the meantime, I'll use the old PR AutoOne set at 7-11 with 5 minute ramp and Pico mask unless I get other suggestions. I did also order a P10 pillow from the same vendor to try out.

I have a follow-up with my doctor in 2 months. Since I'm doing things he advised against (getting an auto machine), I think I need to show some good results to avoid getting chewed out. I wonder if I even need the follow-up. Just another visit I will need to pay for.

Here's last night results:

[Crimson Nape]

Looking pretty good!  My only thought is since this is a P-R machine, you may wish to bump your minimum pressure up to 7.9cm.  That "should" reduce the Hypos and OA's.  P-R machines are a little slower to respond to these events than a Resmed. . . or so I have been led to believe.

[Sleeprider]

CrazyDreamer, you should first be sure you have all the records of sleep studies and Rx that you can get your hands on. Take copies of those to your primary care doc, and explain that you want to manage your own CPAP therapy using the data, and working with your non-specialist doctor. It will cost less, you will have access to prescriptions if needed, and you will get better overall care. It usually only entails reviewing your use of the machine and perceived benefits of CPAP therapy to keep your health record active and current...you don't need the specialist anymore.

[CrazyDreamer]

Thanks. But my doctor suggested I be on fixed at 7.0 as I titrated at that level in my sleep study. Can you help point out to me where a higher level would have been helpful to be fixed at 8.0? (7.9 is not possible on the machine)

I'm very new at this and don't understand what's going on. It looks like my first two events were small and then pressure increased at about 1:18 for reasons I don't understand and then I had OA after that. I also had pressure increases between 2:20 and 3:00 for reasons that I don't understand.

[CrazyDreamer]

Thanks Sleeprider, sounds like a good approach. I have a good report with my primary doctor and I think he'd be fine with that.

I discovered this morning that, in my excitement, I apparently did not finish my checkout at Amazon last night. No email confirmation of my order! I will try again tonight. Rats!

[Crimson Nape]

If you look at your flow rate prior to that time period, you'll see a diminished flow.  This can be a precursor to a Hypopnea.

As far as raising the pressure;  I was just looking at your 95% pressure and making a guess.  Ignoring me is probably wise.

[Sleeprider]

I think once you are using the Autoset you will notice a big difference. The machine will respond much more quickly to precursors to events and prevent them, and it can get there from a lower minimum pressure. No longer will you see that saw-tooth pressure change of 1.5 cm every 10-15 minutes; all pressure changes will have a purpose, and you can enjoy a true bilevel exhale pressure relief. Just saying, you have some good things to look forward to.