Hello Guest, Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.

or Create an Account


New Posts   Today's Posts

New to board; please help me prepare for my appointment with sleep specialist
#1
New to board; please help me prepare for my appointment with sleep specialist
Hello everyone. I am new to the Board but I am not new to sleep problems.

I am a 50-year old male. I am 5'11 and weigh 180 pounds. I have no problem falling asleep but I have trouble staying asleep. I snore very loudly. I have tried a few things to improve my sleep and reduce my snoring. So far nothing has worked.

Background:

In April 2017 I had a sleep study and was diagnosed with Mild Obstructive Sleep Apnea, with an AHI of 9.4 events per hour. Respiratory events were associated with oxygen desaturations to the 80s.

In September 2018, I had another sleep study. This time I was on CPAP at pressures of 5-7 cmH20. I used a ResMed AirFit P10 size medium mask. I slept 5 hours and nine minutes, which is pretty good for me. My overall AHI was 2.5 events per hour. The sleep center recommended I "consider the use of auto-titrating CPAP with a pressure range of approximately 5-12 cmH20." It said "if patient does not tolerate CPAP, then other alternatives such as an oral appliance or ENT referral to consider an upper airway surgical approach should be considered." Around this time I got an oral appliance from a dentist, which helped a lot with snoring and seemed to help a bit with my sleep. I decided not to purchase a CPAP machine.

However, recently I began waking up almost every night gagging/choking, so I stopped using the oral appliance. For several nights, I tried a friend's CPAP machine at pressures of 5-7 cmH20 using a ResMed AirFit P10 size medium mask -- the same as the one I used in the sleep study in 2018. Unfortunately, I was unable to fall asleep for more than a few minutes, if that. My wife says I am a mouth breather, and this may be the problem. I have a deviated septum; perhaps this is the reason I can't consistently breathe through my nose. I do not understand why I was able to sleep with the mask during my sleep study but was unable to do so at home. It is a mystery to me.

I am very claustrophobic and there is definitely no way I can use a full-face mask. (I have tried a variety of masks, including a full-face one.)

Summary:

An oral appliance is difficult for me to use because it causes gagging; I cannot use CPAP with a full-face mask due to claustrophobia; I apparently cannot use CPAP with a nasal mask, perhaps because I have a deviated septum.

Going forward:

I am currently not using CPAP or the oral appliance. I hardly ever sleep more than 5 hours at a time. I have scheduled a new sleep study later this week. I will not be using CPAP. My physician and I want to see what my baseline currently is. I suspect my apnea is considerably worse now than it was in April 2017, nearly three years ago.

Question for this Board:

Two weeks from now I have an appointment with a sleep specialist. I want to make the most of this appointment. Is there anything in particular that you all think I should ask the sleep specialist? What options should I be seriously considering? 

Thank you so much for your help.
Post Reply Post Reply
#2
RE: New to board; please help me prepare for my appointment with sleep specialist
I think the CPAP is the best route forward. Your use of a pressure of 5 to 7 is extremely low and I would suggest the best machine is the Resmed Airsense 10 Autoset with pressures of 6 to 12 and EPR 2 for starters. EPR is exhale pressure relief and acts like bilevel, so at the recommended range your pressure will be 6 inhale 4 exhale to 12/10 maximum. The Airfit P10 is a minimal mask and relatively inexpensive. It's what I use. Since you tend to mouth-breathe consider the Knightsbridge Dual Band chinstrap. It pulls your jaw up not back and is a soft solution that should work with claustrophobia. The Airsense 10 with EPR is a very comfortable solution and can resolve the kinds of events you were probably having on your first CPAP (hypopnea) better than any other option.

