[Treatment] What's Going On? [Aussie struggling]

[granti]

Hi All,

I am from Sydney Australia. At the request of my GP I did an overnight sleep study last Tuesday as I have high blood pressure (managed). I had been putting it off for a while but finally booked myself in after my wife decided to start sleeping in the spare room!

I had a rough night on the sleep study and woke up the worst I've felt in a long time.

On Friday I received a call from my GP to advise that the report had come in and it was not good. Quote: "Very severe OSA with 80.7 arousal's per hour, suggest CPAP therapy expeditiously started under sleep physician supervision. Should not drive until treated".

He warned me against driving and said all I had to do was go back to the clinic get a CPAP machine and then my life would be back to normal.

I contacted the sleep clinic and they advised I would have to:

* Get a referral from GP to sleep physician
* First consultation with sleep physician
* Second consultation with sleep clinic for CPAP machine selection
* Third consultation with clinic for machine setup
* Fourth overnight sleep study to validate CPAP machine effectiveness
* On going consultations....


The above will take at least a couple of weeks and I could not get a straight answer on whether or when I could drive. When I asked about my current legal position I was asked "Well you want to do the right thing don't you?"

I will always do the right thing. I have not driven since based on the above advise (even though driving has never been a problem for me), but I find the whole process as I understand it heavy handed and geared towards lightening my wallet?

This weekend I was gifted a Resmed s9 machine from a good friend. I used it for the first time last night with default settings and then reviewed just now. (usage 5:12, AHI 1.5, Leak 8.4 L/min). I don't think its a bad start and will try to improve on this in the next few nights. I think I wold also do better with a full face mask over nose pillows.

I have an appointment with the sleep physician this Tuesday and I feel like I am stumbling nto the lions den. I am worried as my GP suggested the sleep physician would inform the RMS that I cannot drive. I am worried  that if I see the sleep physician I will be chained to them for an eternity with the threat of no driving hanging over me. I am worried about not being able to drive work for an extended period right now and having this on my RMS record.

Am i OK to use the machine I have been given, advise my GP of the results and continue on with my life while making a few lifestyle changes (I could lose 20kg or so) to improve my Apnea?

Any advice/opinions would be greatly appreciated.

Thanks in advance.   

[trunkizback]

Ive been on a cpap for over 20 years now. 10 years ago I was laid off , after a few years of bouncing around on part time jobs, which left me uninsured, I applied at a auto parts delivery place. Like an idiot  on the application I checked the Have Apnea box. Since my machine had no recording capabilities and I couldn't afford one that does> I didn't get the job/. Get it?

[holden4th]

Hello Granti and welcome to the Apnea Board.

I am wondering who you did your sleep study with. I used SNORE Australia and did it bulk billed which meant that I had a night to determine AHI and another night to titrate my CPAP levels. You have an advantage in that you already have a machine you can use and we can help you set it up though it looks like it's starting to work for you already.

As far as driving goes, at this point you have not been forbidden to drive by law and if you are now using PAP therapy then there is no reason why you should not drive. Therefore, I would cancel the appointment with the sleep physician as you do not want a record of that on your drivers licence. All he/she will do is possibly look at putting you through a PAP titration session (another bad night) and after the results eventually come back suggest a starting point for fixed level CPAP.

Looking at your figures, an AHI of 1.5 is very good first up so you are already well on your way. Can I suggest that you raise the lower setting to about 8 and set the max to what your machine can handle which I believe is 20. If you are not sure how to do this then there is atutorial available from "Set Up CPAP Manuals) at the top of the page. Youtube has videos showing how to do it. It's very easy.

It is also worth downloading the Sleepyhead app so you can keep a detailed track of your data. More importantly, after three more posts you will be able to upload it here for the experts to look at and make suggestions to improve your therapy. Sleepyhead is also available from the top menu bar on this page.

Please keep us posted and feel free to ask further questions.

