LAD22

This pattern is indicative of a machine running before mask is fitted and breath could be detected or mask was loose during this time.

Cyrus, Have you done a recorded overnight oximetry for at least a week on both machines. If not I would talk to your doctor about doing that as an objective measure to check the efficacy of the machines. Subjectively , it’s how you feel after using the machine. The ODI from the oximetry will confirm the activity of events.

As far as the AHI on the download it’s a moot point. Clinically anything under 5 is acceptable especially if you are severe and on download it can be other factors such as head position or leak that can cause it to be artifact.

Apollo,

Have you had a download done recently? Some ResMed machines are designed to shut off if the leak is too high. Also both the new design of the ResMed masks and Respironics Dreamwear line are not that great on stabilization and leak. I would stick with the classic strap style mask such as an N20 or and Eson. They are comfortable, stable and leak less than the tube type headgear does.

You really need to speak to your doctor about this as there can be other issues going on besides sleep apnea. It’s not uncommon to see sleep disturbed by painful disorders or diseases, sleep deprivation or concomitant sleep disorders. Even though you may be very compliant with your therapy these interferences can make you tired the next day. The doctor will assess your case by clinical measures possibly including a test called an MSLT, and will advise you on what can help remediate your daytime tiredness. Don’t get discouraged. It’s difficult for some patients to decipher what is wrong as these disturbances happen during their sleep. Good luck but I am confident that the doctor will find the answer.

Apap machines are a wonderful mode of treatment as they can be set in a range of 4 cm to 20 cm and anything in between. You are correct in saying the doctor is the only one who can prescribe the pressure setting. I was in Sleep medicine for nearly 25 years and patient support was my forte. I can tell you this, your AHI is not the only factor to look at. An AHI is a index of all your apnea activity so if your index went from 40 to 0.5 I’m certain your hypopneas are treated also. Your oxygen level is also very important. If that is coming up to normal and your leak is acceptable and it sounds , from what you stated ,your AHI is down and your compliance is good, then your on a good path. Your not waking as often which is probably indicative of getting through your REM stages. All seems like a perfect remediation with only a suggestion and that is to let you pressure range end at 20. It won’t reach it if you don’t need it but on the other hand if you set the max too low it can’t go above that pressure.

Not everyone feels the WOW! You should however see improvements in small ways, no snoring, wake up much less tired, less naps or none at lol, and if for some reason you could not use the mask for a couple of days I’m sure you would notice a difference from the nights you do sleep with it. All in all it sounds like you’re very happy with your progress. Kudos and keep up the good work.

The actual rule for Medicare and most insurances is the 5 year rule unless the machine has issues before hand. After the warranty period it sometimes is not worth to repair so they replace it. We have had some instances in which the insurance refused replacement even at the 5 year mark, as there was nothing wrong with the machine. They have gotten stricter in cases of lost or stolen machines by requiring police or fire reports. If your insurance is one that will allow replacement after 5 years it’s not a bad idea to keep your current machine as a back up while it’s still operational. These rules, especially Medicare/Medicaid are subject to change so it’s best to check when you are thinking of getting a new one. Secondary or travel machines are not covered by insurance.

Dr.Luisi I do agree that a custom fitted oral appliance can help most mild and moderate apnea with oxygen desaturation that are within an acceptable range. We had patients that actually had both APAP and an appliance. Some used the appliance when they went on vacation or in times when PAP wasn’t convenient to use. Also had a few severe apnea patients on both as the appliance had a dual role, it helped lessen pressure and protect dentition. I also agree that cost factors and coverage come into play. If you cannot use or comply with PAP in a 90 day period the insurance will not pay for the machine or will let you have one more try. But you can give it back, comply, or pay for it out of pocket. With a dental device being fee for service in most cases, regardless of efficacy, you own it. Both therapies come with plus and minuses but absolutely believe that oral appliances should never be ruled out.

This is not an unusual occurrence especially in REM. Pressures can hike up during that time because your muscles paralyze during that stage and apnea can get worse. Patients very often feel that pressure rise and wake up. Hitting the ramp button will restart your beginning pressure as well as turning off the machine. To answer the question of the time for pressure to go down: these machines are “smart machines” so they are designed to go up in pressure within a few breaths. It will decrease the pressure at a slower rate as it is expecting another occurrence of apnea and will not have to come all the way back up. Hang in there, not every night will be the same. Just remember that when pressures go up there is a reason. Your body is calling for it because of obstruction or there is high leak.