Sleep study doesn’t match machine report

I’ve been using a cpap machine for about 8 years. Changed insurance companies and they wanted a new sleep study.

My pressure level has been 8 but I’ve gained weight and wondered if maybe my setting would change. But my machine has not noted AHI’s higher than 1.8 and occasionally it will go up to 2.1 so my machine seems to think all has been well at level 8.

My sleep study interpretation says my level should now be 14! And on the first night I used this level, I woke up about 5 times with my mouth open and really dry. I’ve never been a mouth-breather before this.

When I look at the sleep study, it shows that my AHIs went down when my pressure was 10 but back up at 12 and again at 14. So I don’t understand how they decided I should be at 14.

I tried 10 last night and slept better than I have in a long time. And no open mouth.

It’s a long story but I’m getting a new machine next week from my new insurance company. I think they will want reports showing compliance for the next year. And I don’t want to be compliant at 14. I will use it faithfully but I think the setting is wrong. And what if my insurance company wants to force me to use it at 14?

My issue is that when I first got my machine 8 years ago, the sleep center was where I got supplies. I could ask them anything and they knew the answer and were in charge of the prescription.

Now, the prescription comes from my primary doctor who knows nothing about cpaps but based the prescription on the sleep study (that I think is flawed). The prescription goes to the DME company who isn’t authorized to change the prescription.

I feel trapped and totally disempowered to take care of my own health.

I will talk to the DME guy next week. He seems nice. But I worry that he can’t help me.

Any advice?

Thanks in advance.

Leigh

A few comments:

1. Your sleep study must have actually been a titration test. Does the test result specify the type of apnea events your were having at the various pressure levels tried? In some people the central apnea or clear airway events tends to rise with higher pressures. That could account for why the AHI (which is the total) went up with the 12 and 14 cm pressures. However, a CPAP uses pressure to treat apnea, and pressure does not reduce or prevent central apnea because the airway is already open. Normally when a titration test is done they select the lowest pressure that reduces the obstructive apnea while avoiding the higher pressures if they induce central apnea. In any case I think you are correct in being suspicious about the selection of the higher pressure.

2. I am not sure what restrictions you are on with your insurance company, but I would suggest you try to get your primary care doctor to prescribe an Auto CPAP or APAP instead of a fixed pressure CPAP. That way, if you do not need the higher pressures the machine will not go there, and you will still be in compliance. Future sleep studies should also be unnecessary as the machine will auto adjust. And they really do not cost that much more than a fixed pressure machine at least in Canada and the US. And a good auto CPAP will not increase pressure if central apnea events are detected. It will only identify and count them, but not try to stop them.

3. Again if you have any control and are successful in getting a prescription for an APAP, I would recommend the ResMed AirSense 10 AutoSet for Her machine as the first choice (even if you are male). It has an additional optional setting that works well in people needing pressures up to the 12 cm range. Second choice would be a Dreamstation Auto. If you could get your doctor to specify the ResMed For Her machine in the prescription, it should make dealing with the DME easier...

I'd change my machine settings myself, watch my numbers and never mention anything about it. At least that's what I do. No one notices, they just note the hours I use the machine and the AHI.