Replies to This Discussion

Permalink Reply by Daniel on June 17, 2009 at 9:08pm

While I agree with jnk, I would add that if you have a fixed-pressure CPAP that does not record efficacy data, it may make sense to schedule a new titration study to confirm that your pressure is correct. As we age, our muscle tone tends to deteriorate, including the muscles in the upper airway. This can cause a change in the pressure required to splint the airway open. Doctors at Stanford have told me that one should consider a new titration study once every two years. To me, the most important factor is how you feel. If you notice any recurrance of symptoms from before you were on CPAP, you should get a new study.

And before Judy has a chance to say so, if you have had your CPAP since 1995, you are most certainly eligible to get a new device. Most insurance companies will pay for a new CPAP after five years. When you do get a new device, make sure it is capable of recording efficacy data. The reports from these devices will be able to let you know when and if your pressure is becoming ineffective. Also, discuss the possibility of an AutoCPAP with your doctor. When an AutoCPAP is set to an appropriate range of pressures, it can eliminate the need for future titration studies, since it will increase the pressure if you muscle tone weakens over time. However, the sleep lab won't make any money on titration studies every two years, so there is sometimes some reluctance to prescribe AutoCPAP.

Best of luck,

Daniel

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Permalink Reply by Dave Hargett on June 18, 2009 at 2:08am

I started on CPAP in the fall of 94. I had a minor pressure "tweak" from my sleep doc in 1997 when I lost some weight and we just did it by experiment, first dropping from 13 to 10 and then going back to 12 when I fell asleep the first afternoon after the change to 10!

I then had a study in 2001 just because I thought it had been a long time since I'd had a study. I was not having any difficulties or feeling sleepy. The study confirmed my pressure of 12.

In 2005 I asked for another study because I began to feel as if I were not getting enough air. Sure enough I needed to go to 14. Turns out I was getting extra fluid in my legs which was causing my pressure need to go higher. After going on diuretics to control the fluid issue, I was able to go back to 12. That change came about because I could no longer keep my mouth shut at 14 (and I had before) plus 4 nights on auto-pap in the hospital after gall bladder surgery showed that 12 was an okay pressure for me.

In the summer of 2008 I had another titration, but it was for publicity reasons, helping to publicize the opening of a new sleep center by convincing the mayor to have a sleep study and we did it the same night.

My personal recommendation is to see your sleep specialist once a year and discuss your situation and if you have any symptoms that recur - snoring, sleepiness, etc -- get hold of him/her sooner and discuss another titration and/or just a manual trial of a different pressure if he/she will work with you that way.

I'm not a big fan of auto-PAPS and I even had someone who uses one ask the other day about a new titration study because he felt he was getting sleepy in the daytime. Since his machine does record data, I suggested he have the machine's data read and talk to his doctor if he spent a lot of time at the highest pressure.

Dave

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Permalink Reply by Daniel on June 18, 2009 at 1:17pm

Great story, Dave. You've been a model patient. What I liked best is that you have been in tune with your sleep over the years and have noticed when things have changed. You are absolutely right that for a guy like you, there's no need for an Auto. In fact, I'd argue that you don't even need a data-capable device. I've always felt that the patient's perception of you feel when you wake up and how sleepy you get during the day are far more important indicators than the numbers generated by a CPAP.

Daniel

Dave Hargett said:

I started on CPAP in the fall of 94. I had a minor pressure "tweak" from my sleep doc in 1997 when I lost some weight and we just did it by experiment, first dropping from 13 to 10 and then going back to 12 when I fell asleep the first afternoon after the change to 10!

I then had a study in 2001 just because I thought it had been a long time since I'd had a study. I was not having any difficulties or feeling sleepy. The study confirmed my pressure of 12.

In 2005 I asked for another study because I began to feel as if I were not getting enough air. Sure enough I needed to go to 14. Turns out I was getting extra fluid in my legs which was causing my pressure need to go higher. After going on diuretics to control the fluid issue, I was able to go back to 12. That change came about because I could no longer keep my mouth shut at 14 (and I had before) plus 4 nights on auto-pap in the hospital after gall bladder surgery showed that 12 was an okay pressure for me.

In the summer of 2008 I had another titration, but it was for publicity reasons, helping to publicize the opening of a new sleep center by convincing the mayor to have a sleep study and we did it the same night.

My personal recommendation is to see your sleep specialist once a year and discuss your situation and if you have any symptoms that recur - snoring, sleepiness, etc -- get hold of him/her sooner and discuss another titration and/or just a manual trial of a different pressure if he/she will work with you that way.

I'm not a big fan of auto-PAPS and I even had someone who uses one ask the other day about a new titration study because he felt he was getting sleepy in the daytime. Since his machine does record data, I suggested he have the machine's data read and talk to his doctor if he spent a lot of time at the highest pressure.

