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Questions I should ask at 1st follow-up - Cranberry Ray - 12-29-2016
I'm roughly 5 weeks into CPAP therapy and have my first follow-up visit tomorrow. I have a feeling it's more of an insurance compliance verification (I have been 100%) rather than a "how can we help you" session. Here is a screen shot of last night including the readings from my new pulse oximeter that Santa brought me (my wife couldn't believe that's what I wanted for Christmas). My original sleep study was 29 AHI and oxygen levels below 90% for 46% of the night. Fell to a low of 68%. I feel better but still not feeling great. There are many days that I'm still very tired and falling asleep during the day. My average has been 2.50 AHI since starting CPAP with a high of 8.94 AHI and low of 0.44 AHI.
![[Image: V5C3aqX.jpg]](http://i.imgur.com/V5C3aqX.jpg)
Was wondering what questions I should be asking. Would love to be less tired, maybe it just takes time. I have made minor adjustments to therapy like ramp time, and humidification setting but haven't changed from the prescribed 9.0 cmH2O or CFlex settings. Any advice would be greatly appreciated.
Sleep long and prosper!
RE: Questions I should ask at 1st follow-up - 0rangebear - 12-29-2016
Red
Welcome to the Apnea board
I think you doing pretty well. It may take several more months before you feel better. The negative effects of poor sleep accumulate over time, and the healing process also is slow; once you are sleeping well.
It looks to me like you are sleeping well now
* AHI<2.5
*5+_hrs sleep cycle: Many only dream of this
*SPO2 >91%
Leaks could be better you may have some bogey apnea indications that are cause by the leak rate.
If it was me, I would raise my starting pressure, since there is a pattern of HYPOs in the beginning of the night when the pressure is @ it lowest.
Keep up the good work; I would ask the doctor about a higher starting pressure.
RE: Questions I should ask at 1st follow-up - sonicboom - 12-29-2016
CR-
You might inquire about variable pressure for a week. You have many hypops and RERAs which suggests to me you might benefit from a little higher pressure. RERAs don't effect the AHI calculation but are reflected in the RDI calculation. I noticed I felt better when I tamed the RERAs too. See what the doc advises although you are considered treated with AHI <5 so the advice may be to change nothing. Personally I would experiment with it anyway.
RE: Questions I should ask at 1st follow-up - Sleeprider - 12-29-2016
I agree that you should discuss the use of the auto-cpap capabilities to address your variable needs through the night. For the most part, this looks pretty good, but there are clearly changes in respiratory volume that correlate with snores and RERA. I think your CPAP pressure of 9 looks pretty good, but you'd benefit from being in APAP mode with a max pressure of about 12.
Discuss it with the doctor. The flow rate and event charts point to some residual obstruction. The appointment is mostly to evaluate if you are benefiting from CPAP, and it appears you are. Nothing wrong with letting the doctor know you are engaged and interested in optimizing therapy with his guidance.
RE: Questions I should ask at 1st follow-up - srlevine1 - 12-29-2016
(12-29-2016, 11:06 AM)Cranberry Ray Wrote: I'm roughly 5 weeks into CPAP therapy and have my first follow-up visit tomorrow. I have a feeling it's more of an insurance compliance verification (I have been 100%) rather than a "how can we help you" session.
Was wondering what questions I should be asking.
One, you are probably right about the visit to validate compliance for insurance.
Two, the tone you set will now govern the rest of your relationship.
Three, what the doctor usually looks at is a summary of the compliance data and most never look at the underlying data.
Four, I take my laptop to show how my sleep progresses throughout the night. I have pre-selected several areas where I have a higher AHI and am showing apneas and hypopneas.
I also print off relevant charts where I circle areas that are of concern to me.
I expect an answer to my questions: what does this graph tell you about the quality of my sleep and the progress of my therapy. If I want to try an experiment, like raising the pressure, I ask him what increments I should use, over what time intervals, and what are the signs I should discontinue the pressure increase and return to a previous value. I also ask him about the conditions which would mandate a call and/or a visit outside of the normally scheduled appointments.
Five, as mentioned by other users, I would ask about the use of my APAP to self-titrate the pressure and then use those settings with his knowledge and permission. Remember, it is better to ask for permission than appear to go rogue. Of course, if your doctor is a schmuck -- you need to go rogue or change doctors.
Six, I am privileged to have a physician who is the department head of a world-class hospital and who is willing to discuss specifics rather than generalities. Not all physicians are willing to discuss details with laypeople -- unless they educate themselves using resources such as this forum.
Hope this helps. Best of luck with your therapy and continued progress.
RE: Questions I should ask at 1st follow-up - Cranberry Ray - 12-30-2016
Wow, how can I thank everyone for all the great advice. I have a feeling I will end up having to take control of my own therapy. Unfortunately I don't have a very good Dr. Actually have never even spoken to a doctor in the practice my PCP referred me to. Have done a home sleep study, in lab titration study, and picked up my CPAP and have yet to see or talk to a doctor. Seems very much like a factory that is more interested in getting insurance payments than helping me a with my condition. Will try to ask permission first as srlevine1 suggests but considering the fact that the doctor had still not issued a report 2 weeks after my titration study I don't have much faith. I guess the first thing is making sure the insurance company is satisfied with my compliance and willing to cover the cost of the CPAP. Once it's actually purchased I'll have more freedom to run a self titration with the APAP setting and tweak things. I am really grateful for all the suggestions. I fully intend to stay with this till I see the results I should have.
Wishing all a very Happy New Year!
RE: Questions I should ask at 1st follow-up - Sleeprider - 12-30-2016
Good luck with your appointment. You seem to have a realistic view of what it will do. For heaven's sake, don't repeat anything I said in post #4 above or the doctor will think you're a nut. That is for your long-term use now that you have an auto.
RE: Questions I should ask at 1st follow-up - Cranberry Ray - 12-30-2016
Sleeprider, I won't throw you under the bus. I do have a couple days data printed off which I was going to take along. They will probably think I'm some kind of nut anyway.
RE: Questions I should ask at 1st follow-up - Cranberry Ray - 12-30-2016
Well, had my first followup today after 35 days of therapy. Was seen by a PA (no doctor on duty). She looked at the information that was on the Dreamstation and said she thought I was doing good. I then told her that I do feel better in some ways, sharper thinking, more strength in workouts, quicker recovery. But fatigue and sleepiness is still a huge problem. I pulled out the last 2 nights charts from Sleephead and gave them to her. She appeared to have no idea how to read or interpret the graphs. She offered 3 options.
1) Continue with current settings for 3 months to see if things get better
2) Increase the static pressure on the CPAP
3) Switch to APAP mode
I choose to go with switching to APAP which she wanted to make the adjustments. She set the pressures at 5-15cm. I asked how she came up with those settings and she said that my original static pressure was 9 cm and that was about midway between 5 and 15. Doesn't sound very scientific. I will go with these settings for a few nights and see what my nightly charts look like and see if it has an effect on the fatigue. I think going forward that I will have to make adjustments based on how I feel.
Thanks again all for the advice!
RE: Questions I should ask at 1st follow-up - Sleeprider - 12-30-2016
Your machine is not a fast responder, and your results are "okay" at 9.0 CPAP. If moving to APAP from a CPAP pressure of 9, just set it to 8.0 minimum pressure. It won't bother you, and it will work better.