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Permalink Reply by Judy on March 30, 2009 at 10:48am

Unfortunately, in this society w/o the money ...... still, you might want to try contacting A.W.A.K.E. Supposedly they provide assistance for those who need PAP devices.

Or perhaps you can find someone who would provide financial assistance to buy a lightly used APAP at cpapauction.com However you do need a script for a CPAP to buy a C or APAP at cpapauction.com. Your original script is good for life w/online DME suppliers and w/cpapauction.com

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Permalink Reply by susan finn on March 30, 2009 at 3:16pm

I know my cpap is not as effective b/c I have gained about 20 lbs...but I still owe from the last time I was re-titrated....so...the obvious solution for me would be to lose weight! Which as we all know is easier said than done!

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Permalink Reply by Banyon on March 30, 2009 at 7:58pm

I agree with jnk's last post. For me having a data-capable machine with software is much more important than having the autotitrating feature. I have done well with my therapy by regularly monitoring apneas, hypopneas, snores and leaks. This allowed me to make the necessary adjustments. I found a "sweet spot" for a single pressure setting which takes care of most of my events.

Now having said that, I do use the autotitrating function. My single-pressure "sweet spot" is set as my minumum auto pressure and 20 cm is the max. This helps me just a little bit by bumping the pressure up by 0.5 to 1.0 cm several times per night and blowing away some hypopneas and a few minor apneas that the straight pressure would have missed. It is not a real big deal but it does make the daily detail graph a little cleaner.

Where the auto feature really fails is when I need considerably more pressure than the minimum. For instance, if I roll onto my back I need much more pressure and the auto just never ramps up high enough to control my apneas.

That is a major failing of autos, IMO.

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Permalink Reply by B Robles MD on June 17, 2009 at 12:45am

Mike,
Pressure is not something that patients develop tolerance to like medications, such as narcotics. Nonetheless, there are many variables that affect the tone of the airway. Weight for sure is a biggie! Then there is age. With age EVERYTHING will sag a bit more and in patients with sleep apnea, age alone can affect their condition. Alcohol is also a big no, no for patients with OSA as that substance can also affect airway tone. In some cases, for whatever the reason, if patients reach a point where simply positive pressure does not resolve their problems, then a tracheostomy can become a last ditch effort. With a tracheostomy there is no longer a physical obstruction of the airway but with excessive weight still on the body, the body has to work harder to breathe just to move all the tissue on their chest and abdomen. The bigger you are the harder it is to breathe on your back or any recumbant position.
B. Robles MD

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Permalink Reply by Mike on June 18, 2009 at 1:18am

well said, thanks.

B Robles MD said:

Mike,
Pressure is not something that patients develop tolerance to like medications, such as narcotics. Nonetheless, there are many variables that affect the tone of the airway. Weight for sure is a biggie! Then there is age. With age EVERYTHING will sag a bit more and in patients with sleep apnea, age alone can affect their condition. Alcohol is also a big no, no for patients with OSA as that substance can also affect airway tone. In some cases, for whatever the reason, if patients reach a point where simply positive pressure does not resolve their problems, then a tracheostomy can become a last ditch effort. With a tracheostomy there is no longer a physical obstruction of the airway but with excessive weight still on the body, the body has to work harder to breathe just to move all the tissue on their chest and abdomen. The bigger you are the harder it is to breathe on your back or any recumbant position.
B. Robles MD

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