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Permalink Reply by Mary Z on March 29, 2012 at 9:58am

Twy, it takes some of us longer to feel better than others.  After four years and a change to an ASV machine I am finally getting my AHI to ten or under.  I still sleep long hours and some days take Provigil to stay awake.  Hopefully your doctor will be of some help today.  The DME can only follow the doctors (or NP) orders, so I would not count on them for setting the effective APAP range.  Were you really first prescribed a CPAP and insisted on an APAP?  I know this is the recommendation on other forums and I think it is faulty.  Some of us do better with one continous pressure.  When the doctor reads your data today he/she will have a better idea of what to do.  Good luck.

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Permalink Reply by ZolliStar on March 29, 2012 at 3:18pm

     In most matters, the KISS principle ("Keep it simple, silly!") really works. I also subscribe to the  less-is-more idea. Thus, I bet that for most of us, not all of us to be sure, but for most of us, basic CPAP is a good way to go.

     I got my CPAP in June, 2011. It's a basic machine and isn't, alas, data capable. That said, It may be all I need (considering the cost of buying a data capable machine).  I've been feeling my way ever since and I am feeling better. Thanks to this site, I realize that it takes time (Silly me, I thought I should feel GREAT on the first day). I remain very, very grateful to SleepGuide.com for all the help and advice from been-there, done-that members.

     And special thanks go to M&M -- Mike and Mary. Thanks, guys!

    

Mary Z said:

Twy, it takes some of us longer to feel better than others.  After four years and a change to an ASV machine I am finally getting my AHI to ten or under.  I still sleep long hours and some days take Provigil to stay awake.  Hopefully your doctor will be of some help today.  The DME can only follow the doctors (or NP) orders, so I would not count on them for setting the effective APAP range.  Were you really first prescribed a CPAP and insisted on an APAP?  I know this is the recommendation on other forums and I think it is faulty.  Some of us do better with one continous pressure.  When the doctor reads your data today he/she will have a better idea of what to do.  Good luck.

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Permalink Reply by Twy on March 30, 2012 at 1:26am

I mentioned about central sleep apnea to my NP today connected to being having to high of a range. She seem to disagree with that. I am interested in learning more about that.

Twy said:

I have read something about that in somewhere but I read so much and was getting bit confused. I was overwhelm. Thank you for putting it in simple terms.  

99 said:

two things it takes severn years to quit smoking so congratulations!!

secondly by limiting you range you stop the APAP running away or going higher should a leak occur as higher levels may cause centrals

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Permalink Reply by Twy on March 30, 2012 at 5:17am

I saw my NP and there was alot of miscommunication somewhere concerning my treatment. The NP said she prescribed 4cm to 12cm. The DME made it 4 to 20. It is going to be taken care of. I mentioned to the NP about possible central apnea occurring resulting from having a wide range. It seem like she knew nothing about this. She indicated that this would not happen. How and why would central apnea be a possible adverse effect occurring from a wide range setting on an apap?
My NP pointed out that she ordered the cpap 1st because that is what was used in my sleep study. I mentioned to her that there was no mention of a cpap except it being used as a means to find my therapeutic level and that I was suppose to get the apap. She did not have the sleep study results with her but I had my copy with me. I showed her the part she was talking about, then I turn 2 pages and showed her the Impression and then the Recommendation. The apap was recommended because I did not reach REM in the 2 studies that were done. At the end it said "to script". The sleep doctor did not send a scrip with the study and the information in the study was a bit scattered thru out about 4 pages. I have had one very stressful week trying to get this right. The guidance y'all gave me is appreciate. I am getting my nose pillow back and a different RT is going to be helping me out. My 7 day report was done today. My AHI in the sleep study was a 18. After 7 days on the apap AHI is 6.5

Twy said:

Thank you for your reply this will help. It makes sense. I work directly with many medical professionals. They are human therefore they do make mistakes at times. I think most of it has to do with communication and assumptions. Not to mention many health care personnel are over worked and sleep deprived . I have had sleep apnea for years not knowing it. I thought being so tried all the time had to do with all the force over times for the last 10 years. And being treated for depression. I went out on disability due to stress and months later I notice I was still tried. I could no longer blame it on work (force overtime = another 8 hrs and usually happens every other day). Then my brother visit me and said he did not sleep well because of my snoring. I told him I do not snore. Well I ended up recording me while I slept. Boy did I ever snore. I live alone and had no one to tell me this. I put 2&2 together = possible sleep apnea. I then asked my NP for a sleep study. I am grateful I was so stressed that I had to stop working other wise I would had never known.  I would like to mention that I am a shift worker which really has messed up my sleep.  I am grateful that this site is here. This is helping so much.

RockRpsgt said:

Hmm where to begin. Let's start by saying that without seeing what the techs or doc saw I can't say whether they were right or wrong. That would not be fair or professional.

 

An auto setting of 4-20 is an "auto-titrating" or exploratory pressure."  You are basically going through a titration study every night. This means that every night your machine titrates or searches for the best pressure for you. In order for the machine to change pressures you must register breathing events. With this type of wide open setting it is also possible that insignificant events such as swallowing, biting, or holding your breath will be counted as events. Not only could the pressure be going to high but the constant changes could be causing arousals as well.

 

You are correct int that your ranges should be slowly reined in to meet your specific needs. ideally you are gonna want a 3-4cm difference or as tight as possible.

 

 

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Permalink Reply by Mary Z on March 30, 2012 at 8:47am

Twy, your AHI is still a little high, it should be five or under, but sometimes that takes awhile to achieve. I am not  there  yet. After only seven days you have made great progress. I would not worry about central apneas.  Too high a pressure can cause them, but I think it would be unlikely with an AUTO set wide open, and less likely when they set it correctly to 4/12. It's not too high of a range, but too high a pressure.  Unless you're having more than 5 central apneas/hour I would not worry about them.

Did your sleep study show any centrals? Zollistar is right- keep it simple- you are just starting.

It takes some of us months to start getting things right.  Keep learning.

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