Advice Starting Out

[hapidasary]

I am just starting down the Apnea trail and looking for direction. The forum has been a huge source on info so far, so thank you already!

My girlfriend has suspected I had sleep Apnea for years but I haven't done anything due to finances or lack of insurance. She recently got diagnosed with Sleep Apnea and I'm getting to a point financially where I can get full insurance and I'm planning to get a sleep test in the near future. In the meantime, she let me try her ResMed Airsense 11 for a couple nights on her settings and the MyAir results the first night were worse than hers and the second night closer to her higher results. Both nights were the first night of feeling like I got some actual rest in a long time.

I was able to get my hands on a used AirSense 10 from a friend who go a newer machine and started doing some self treatment. I wanted to play it safe and use the APAP setting and started with pressure settings similar to another post I found and meshed it with some of my girlfriend's settings to create a starting point. The first night when I woke up the pressure was really high and I adjusted it down for the second night. I sleep with my mouth open a lot and using a full face mask which I am also going to get the next mask size down to try and get a better fit. I imported the first two days on the AirSense into OSCAR and would love if someone would help me with a good direction of things.

A few starter questions as well:
-Will self treating before a sleep study affect the results of a sleep study?
-If the machines are accurate and I am showing complex Apnea, would it be foolish to self treat?
-Insurance wise, I only have supplemental private insurance and trying to find if it would cover anything sleep related. I can get an at home test done and pay out of pocket but I'm worried I might have to redo it through insurance or it may affect my chances of getting a more in depth test covered if I skirt the system a bit. I know insurance is a crazy ridiculously complex world but any insight would be greatly appreciated (knowing full well no personal insight may actually apply in my circumstance   )  

Thank you in advance for any help!!
On to the data:

ResMed AirSense 11:

CPAP Mode, Pressure 11.0, EPR Full Time Level 3, Nose Pillow Mask

1st Night: 12 events/hr, usage 2 hr 40 min, 37.2 L/min leakage, on/off 2 times, score 44/100

2nd night: 7.8 events/hr, usage 5hr 19min, 32.4 l/min leakage, on/off 1 time, score 74/100
(AHI 7.8, Total AI 7.3, Obstructive AI 1.6, Central AI 5.2)

ResMed AirSense 10:

   

   

[Sleeprider]

You are using EPR 3, so your minimum pressure must be 7.0 cm in order to keep that consistent The lowest pressure of your CPAP is 4.0 cm and with a minimum pressure of 7.0, the delivered mask pressures are 7.0/4.0 (inhale/exhale). Using anything less that 7 is kind of handicapping your machine because it is the exhale pressure that keeps the airway patent against obstructive apnea. Many of your events are occurring near the end of the night in a single large cluster. This is likely to be a positional issue where you might be bunching up your pillow to raise your head causing a bend in the airway, or some other position. Here is a link to our wiki discussing this issue http://www.apneaboard.com/wiki/index.php...onal_Apnea Finally, the ramp is not doing much good for you, and a lot of uneven breathing spikes are apparent. You should turn ramp off or set the pressure to 7.

Overall, your therapy looks pretty good, and I''d be surprised if you didn't have a positive sleep test. Don't rush out for a test. Nothing is more expensive than having insurance, but then paying deductibles and co-payments for something you can do yourself quite well, and not make boat payments for doctors, clinics and suppliers that have made the insurance racket a lucrative living. If the therapy makes you feel better, it's doing its job. We can help you to optimize it, and when you feel you want to formalize the diagnosis and prescriptions, you can go for it. Meanwhile, it doesn't hurt to keep additional diagnosed conditions off your medical record.

[hapidasary]

Thank you so much!!

I really appreciate the advice and I'll adjust the low pressure setting to 7.0, remove the ramp and see how it goes for a few weeks. I'm going to get a neck collar as well to hopefully address the positional apnea. Thank you with the insurance recommendation as well. I try to maintain a good balance between self care and professional care and excited to try to gently address my sleep issues on my own and in the process learn to understand more about Apnea in general.

In the morning, the pressure would always max out following the RERA event, could that be caused by positional apnea?
If not, do you have any thoughts as to what it may be or what I can do to figure that out?

[Sleeprider]

The pressure increase is from flow limitation, which is a partial obstruction during inspiration that causes the peak flow to be limited. This can be seen as a flat top on the flow chart, and can arise from positional obstruction, and the way you know is by looking at the pattern. Persistent flow limitation can be sort of built-in to an airway obstruction like tissue obstruction from a deviated septum or excess tissue in the palate. Intermittent or clustered flow limitation is often related to sleep position, i.e. kinking the airway. Flow limitation is often the root cause of RERA (defined as increasing flow limitation leading to an arousal), hypopnea (a reduction in respiratory flow, and obstructive apnea (cessation of flow). As you read in the wiki linked above, positional issues tend to occur in clusters or intermittently, because the airway is performing just fine, until it's not.