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Newly diagnosed with OSA. Need some advise on how to proceed.

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mrhasan +0 points · over 2 years ago Original Poster

Hello everyone. I am 29 years old and got diagnosed with OSA today. My AHI is 76 (scary!). I am from Canada and the private sleep clinic has given me the option to either pursue with their trial run (will cost me $200 for the mask and will let me switch it within a month if the initial one doesn't suite me) and then (if I want to move further) purchase one of the their three machines they are offering (the fixed pressure one @ ~$1600 with the variable pressure model @ ~$2400).

I did a little research online and seems like I can get "Resmed AirSense 10 AutoSet with integrated humidifier and climateline air tube" + "resmed p10" OR "resmed quattro" for ~$700 shipped. The other option would be "dreamstation pro heated tube + humidifier" + "dreamwear nasal mask" OR "wisp nasal mask" for ~$600 shipped. Insane difference.

The sleep tech was telling me that they are providing 3 years vs 2 years warranty along with "followups" and "adjustments" but with this much of a price difference, I will need to replace the machine few times before hitting the amount of money they are charging.

I took these numbers to my family doctor and he was blown away by the difference. He told me to just get the machine online and he will be able to help me with any sort of adjustment required (as long as the machine logs data and he can look at it). I know the prescription has been signed off by the sleep doctor but I am not sure if the suggested pressure is mentioned in there.

So I am just wondering if I should do the trial and then buy the machine myself or just get the machine directly and then go from there. I am pretty good with understanding and operating complex devices so setting pressures and such should not possess any challenge for me but I am not sure where to start for the pressure (assuming the prescription won't state the pressure). I am 100% sure the sleep technicians just go off a chart or something to tune these machines (now that they are so advance, especially the automatic ones) based on the data and such.

Any suggestion and information would be greatly appreciated.

Thanks :)

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Biguglygremlin +0 points · over 2 years ago Sleep Enthusiast

Hi mrhasan,

This is the kind of query that this forum is really good at assisting with, but not me. There are far more qualified folk about who can provide detailed info especially once you have a machine and some feedback data.

I would encourage you to check back when there are more qualified responses.

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Biguglygremlin +0 points · over 2 years ago Sleep Enthusiast

What you are proposing is not as radical as it might seem.

My numbers were a lot lower than yours (50+) but I did not follow through with most of the 'normal' processes.

The sleep specialist authorised a CPAP machine (which normally comes with fitting and training and followup adjustments etc) He had given me instructions for the sleep clinic to start at 12 but I asked them to show me how to access the settings then I simply picked up the machine and went interstate. Only returning some weeks later to finalise the paperwork which was effectively a lease of the machine from the public hospital for a nominal fee.

During those weeks I started at pressure of 11 and tried a few different masks till I found one that worked, then I increased the pressure night by night till the osa numbers dropped and I kept increasing it till the csa began to rise then I dropped the pressure back down till it was comfortable but safe.

I am not recommending this approach, but for me it was necessary at the time and it was effective.

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Sierra +0 points · over 2 years ago Sleep Patron

I am in Alberta, and the sleep clinics here will do a free (probably Alberta health pays) 2 week trial. Their prices for a machine are similar like $2400 for an APAP. The benefit of a trial is to find a mask that works for you, and to confirm your apnea can be treated with pressure. You should ask for a written copy of your sleep test, and pay particular attention to the % of the AHI that is central. Central apnea is not improved with a basic APAP.

After I completed my trial I gave them the machine back, and bought my own on line. If you have basic apnea I would recommend the ResMed AirSense 10 AutoSet. They are a bit more than the Dreamstation, but are better in my opinion. I am on vacation now, and do not have a link handy, but if you look at some of my other posts you should find a link to a technical clinician manual for three Rested machine. It explains how to set it up. It is normal to start out wit a minimum pressure of about 7, and a max at 20. After using it for a few nights you can refine that.

I would also recommend you google and download a free software program called Sleepyhead. You can also find a beginners manual for it on line. It let's you view your detailed data on a computer, using the SD card in the machine and a card reader.

In any case if there is a way you can do a trial free or at low cost, that is the safest way. Then buy your own machine on line. Try to get the ResMed AutoSet for the trial too.

Hope that helps some. My wife was diagnosed at 80 or so, and now averages about 1. I was diagnosed at 34 but have trouble staying under 3. She has no centrals, and over half of my AHI is centrals.

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Sierra +0 points · over 2 years ago Sleep Patron

See the posts started by SirRobin. He is from BC and I have given him the basics on how to set up a machine. You also may want to consider the For Her version of the AutoSet. It does all the same things as the standard machine, costs the same, but has the extra optional For Her algorithm. It may or may not work for you, but is easily switched to the standard algorithm.