[ajack]

I see no reason not to see the specialist. Take the SD card from the S9 with you. If the sleep study didn't throw up other problems, with those numbers there is no need for a titration sleep study or to buy a new machine. As it is being successfully treated. I think it's sensible to have a specialist review you once a year, to follow and advise you. I'm going for a lab sleep test at the end of the month to review my PLMD, as well as a titration while I'm there.

[Sleeprider]

Many of us have self-titrated. It is easier using an auto machine, but there is no magic performed in a sleep lab. They go through the same process of trial and error that you will. Normally a sleep study simply starts at 5 or 6 cm pressure, and gradually increases pressure until "good treatment" is achieved (Usually defined as < 5 AHI), and they will often push upward in pressure. The prescription comes from the trial that produced the best results for 20 minutes to an hour in the lab. That is all they do. You can accomplish the same thing using an Auto CPAP, or a little trial and error with fixed CPAP with data.

Your machine already shows AHI of 1.5 which is good therapy. It might be nice to see the leak rate drop, however once you can demonstrate effective use of that machine, you can resume driving. You can get a free copy of Resscan software from the forum to produce reports that will prove your use and efficacy. http://www.apneaboard.com/forums/Thread-...hines-only We advocate the use of #Sleepyhead because it is easier to use and understand, but Resscan is the "official" software for your S9.

[Apnea Infant]

SR, as ever, is so right.

My hospital sleep study was essentially sleeping with an APAP with FFM and the technicians increasing pressure to overcome any obstructions. As it titrated to 20 cmH2O with what was very moderate AHI of 7, they made me do a home titration for another 2 weeks with an APAP. As I was totally green with Sleep Apnea, I did not know what to ask and had not joined the this forum then yet.

Pressure prescribed after home titration (with APAP) was 16.8 cm H2O but I was given a CPAP. I was then left to free wheel and suffered tremendously with too much pressure. 

It was only after joining this forum with learning more about what I needed and what suited me that my therapy became effective.

Basically, leaks through the FFM was unhelpful and all but destroyed the therapy. Obstructions were caused by back sleeping and the FFM did not help. It is interesting to note that I do find that I wake up on my back often now but the using the collar, learning to close my mouth, breathing through my nose and the nasal pillows have all helped.

So what I am saying is I concur with what SR has noted, that if you have an APAP with which you can self titrate with the help of the gurus on this forum, you could not find better.

[trish6hundred]

Hi granti,
WELCOME! to the forum.!

Good luck to you with CPAP therapy and also with your decision to self-titrate or see the sleep doc.

[Kyteflyer]

Hi Granti,

I'm also in Oz and have been on treatment for my OSA for 10 years.  Your concerns about not driving are valid but it is unlikely to affect the final outcome which is that once you are in treatment, you'll have to have a medical annually.  After a while they stop bothering you with this, because you've shown yourself to be compliant with treatment.  The only time they will stop you driving is if you become non-compliant.

I still have to have annual medicals for other reasons, but they no longer ask about OSA treatment.  From recollection, that stopped after 5 years or so.  It probably also differs from State to State.  I'm in NSW, if thats of use to know.

[dwd1249]

This is from the Austroads fitness to drive.
I drove a bus for a few years and had to see a sleep Dr every year. If it's just a normal license then all that is needed is for your GP to be happy.
Full doc can be downloaded from the Gov site http://www.austroads.com.au/drivers-vehi...le-drivers

[holden4th]

I have an unconditional licence despite going through a sleep study and I know that many OSA sufferers in Australia are the same as me. It is all down to the reporting conditions and my Sleep study guys sent my data off to my GP believing that he would report it. He didn't as his knowledge of OSA is perfunctory.

The reason not to go onto any list is in the first dot point. It is extremely vague and medically inaccurate. The bottom line is that the first thing that they will do is take your licence off you. Getting it back will not necessarily be easy and could also be a long process.