"please keep me updated about oximeters "
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a ResMed User's Trip to Her Doctor
"I just wanted to share the experience I had today with those who understand. (I have only been using the CPAP (ResMed Escape) since April 3rd.)
Before my appt in Denver today I printed out all the advice I got from you guys on the forum. I wanted to get some answers from the doc. and I was bound and determined to do so.
First of all, I only have OSA not Mixed, and not Central. And it was because of this forum that i knew enough to ask the right questions. It turns out he typed in the wrong diagnosis into my medical report. ( !!) The centrals he was referring to were the ones that are induced by the titration past the setting of 16. geeze
I asked the doc to prescribe the ResMed self adjusting CPAP, S 8 AutoSet II, fully data capable. He said, "Sure that sounds fine I will fax over an order to the DME". YEA! And since I only have OSA that should be just great. I have trouble with the exhaling pressure so this might be easier for me to use. Do you guys agree?
I also got the FULL split sleep study to take home with me. They kept handing me the summary...and I said no, I want the numbers! (Because you guys told me to do this). So now I have a whole bunch of numbers that mean absolutely nothing to me. Where can I find out that all of those numbers mean?
I also don't have to go back to Ntl Jewish for follow up on the OSA, I can go to my local ENT who is trained in sleep apnea. I do have asthma, and GERD but they are under control for now.
The doctor changed my setting from 11 to 9 with no data at all for the last month. ? My Escape does not have a data card. So why would he change my number like that? I told him it was hard to exhale, not inhale.
I am using the LT Swift nasal pillows and love it a lot. So I am hoping that I will soon be on my way to a good CPAP experience. THANKS, THANKS and THANKS again!"
Before my appt in Denver today I printed out all the advice I got from you guys on the forum. I wanted to get some answers from the doc. and I was bound and determined to do so.
First of all, I only have OSA not Mixed, and not Central. And it was because of this forum that i knew enough to ask the right questions. It turns out he typed in the wrong diagnosis into my medical report. ( !!) The centrals he was referring to were the ones that are induced by the titration past the setting of 16. geeze
I asked the doc to prescribe the ResMed self adjusting CPAP, S 8 AutoSet II, fully data capable. He said, "Sure that sounds fine I will fax over an order to the DME". YEA! And since I only have OSA that should be just great. I have trouble with the exhaling pressure so this might be easier for me to use. Do you guys agree?
I also got the FULL split sleep study to take home with me. They kept handing me the summary...and I said no, I want the numbers! (Because you guys told me to do this). So now I have a whole bunch of numbers that mean absolutely nothing to me. Where can I find out that all of those numbers mean?
I also don't have to go back to Ntl Jewish for follow up on the OSA, I can go to my local ENT who is trained in sleep apnea. I do have asthma, and GERD but they are under control for now.
The doctor changed my setting from 11 to 9 with no data at all for the last month. ? My Escape does not have a data card. So why would he change my number like that? I told him it was hard to exhale, not inhale.
I am using the LT Swift nasal pillows and love it a lot. So I am hoping that I will soon be on my way to a good CPAP experience. THANKS, THANKS and THANKS again!"
Views: 77
Replies to This Discussion
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Permalink Reply by Mike on
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I'm no pro but we have folks on the forum who do this for a living and can tell you what each and every part of your sleep study says. Can you scan it in and attach it to this thread in a response? You can of course white out your name/personal info. But it would be best to scan in the whole report so that some of the experts here can have a looksie.
Now, on to your question. You're getting one of the finest CPAPs out there -- probably the finest one, so great job! I think it will help you with your exhalation issue. Make sure they enable the EPR function (expiratory pressure relief). that will help with your exhalation.
They decreased your pressure because they figured it would make it easier for you to exhale. You can keep the same pressure on your new machine and just turn on the EPR instead. would think that should do the trick.
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Permalink Reply by BeeAsleep on
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Thanks so much. I am going to upload the sleep study paperwork so I can get feedback on what all the numbers mean.
- Attachments:
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SStudy10f4.pdf, 149 KB -
SStudy3of4.pdf, 117 KB
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SStudy2of4.pdf, 131 KB
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a couple of more files
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SStudy1of3.pdf, 136 KB
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SStudy2of3.pdf, 157 KB
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Permalink Reply by Judy on
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The only reason I can think of at all for his scripting a pressure of 9 cms rather than 11 cms would be that you spend considerably more time at 9 cms of pressure than at 11 cms and "maybe" he figured out the percentages of "events" for the time spent at that pressure and 9 cms worked out better. And that may have had to do w/he suggests that perhaps you had a considerably higher leak rate at 11 cms w/the mask used. He didn't seem to be particularly impressed w/the mask you used during the study. Just guesses from a fellow patient w/NO MEDICAL OR SLEEP BACKGROUND.