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sleeptech +0 points · over 2 years ago Sleep Enthusiast

Have you had a study with CPAP to make sure it works? It's be nice to be sure the treatment is effective before committing to it. Aside from that I'd strongly consider buying my own machine if I were you. You will save a lot of money. Especially when you have support of a helpful doc.

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mrhasan +0 points · over 2 years ago Original Poster

Hello everyone. Sorry for not responding sooner.

Thank you all so very much for all the great advises; greatly appreciate it :)

Anyways, I followed up with my extended health coverage from my employer and it turns out that the employer recently revised the policy and now everything is 100% covered (previously it was 70% or 80%)! The sleep clinic sent a request to the insurance company to check how much they are going to cover (a total of $2560 canadian $) and the insurance company got back to us, saying they will cover $2520 (cpap + mask + filters + humidifier + heated tube), $40 for the dc adapter excluded. Pretty darn good I must say! So I decided to move forward with the sleep clinic. I get the extra 1 year warranty (3 years vs 2 years) and follow ups and such for no additional cost.

Now the clinic is giving me the option of either getting a Philips or a Resmed. I got the philips today for a week trial and then will move to resmed to see if that is any better and then I can choose whichever I want (same cost).

Should I opt for the philips or the resmed?

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Sierra +0 points · over 2 years ago Sleep Patron

You may also want to check with your insurance company directly for any other options. My son had employer Sun Life insurnce, and he worked out a deal with them to buy both a home machine and a travel machine, on line for a total cost of about $2000. The insurance company went for that as it saved them about $500. Not totally sure of the value of a travel machine, but in case you are interested it may be an option.

As for the two choices of machines, they do basically the same thing, and both are supported by SleepyHead. If you are going to try them both, I would suggest downloading SleepyHead so you can see how each machine operates for you personally. They do behave a little differently. You can also access this basic SleepyHead manual for some help using it. You do need a SD card reader and a PC of Mac computer for it though.

The Dreamstation uses what has been called a hunt and peck method of controlling pressure. It bumps pressure up every 10 minutes or so to see if breathing is improved. If it is not, then it ramps back down again. It results in a more "bumpy" pressure ride during the night. The ResMed tends to respond faster, and then maintain the pressure longer, giving a smoother pressure ride. But, if you use SleepyHead during your trial, you will see that. SleepyHead will allow you to use multiple machines in your same setup.

My preference in the two machines is the ResMed AirSense 10 AutoSet For Her. The For Her version gives you a choice of another algorithm which you can use at your option. It also offers the standard one with a mode change. The price on both machines are the same.

Other than the smoother pressure ride, the nice feature with the ResMed is that it lets you use EPR (expiratory pressure relief) during the ramp only. That is better than having it on full time or off full time in my opinion. It also offers an Auto Ramp feature that I find very comfortable. Instead of ramping up pressure, it holds the pressure at your selected level until you go to sleep. So you get the comfort of EPR and a fixed pressure while you are awake, and then it switches over to more effective treatment pressure with no EPR, when you fall asleep. The only bit of an issue is that some sleep clinics can't be bothered to set the machine up properly to use these more advanced features. It can be easily done yourself though. Here is a link to a Technical Manual which describes how the machine works and what the options are.

Here is an example of how the ResMed machine operates when set up with the AutoRamp and EPR at 3 on Ramp Only. You can see the pressure cycling (Mask Pressure) during the going to sleep mode, and then stop cycling when you fall asleep. You can also see how the pressure self adjusts during the night to events.

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Biguglygremlin +0 points · over 2 years ago Sleep Enthusiast

I think the choice will be fairly obvious once you have handled and used both machines.

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Bigmike52 +0 points · over 2 years ago

I feel each machine has its advantages and disadvantages. I started out with the Resmed and later bought a Dreamstation. I am not sure what the hunt & peck that Sierra is talking about is, as my new Dreamstation works just fine. I know some of the settings are a lot different than I had on my Respironics System One and the Dreamstation replaced it. The Resmed advantage as Sierra mentions is reacting faster to hypopnea's to prevent apnea's. Some times that stronger and quicker reaction wakes some people up and for some of us it was quite a few times a night. That's the difference between the Resmed and the Resmed for Her. A gentler kinder response to the hypopneas. The EPR (Resmed) is called Flex on the Dreamstation but does a similar thing and that is to add comfort to your breathing.

The Resmed is number one in sales with the Dreamstation a distant second. My wife did not like the Resmed as it made more noise than the Dreamstation. Some people will say just the opposite. I personally think both machines are almost equally quiet, but the mask can make the noise difference. I would honestly say either one is a great choice and for the best support stick with #1 or #2 and look no further. This forum is great because many people trying to help have long time usage and experience.