Dave

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Permalink Reply by Jeffrey Donaldson on July 2, 2009 at 11:08pm

Well, I had my follow up sleep study a couple of days ago. It was quite interesting. They asked me to bring in my machine. A vintage 1995 resporonics antique. They told me that I was having a "split" study which means that I had to start my night without my C-Pap. That was not a comfotable thought, since I can count on one hand the amount of times that I've got without it since the day I got it back in 1995, so I had a heck of a time going to sleep. About 2 hours later, they came in and had me mask up and they used their machine set to my pressure. About 2 hours later the other tech came in and said that I had a leak of 80, whatever that mean't. She said that my mask and chin strap just wasn't working and took it off. First of all, this lady reminded me of Phillis Diller. She imatated what my lips were doing with all the air coming out and she got a real "kick" out of my mask saying that she hadn't seen a swival like that in years. She returned with a real huge mask that made me wonder what the heck is that. Turns out, it was a full mask. She put that on and said something to me that I tried to answer. I quickly found out that I sounded like I was laying underneath the mattess instead of on top of it. A really wierd sensation. She returned a little while later and said that I still had a major leak and tried another full mask. After some adjusting, it fit with little leakage and I went back to sleep. I slept very well for the rest of the night and felt great when they got me up. I really liked that full mask. It was quite comfortable and I think that it helped me out well. I quite often have a stuffy nose and allergies, so I think that it may work out better. I just got the call from the medical supply tech and he is bringing me my new machine and several masks to try out. I can't wait. I really liked that full mask and I may go with that one. No more tight chin strap and no more sore upper lip. That is the one thing that has always bothered me about the nose mask. I'll keep you all posted on my progress with the new equipment. I guess I'm all done using the antiques.

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Permalink Reply by Judy on July 2, 2009 at 11:51pm

Daniel has my number all right! Since you stole my thunder, Jeffrey, and are getting that nice new CPAP I hope to goodness that you INSIST that it be a fully data capable CPAP. I know, you've gone all this while w/o data and done so well .... but, really, just the fun of checking your data is worth the standing your ground and insisting on fully data capable or no sale.

How great that you've found a new mask that you like so well!!! That "antique" CPAP has served you well. You might want to consider having its pressure output checked by manometer and then storing it as a back up device - just in case. It never hurts to have a backup. Besides, whilst they've increased the "comfort options" on these new CPAPs they aren't as well-built for durability as they were back in 1995. I doubt all that many of today's CPAPs are going to be still working satisfactorily at 10 and 13 years of age as so many of those older models have been doing..

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Permalink Reply by Jeffrey Donaldson on July 19, 2009 at 7:19pm

Well, I've used the full mask for a couple of weeks now and I like it. I noticed that I've been dreaming more since I started using it. The Doctor told me that I had virtually no stage 4 with my old mask and I had some after they put on the full mask. I have been making fine adjustments to it for preventing leaks and it is way more comfortable than the nasil mask. The new machine is a varible type and I only noticed once that it was up on pressure when I woke up in the middle of the night. I have always thought that more people need chin straps than are given one. This full mask eliminates that. It is a different feeling, but It is definately more comfortable. Some people may feel somewhat claustrophobic with a full mask, but I was fine with it.

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Permalink Reply by Jeffrey Donaldson on July 19, 2009 at 7:28pm

Hi Judy. It is a data capable machine and is also sensitive to apneas and adjusts for them. They said that they will send me a new data card and I'll send them the old one. Its a Fisher & Paykel Sleep Style 200. I love this new machine. It is vurtually silent. Yes they did check my old machine and the pressure was almost the same as the new one. It was actually one point higher. I have put it away as a backup. That is what the setup tech suggested.

Judy said:

Daniel has my number all right! Since you stole my thunder, Jeffrey, and are getting that nice new CPAP I hope to goodness that you INSIST that it be a fully data capable CPAP. I know, you've gone all this while w/o data and done so well .... but, really, just the fun of checking your data is worth the standing your ground and insisting on fully data capable or no sale.

How great that you've found a new mask that you like so well!!! That "antique" CPAP has served you well. You might want to consider having its pressure output checked by manometer and then storing it as a back up device - just in case. It never hurts to have a backup. Besides, whilst they've increased the "comfort options" on these new CPAPs they aren't as well-built for durability as they were back in 1995. I doubt all that many of today's CPAPs are going to be still working satisfactorily at 10 and 13 years of age as so many of those older models have been doing..

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Permalink Reply by Cheryl L. Duhamell on March 15, 2012 at 6:51pm

I have been through so many different kinds of mask and nothing seems to work for me so I am going to try the Sleep Weaver. But my  DR. said that the normal time to to go back for another study  is at least once a year. and it also depends on your insurance.