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Dang! I go soooooo aggrivated when I type up a reply and it doesn't get posted!!!! I don't even fully remember all I commented on and am too aggrivated to go back thru all 5 pages of the reports and comment again! Grrrrrrr!
Basically, maybe he scripted 9 cms instead of 11 cms because you spent considerably more time at 9 cms than at 11 cms and maybe percentage-wise you did better at 9 cms than 11 cms. He didn't seem at all impressed w/the mask you used during the study aand maybe he felt you had too high a leak rate at 11 cms and that might have skewed the results a bit. Just a fellow patient's guesses. I'm no medical or sleep professional!!
How refreshing that he so willingly scripted the Resmed S8 AutoSet II w/o batting an eye!!!! I thought a time or two of driving out to Denver and Nat'l Jewish. Maybe I should have. You can't do much better than Nat'l Jewish except PERHAPS for Stanford.
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My DME just called.
I had it easy with the doc...now I am in for the REAL WORK. The DME did not have an order for the new machine just the pressure change. geeeze. Why does is always have to be so hard? Well...I am ready for the fight! :>D
Judy said:Dang! I go soooooo aggrivated when I type up a reply and it doesn't get posted!!!! I don't even fully remember all I commented on and am too aggrivated to go back thru all 5 pages of the reports and comment again! Grrrrrrr!
Basically, maybe he scripted 9 cms instead of 11 cms because you spent considerably more time at 9 cms than at 11 cms and maybe percentage-wise you did better at 9 cms than 11 cms. He didn't seem at all impressed w/the mask you used during the study aand maybe he felt you had too high a leak rate at 11 cms and that might have skewed the results a bit. Just a fellow patient's guesses. I'm no medical or sleep professional!!
How refreshing that he so willingly scripted the Resmed S8 AutoSet II w/o batting an eye!!!! I thought a time or two of driving out to Denver and Nat'l Jewish. Maybe I should have. You can't do much better than Nat'l Jewish except PERHAPS for Stanford.
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Judy, you need a faster browser and cable hookup... :>D
BeeAsleep said:My DME just called.
I had it easy with the doc...now I am in for the REAL WORK. The DME did not have an order for the new machine just the pressure change. geeeze. Why does is always have to be so hard? Well...I am ready for the fight! :>D
Judy said:Dang! I go soooooo aggrivated when I type up a reply and it doesn't get posted!!!! I don't even fully remember all I commented on and am too aggrivated to go back thru all 5 pages of the reports and comment again! Grrrrrrr!
Basically, maybe he scripted 9 cms instead of 11 cms because you spent considerably more time at 9 cms than at 11 cms and maybe percentage-wise you did better at 9 cms than 11 cms. He didn't seem at all impressed w/the mask you used during the study aand maybe he felt you had too high a leak rate at 11 cms and that might have skewed the results a bit. Just a fellow patient's guesses. I'm no medical or sleep professional!!
How refreshing that he so willingly scripted the Resmed S8 AutoSet II w/o batting an eye!!!! I thought a time or two of driving out to Denver and Nat'l Jewish. Maybe I should have. You can't do much better than Nat'l Jewish except PERHAPS for Stanford.
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Tell me about it! Talk to my phone company, will you? Or the cable company that comes w/in a 1/4 mile of our house and will bring cable to us .... for $4000 in construction costs. Yeah. Sure. When hell freezes over. Phone comes in from one direction, cable from the other direction and we sit in the middle w/nothing from cable and limited phone options from Verizon. We keep getting mailings from Verizon offering deals on their new high speed dial up ... except when we call, oh its not available in your area yet. We are the last house on their line. The next house east is AT&T, Ma Bell. Hey, it took 6 months and a certified letter to the Public Service Commission cc'd to the phone company to get A phone at all. And 13 years here to get a private line!!! It can be frustrating being the tail on the donkey's a$$. But then I have to drive into town for something .... and I sooooo appreciate where we live!!!! We've thought of satellite but its so dependent on the weather .... and I'm cheap, tight, miserly, somethings are worth paying for, other things .....
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You did say you have a copy of your script in hand, right? To rub the DME supplier's nose in? Let them know that less than the truth isn't exactly appreciated by you, eh.