As far as the sleep specialist, I like the approach of getting a diagnostic study if needed, but not a titration study. I think the machines can give you all the feedback you need to optimize without the expense in discomfort of a second sleep study. Another alternative is a split study where diagnostics and titration are done in one night. If you have the results of your first sleep study then take those and discuss your current symptoms. Let him know you are interested in resuming therapy and see if he will support that without a sleep study. If you don't think CPAP can work for you, there are alternative therapies like INSPIRE, but it is fairly invasive and has a relatively low efficacy compared to CPAP.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#3
RE: New to board; please help me prepare for my appointment with sleep specialist
Some or all of the gagging/choking might be a response to obstructive events rather than to the appliance -- yet another reason in favor of trying CPAP.

Do try the chin-strap that Sleeprider has recommended. You could also try using Somnifix tape, which has a skin-friendly adhesive that can keep your lips closed, if that is part of the mouth-breathing problem. I use these strips horizontally, as they are intended to be used, but you could also try cutting them in half and using them vertically in the middle of your mouth, if that would feel less claustrophobic to you and still do the trick.

It would be nice to know why you could sleep with the P10 during the study but not using your friend's machine. But sleep is so variable that there may be no answer that would be useful to your decision-making.

Do you think you would be full-on claustrophobic if you used something like the ResMed Mirage Liberty or the Amara View? They don't have anything on your forehead, and they have under-the-nose cushions. It'd be great if you could try them on during your upcoming appointment.

If you do move ahead with CPAP, please keep us posted. There are lots of people here who would be ready and willing to help you make a good adjustment.
Post Reply Post Reply
#4
RE: New to board; please help me prepare for my appointment with sleep specialist
Thank you so much Sleeprider and Dormeo. This is very helpful.
Post Reply Post Reply
#5
RE: New to board; please help me prepare for my appointment with sleep specialist
(01-06-2020, 01:23 PM)Aa438sj Wrote: However, recently I began waking up almost every night gagging/choking, so I stopped using the oral appliance. For several nights, I tried a friend's CPAP machine at pressures of 5-7 cmH20 using a ResMed AirFit P10 size medium mask -- the same as the one I used in the sleep study in 2018. Unfortunately, I was unable to fall asleep for more than a few minutes, if that.

Until you can get this sorted you will need to do one or the other!

Quote:I am very claustrophobic and there is definitely no way I can use a full-face mask. (I have tried a variety of masks, including a full-face one.)

I recommend you try more than just one full face mask. Look at something like the AmaraView, for example. It seems less claustrophobic to me than a nasal mask.

By the way, since you have the deviated septum issue have you given any thought to seeing a good ENT? Even topical sprays like Asteline and Flonase can be a big help. If you have nasal congestion you may find that something like the NeilMed Sinus Rinse Kit is a huge benefit.
Sleepster

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#6
RE: New to board; please help me prepare for my appointment with sleep specialist
Hopefully you can try a hybrid FFM like an F30 or a Dream Wear mask.

While the sleep study is important, it is the fast freight that happens when a prescription is written and sent to a DME. Trust me, before you know it you have a machine you nothing about on your nightstand.

If you have a friend who can recommend a good DME, get the prescription sent there. If you are in doubt, get a physical prescription in hand and not have one sent electronically.

Most people will recommend a Resmed Airsense 10 APAP, unless you need something more advanced.

CPAP is a good thing, I’ve been doing it for a long time.

John
Post Reply Post Reply
#7
RE: New to board; please help me prepare for my appointment with sleep specialist
"While the sleep study is important, it is the fast freight that happens when a prescription is written and sent to a DME. "

Thank you so much for your feedback, but I don't understand this.
Post Reply Post Reply
#8
RE: New to board; please help me prepare for my appointment with sleep specialist
The first thing to do before choosing a DME is to get the list of the suppliers that are in-network for your insurance. If you use an out-of-network supplier, they can charge extra fees and higher costs. With the list in hand, choose the one you want based on recommendations, friends, research etc. and make sure they dispense the Resmed Autoset.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Post Reply Post Reply
#9
RE: New to board; please help me prepare for my appointment with sleep specialist
(01-08-2020, 10:55 PM)Aa438sj Wrote: "While the sleep study is important, it is the fast freight that happens when a prescription is written and sent to a DME. "

Thank you so much for your feedback, but I don't understand this.
Most DME’s typically do not look out for the best interests of the patient.  They make money on dispensing equipment.  Once they get a prescription, their job is to get it filled quickly with the lowest costing machine and make more profit.