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Permalink Reply by Ernestine Webster on March 16, 2012 at 9:11pm

i was wondering the same thing about going in for a followup sleep study, as you know i have been on cpap for about 8 months now and am still having problems falling asleep even with going to bed as soon as i take the ambien, thinking i may be growing a tolorance to this sleep aid i started taking 300 mg of the Gab, capsule that was prescribed by my sleep doctor , i have been going to the same sleep doctor for the entire time of 8 months and he is always wanting to change mask which i keep telling him it is not the mask it is me but i still do not know why i still have problems falling asleep . i still see no difference in the quanity of sleep i get. the quality of sleep is better . i wonder if i should see a different sleep doctor and have another sleep study done. i have no doubt i have sleep apnea because of the way i feel when i get up in the mornings but i have insomina as well and really do not know where to turn to find out what the problem is with that.          

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Permalink Reply by ZolliStar on March 16, 2012 at 10:58pm

Ernestine,

      I was misdiagnosed at a sleep disorder clinic as having insomnia when, in fact, I have SA. The clinic never ordered an overnight because it was so sure that all I have (had?) is garden variety insomnia. That said, the doctors did convey useful sleep hygiene tips. I suspect that they would help you, so I'll pass them on.

      In addition to keeping to regular bedtime and waking hours, including on weekends, observe the following:

1. No alcohol four hours before bedtime.
2. No eating (other than a small, non-sugary snack) for 3 to 4 hours before bedtime.
3. Close down your computer 60 to 90 minutes before bedtime.
4. Lower your lights (for a while, I even resorted to candlelight!) an hour or so before bedtime.
5. Do things that calm and relax you an hour to 90 minutes before retiring. Examples: read, listen to music, pet your dog or cat, chat with a family member or call a friend, etc.
6. Go to bed when you're drowsy.

     Don't forget the basics like: a dark room, cool ambient temperature, and a comfortable bed and bed clothes.

     These are small things but all together, I've found that they make a difference.

Ernestine Webster said:

i was wondering the same thing about going in for a followup sleep study, as you know i have been on cpap for about 8 months now and am still having problems falling asleep even with going to bed as soon as i take the ambien, thinking i may be growing a tolorance to this sleep aid i started taking 300 mg of the Gab, capsule that was prescribed by my sleep doctor , i have been going to the same sleep doctor for the entire time of 8 months and he is always wanting to change mask which i keep telling him it is not the mask it is me but i still do not know why i still have problems falling asleep . i still see no difference in the quanity of sleep i get. the quality of sleep is better . i wonder if i should see a different sleep doctor and have another sleep study done. i have no doubt i have sleep apnea because of the way i feel when i get up in the mornings but i have insomina as well and really do not know where to turn to find out what the problem is with that.          

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Permalink Reply by Terry Vella on March 17, 2012 at 4:26am

Ernestine, I know how you feel, I have the opposite, I can fall asleep but still wake up earlier than I want, but do feel 100% better now that I'm on CPAP. What med is Gab? There are a huge amount of meds you can take to try to get you back in the proper sleep pattern, but you don't want to stay on them too long and get addicted. Some may also interact with SA and not give you the benefits. If you are no happy with your sleep Dr, try another, it can't hurt and you have already been diagnosed with SA. I'm not sure another sleep study would be worth it just yet as your problem isn't during sleep it's getting to sleep. let us know how you go.

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Permalink Reply by Ernestine Webster on March 19, 2012 at 3:25pm

really do not feel my sleep specialist is listening to me , i thought once i had the sleep study and found out i had OSA i would get wonderful sleep but that has not been the case with me at all, the first week was great but after that first week it went downhill and has not improved without some kind of sleep aid and then it still takes me hours to go to sleep. i have tried all the sleep hygene i have read about . the medication my sleep doctor prescribed for me is Gabapentin 300 mg. , 2 out of 3 times i have taken it i have scary dreams . don't know if it is the medication or there is a problem with my mask and am not waking up to know it, all i know i dream about snakes everywhere and i horrified of snakes so i manage to get woke up enough to get out of bed  and stay up for awhile til i get settled down enough to get back to sleep. so i guess i need to start looking for a doctor that will hear me when i tell them i cannot fall asleep even with the cpap machine. i wonder if i may be depressed since i have lost a job i loved dearly and got laid off over 2 years ago and am not enjoying staying at home. thanks for listening      
Terry Vella said:

Ernestine, I know how you feel, I have the opposite, I can fall asleep but still wake up earlier than I want, but do feel 100% better now that I'm on CPAP. What med is Gab? There are a huge amount of meds you can take to try to get you back in the proper sleep pattern, but you don't want to stay on them too long and get addicted. Some may also interact with SA and not give you the benefits. If you are no happy with your sleep Dr, try another, it can't hurt and you have already been diagnosed with SA. I'm not sure another sleep study would be worth it just yet as your problem isn't during sleep it's getting to sleep. let us know how you go.

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