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Permalink Reply by Melinda Hertel on
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Hi there....Sorry to hear you are having some difficulties. Regarding the machine: ResMed is one of the best brands out there. However, you do not necessarily need an autotitrate unit. I just had a patient in today that had an autotitrate and had to change it to CPAP mode in order to adjust to using it. The physician I work with is not a fan of autotitrates unless the sleep lab was unable to adequately titrate the patient during the study. Often a patient will try an autotitrate temporarily to desensitize. You should do just as well with the S8 Elite II--it has the same data capability and EPR (expiratory pressure release) as the auto. The EPR can be very helpful for those who do have trouble with the exhalation part. You want to make sure it is set at 3 to get the maximum benefit of EPR.
As far as your study numbers, which would you like to understand? I don't know what all of them mean, but I do know which ones are important for determining your therapy. I looked over your study pages, specifically the one that shows your titration numbers. What I notice is that the tech did not leave the pressure set long enough at some levels. It often takes the body more time to adjust to the pressure, so changing the pressure too rapidly does not give us adequate information. Also, I notice that they increase the pressure in increments of 2. Not sure why they did that. It looks like you could do well anywhere between 7 and 11 cm. I am on 8cm, but they didn't try any even numbers in your study! What the docs look at is at what pressure did you sleep the most time with the least amount of apneas/hypopneas. Sometimes not all apneas can be eliminated, so they choose the pressure that did the best. However, choosing a pressure also involves the doctor's experience. The doctor I work with would either have you repeat that titration or try different pressures and test your nocturnal oxygen saturation at each pressure at home. My guess is the doctor dropped your pressure to 9 to make it easier to exhale, knowing that you did fine at 9cm in the study anyway.
I hope that helps. I would be happy to answer other questions or explain myself better if you need more help!
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Well, I told the DME to call the doctor and the the correct information, because I wasn't going to do it for her. I have the original Physician's Order with his signature that is ordering the S8 AutoSet II CPAP. They weird thing is, she didn't even sound like she had any idea what machine I was talking about...no kidding. I think I will be spending most of my work hours next week getting the ball rolling with Lincare. sigh.
Judy said:You did say you have a copy of your script in hand, right? To rub the DME supplier's nose in? Let them know that less than the truth isn't exactly appreciated by you, eh.
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Melinda, Thanks so much for your very helpful info. I am renting the machine so I will make sure that this machine fits the bill, if the Autotitrate unit doesn't work for me I will be asking the doc for a new prescription.
I would like to ask the forum users of the S 8 AutoSet II to send me a pdf of the users manual so when I get mine I will be prepared to ask questions.. :>D What do you think? I feel I need to get as much knowledge as I can to get the machine I need. bee
Melinda Hertel said:Hi there....Sorry to hear you are having some difficulties. Regarding the machine: ResMed is one of the best brands out there. However, you do not necessarily need an autotitrate unit. I just had a patient in today that had an autotitrate and had to change it to CPAP mode in order to adjust to using it. The physician I work with is not a fan of autotitrates unless the sleep lab was unable to adequately titrate the patient during the study. Often a patient will try an autotitrate temporarily to desensitize. You should do just as well with the S8 Elite II--it has the same data capability and EPR (expiratory pressure release) as the auto. The EPR can be very helpful for those who do have trouble with the exhalation part. You want to make sure it is set at 3 to get the maximum benefit of EPR.
As far as your study numbers, which would you like to understand? I don't know what all of them mean, but I do know which ones are important for determining your therapy. I looked over your study pages, specifically the one that shows your titration numbers. What I notice is that the tech did not leave the pressure set long enough at some levels. It often takes the body more time to adjust to the pressure, so changing the pressure too rapidly does not give us adequate information. Also, I notice that they increase the pressure in increments of 2. Not sure why they did that. It looks like you could do well anywhere between 7 and 11 cm. I am on 8cm, but they didn't try any even numbers in your study! What the docs look at is at what pressure did you sleep the most time with the least amount of apneas/hypopneas. Sometimes not all apneas can be eliminated, so they choose the pressure that did the best. However, choosing a pressure also involves the doctor's experience. The doctor I work with would either have you repeat that titration or try different pressures and test your nocturnal oxygen saturation at each pressure at home. My guess is the doctor dropped your pressure to 9 to make it easier to exhale, knowing that you did fine at 9cm in the study anyway.
I hope that helps. I would be happy to answer other questions or explain myself better if you need more help!
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