[Treatment] Noob Alert

[dracus]

Howdy Everyone,

   I want to thank everyone in advance I have been scouring this board lurking for about a month now. Trying to gleen as much info as I can. I did read the wiki and lots of posts. 

   I was diagnosed with Moderate OSA (AHI 22.9) about 5 weeks ago in a sleep lab, and I did a tritation study and was able to get my AHI down to zero with a pressure of 11. While I didn't love the experience, it wasn't the worst thing ever. I opted not to screw around and went with the simplus during the study to make things easier to figure out.  We did play around with a nose mask (eson). The technologist gave me both masks we used at the end of the study because they are single use.  

Today, I got dispensed my machine. I was expecting some sort of fitting but it was litterally a here's your machine, what mask do you want, sign these papers. I opted to try the dreamwear but I do get 30 days to try out whatever. Here's the rub though. I was told by the DME that caresource (ohio medicaid) only pays for the replacement of a mask once per year and doesn't cover any of the cusions, no changes of humidifers containers, and didn't cover the heated hose either. A quick note also, the new a10 autosets also don't come with sd cards anymore either. No biggie but worth noting. 

So quesiton #1 if I'm going to have to pay for cusions, pads etc out of pocket does anyone have an recomendations of what mask might have the least need to replace things. I had concidered trying the airtouch but the memory foam pads alledgedly need to be replaced monthly and they are costly. 

Question #2 

  Any basic recomendations as far as adjusting the machine or should I just leave it setup pressure wise at the 11 and see how it goes.

 I have copies of both my polysom and tritation if anyone needs to know. I am fairly technically minded but even I am going to need to get the dictionary out to figure out some of this. 

 Thanks in advance...

[jaswilliams]

First thing you need to do is get a SD card so you can get detailed data you might want to look at getting a toshiba flashair card this will allow you to with some small effort connect it to your WiFi so you can get the data off the card without removing it from the machine.

The flash pap software can be used or sleep master to get the data onto your computer then you can use sleepyhead for analysis


Jason

[DeepBreathing]

G'day Dracus. Welcome to Apnea Board.

quesiton #1 if I'm going to have to pay for cusions, pads etc out of pocket does anyone have an recomendations of what mask might have the least need to replace things. I had concidered trying the airtouch but the memory foam pads alledgedly need to be replaced monthly and they are costly.

While cost is definitely a consideration, it's more important to select a mask which fits well, is comfortable and doesn't leak. This is often a matter of trial and error and what suits me may not suit you. You said you went OK with the Simplus, which is a very popular model. I don't know why they said it was single use, unless he meant they are only allowed to use it for one patient (which seems reasonable). The cushions last a lot longer than the recommended replacement schedule, which seems to be set up to enhance the profits of the industry at the expense of patients.

Question #2

Any basic recomendations as far as adjusting the machine or should I just leave it setup pressure wise at the 11 and see how it goes.

Start with your titrated setting and see how it goes. Your machine can adjust pressures up and down as needed within defined limits. Use #SleepyHead to monitor your progress and upload your charts here so we can have a look at them and see what changes might be beneficial. The first few weeks you'll probably see quite a lot of variation as you get acclimatised, so don't be tempted to change your settings frequently.

Getting back to the replacement schedule - the recommended schedules are excessive. For example I have just replaced my heated hose after 3+ years, and only because the mask interface was a bit worn. Likewise with masks and cushions. I'm still on my first humidifier tank after nearly four years. There is no need to replace these things all the time. Take care of them, wash them regularly and they will last a very long time.

[dracus]

I have a normal run of the mill SD card, and I've already set up sleephead. I'll have my first chart tomorrow..

I had no idea they made cobo/wifi sd cards. Definintly worth the investment going forward.

The sleep lab doesn't reuse the masks, or hoses with multiple patients. "Offically" they are supposed to throw them out. My technologist was cool and said now I'm going to set these right here by the garbage where I'm supposed to put them. I'm not allowed to give then to you but if you should happen to put them in your bag before you leave well.....

Currently, my machine is set in CPAP mode at the tritation pressure (11), with EPR at 2...It starts out at 4 and ramps up. I may turn that up a bit it seems a bit low to start.

[jaswilliams]

I would suggest Auto mode is better than fixed CPAP if you set the machine with settings around the recommended CPAP pressure then we can review the sleepyhead data afterwards.

I suggest a minimum pressure of 9 and a maximum of 15 (It should not go this high but gives some headroom) increase the starting ramp pressure to 6 and then sleep with the machine and see how it goes.

[Gideon]

I would suggest that you post a copy of both your sleep studies and your daily charts.  Please use BBlink in IMGUR (see my signature)

The sleep studies will provide a background/reference for your initial sleep evaluation.  And the daily's, will they are the key to what is going on, down to a detailed breath by breath view if needed.  Organization  is important, not all charts are as important as others and if we need additional charts we will ask.


Good luck on your journey

Fred

[Sleeprider]

Welcome dracus! With regards to what Caresource and your Part B insurance covers, I would recommend you contact a benefits coordinator directly, rather than taking the word of your DME as to your coverage. It is not uncommon for the DME to receive such low reimbursement levels that they simply try to steer patients away from requesting them. Generally Medicare allows for mask replacement on a 6-month basis (headgear, frame, cushion), and a new cushion on a monthly basis. New tubing and humidifier chamber may be 6 or 12 month. Depending on your deductibles and copay, you may be better off with one of the online suppliers or Amazon, but check with your insurance before just walking away from benefits.

Be sure to retain a copy of your prescription(s) so you can establish accounts with online suppliers of your choice. You should also obtain copies of your full sleep study, as this can help you avoid future costs and studies.

[trish6hundred]

Hi dracus,
WELCOME! to the forum.!
Good luck with CPAP therapy, hang in there for more answers to your questions.

[dracus]

YEA!!!! I made it through my first night. 

It wasn't prefect but better than than the sleep lab at least subjectively.

I felt great this morning when I woke up. I usally feel great so I am looking forward to the future of even better....

Sleepyhead reports a massive leak and for some reason broke up the night into two sessions. My AHI during the longest session was .55 which I think is pretty darn good even with the mask leaks I was getting acording to sleepyhead.


Someone requested my sleep study info:

Sleep Study
Tritation

I'm going to adjust the ramp pressure, and change it to auto.

 Not sure about this dreamwear mask. It seems really noisy to me on breathing in and has an odd exaust on top which bouces of my head board I had though it was a leak but it seems to be a feature. That being said I do like its minimalist head gear. Think I need to try it out for a few days in a row before I switch to the other two masks I have to play with.

My biggest thoughts were it seemed like the air was really cool to me. I have the humidfier on so not sure why I'd feel my nasal passages were so cool.

Here is the screenshot.

[Gideon]

Ramp is for your comfort, starting at 4 is difficult for many, finding it hard to inhale.  If this is so in your case raise it to what is comfortable between 6 and 8.  Many of us started with a ramp but disabled it, your choice.

Your initial Sleep study showed no CA events (Central Apnea/Clear Airway),  this is good.
Your titration study showed some which disappeared at 11 cm H2O.  You have some in your daily chart but not enough to be a concern.  These should go away as you adjust to CPAP therapy.

Your numbers are good, no VERY good.  Many users would love them.  ANY changes to setting should be small and based more on your comfort that trying to minimize the AHI number.


Fred