Most new patients assume the DME is there to help them transition to CPAP therapy.  It is not until they already have their machine that they may have been stuck with something that provides little data to help the patient adjust treatment.

In 2001 I got a call from a DME right after I saw the doctor wanting to come by and set up my equipment.  I got a prescription and bought online for less than half.

In 2011 the DME said I couldn’t have an APAP because the prescription didn’t have a range.  Luckily I had looked up the Resmed models and at least got a data machine. A few years later I bought an APAP from a private party.

I actually found a good DME for my last machine.  I called them and hand carried in my prescription and documents.

John
Post Reply Post Reply
#10
RE: New to board; please help me prepare for my appointment with sleep specialist
Thank you very much for all the feedback and comments. It's very helpful. Here's an update to anyone who is still following the thread:

It's Thursday morning, and I just got back home from my sleep study. To my surprise, I did a split study: half the night with no CPAP and half the night with CPAP. The technician kindly spoke to me about my results after I woke up this morning. He told me that during the first half of the night (no CPAP) I had obstructive sleep apnea with an AHI of 56 events per hour.  During the second half of the night, after the technician woke me up, I used a Respironics Dreamwear full face mask (size medium). I told the technician last night that I would not be able to use a full-face mask, but he said I'd be fine and -- lo and behold -- I was. I really liked this mask.

I am not sure what kind of CPAP machine I used. The technician manually controlled the air pressure. He said he raised the pressure gradually, peaking at 12 cmH20. At this pressure, he said my apnea was well controlled. I woke up after a short period of time (maybe after 1 hour of sleep, not really sure). I asked the technician why I woke up after a short period of time if my apnea was well-controlled. He said "I don't know, but it wasn't a respiratory event."

Overall, I'm quite pleased with the study. I'm glad I now know that my apnea is severe.  And I am very happy to know about a full-face mask that does not cause claustrophobia. My only concern: I don't understand why I woke up if the CPAP machine and mask were working so well. Isn't the whole point of CPAP to be able to sleep solidly without waking up after an hour? Ironically, I feel as though I got much better sleep during the first half of the night without the CPAP. That is my subjective perception, anyway. True, there were lots of apnea events, but I was definitely asleep when the technician came in the room to wake me up. On CPAP, by contrast, I woke up on my own -- wide awake -- after a short period of time. What might have caused me to wake up and how concerned should I be?
Post Reply Post Reply


Possibly Related Threads...
Thread Author Replies Views Last Post
  [Treatment] Request for Sleep Data review compared to Sleep Study thesingingchef 2 161 03-14-2024, 05:14 PM
Last Post: thesingingchef
  Sleep physicians that value OSCAR and the Apnea Board community FrankFuss 26 3,315 02-28-2024, 05:25 PM
Last Post: SuperSleeper
  New to the board: Pre Therapy, suspected Central Apnea MVoltaire 12 481 02-28-2024, 04:31 PM
Last Post: MVoltaire
  adding sleep report (Wondering whether changing sleep position can "cure" apnea) NewlyDiagnosed 1 205 02-26-2024, 10:19 PM
Last Post: BoxcarPete
  Got new sleep Dr - how to add 'specialist' to team? CPAPnerd 8 342 01-20-2024, 08:32 PM
Last Post: CPAPnerd
  New to Board. Need help interpreting OSCAR Travel2BFree 23 1,651 12-07-2023, 12:19 PM
Last Post: UnicornRider
  Inconsistent Sleep Patterns and Confusing Sleep Studies - Please Review mperry99 17 1,360 10-14-2023, 04:20 PM
Last Post: mperry99


New Posts   Today's Posts


About Apnea Board

Apnea Board is an educational web site designed to empower Sleep Apnea patients.