Lastly make certain your machine is NOT what is considered a "brick". That is a machine that is not data capable and has no capabilities to download Sleepyhead charts. Some DME's will sell you those as they make more profit on them. Don't get yourself fixed on worrying about the numbers. With those downloaded Sleepyhead charts you will get the help here that you need. I would rather have my AHI number at 4.00 and sleeping very well and rested, than at <1.00 and feeling like a zombie. Welcome to the forum MrHasan.

Mike

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Sierra +0 points · over 2 years ago Sleep Patron

Mike here is an example in SleepyHead of how the DreamStation behaves, and what I mean by a more bumpy ride.

Notice how the pressure goes through very large swings both up and down. And on top of that you can see the spikes in pressure which happen periodically. That is the machine doing the hunt and peck method to see if the pressure should be changed. In comparison the ResMed gives a much smoother ride. But, if one does not notice it, then both machines can do the job.

The ResMed AirSense 10 has both a standard and a soft response. So, you can dampen out the response even more if you want to. I have never tried the Soft response setting, so don't know what it really does from experience. I see it there as an option though. The For Her mode is slightly different than the response setting. It gives a quicker early response to hypopnea, and holds the increase longer. It will not go above 12 cm in response to obstructive apneas, so that setting will work for some, but not others that need higher pressure. I was not aware of the For Her differences when I bought my AirSense 10 machine, or I would have bought one. I thought it was just an appearance difference.

Flex on the DreamStation is a bit different than the ResMed EPR. The EPR gives a full 1, 2, or 3 cm reduction in exhale pressure. The Flex technique although it uses the 1, 2, 3 number system, does not really reduce pressure by those increments. It just changes the shape of the pressure switch from inhale to exhale. And, to my knowledge DreamStation does not have the option to use Flex during the Ramp only. It is either on or off the whole time the machine is running. Here is a link that explains how different manufacturers do the expiratory relief.

Comparing Expiratory Relief in Different Machines

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Bigmike52 +0 points · over 2 years ago

Sierra I must say that is one colorful chart. The pressure reminds me of a ski slope I wiped out on a long time ago. My pressure (attached) is as flat as Kansas compared to the chart you posted. You are correct that Dreamstation does not flex during ramp. Since I have lowered my pressure to 9 and run a flex 2, I don't use ramp. Quite honestly I never used flex until I had the problem with aerophagia. I have just about got that under control and then I'll stop flex completely. On your link the writer says Resmed reacts to the users breathing while Dreamstation is more a guesstimate of when the user will breath again. I know that is correct but for me it stays in sync with my breathing so it isn't an issue. I appreciate your comments Sierra and now I'll turn the thread back to mrhasan.

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Sierra +0 points · over 2 years ago Sleep Patron

Mike, in comparison to the example I posted your machine is well set up. You, or whoever has set it up have done a good job of taking control away from the DreamStation. That is why your pressure response is so flat. The minimum pressure has been raised thus taking control away from the machine. You could go one step further and simply set the machine into fixed pressure CPAP mode and set it at about 9.5 to 10 cm. That is where I am currently at. I have ran auto pressure with it running up as high as 15 cm, but I am now getting better results with a fixed pressure of 11 cm.

The example I posted was picked because that machine was set up with a low minimum thus giving control to the machine. That is why you can see the hunt and peck classic pattern of the DreamStation. That machine is poorly set up, and is essentially in the default setup mode that unfortunately many sleep clinics put it in. My suggestion to improve that setup would be to increase the minimum pressure to 9 cm and reduce the max to 10 cm, or just set the machine to fixed CPAP mode at about 9.5 to 10 cm. Ramp start could be about 7 cm.

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Bigmike52 +0 points · over 2 years ago

Sierra, I took control over the Dreamstation quite by accident. I retired on 04/17 and moved from northern Ohio to northwest Arkansas to be close to my family. Before I moved I had a sleep study done but the DME somehow lost my contact info and never contacted me until February 2017. Too late to get set up for a machine I decided to wait until I relocated. When I took the prescription to my doctor I was advised my new state didn't honor prescriptions from a nurse practitioner and I had to get a new sleep study. Through delays with our Medicare system I didn't have the new study until January 2018.

My study AHI in Ohio was 29.1 cmH2O a year earlier and my new AHI was 34.4 cmH2O. After much tinkering I seemed to do well controlling my apnea, but never felt great. I just attributed this to my age. Just recently I had a severe bout with aerophagia and my numbers went >5.00. and I felt like a balloon and in addition to gas, had severe diaharrea. I knew one of the solutions was to lower pressure (minimum was 12) so I thought I would just try my first sleep study's recommendation of minimum pressure 7 cmH2O. To my surprise it worked great. I am feeling better and starting to sleep longer than I did for years. (in spite of my age) I think your advice is spot on as I was going to lower my maximum pressure to about 10 or 11 but straight Cpap makes more sense. Thanks for your help and I will keep you posted as to results. Mike

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