hi. i was just diagnosed with sleep apnea. I have an appointment to get a sleep apnea machine this week. I don't know what to say to ask about machine or what kind of mask is best for me? I get dry eyes. and dry mouth. also i move around when im sleeping. can anyone give me some tips or questions to ask during my appointment?
You should ask to get a copy of your sleep study report. One of the most important factors in the report beside the total AHI number is the portion of the total that is obstructive apnea and the portion that is central apnea. Ask for these numbers. Standard CPAP machines are very effective in treating obstructive apnea, but not so effective in treating central apnea. If you have a high proportion of central apnea you may need a different type of machine. If you have basic obstructive apnea and have any choice in the machine, I would select a ResMed AirSense 10 AutoSet For Her (even if you are male). It has the best features.
Masks are difficult. I have tried 5 masks so far, 2 full face, 1 nasal, and 2 nasal pillow types. For me, I find the nasal pillow masks to be the most comfortable. Of the two I tried, I prefer the ResMed AirFit P10 over the F&P Brevida. But everyone is different. Ask to try different masks to see what works for you, if that is possible. The common problem with a nasal, or nasal pillow mask is that you open your mouth in your sleep and air escapes out. Some learn not to do it, and others use a chin strap to help keep your mouth closed. The other option is a full face mask, but that tends to have more trouble with leaks, and some find it claustrophobic.
Hope that helps some. Any questions just post...
If your AHI's are on the low end I would suggest a dental/oral device from a sleep dentist.
Hi Kinikea.
Actually, CPAP is always the first treatment recommended for OSA, no matter what the level of AHI is. CPAP is the most effective and least invasive of all the different treatments offered. The dental devices are not without their drawbacks, as some OSA patients have sadly learned. The drawbacks include potential rapid-onset TMJ disorder, which is really no fun at all, and a permanently distorted bite and/or muscle atrophy, tension and jaw pain that doesn't go away. Many dentists believe that the risk of these things happening is very slight or that the technique wearers use for treatment dismisses the problems. But believe me, if you ever develop any of this stuff, you will earnestly hope that no one else ever does. We really don't know how often disfunction and/or disfigurement occurs from these dental devices used for treating sleep apnea because no medical researcher, that I know of, has actually studied this.
I use a dental device that a TMJ dentist/specialist issued me for TMJ Disorder. My TMJ Disorder was brought on by the treatment pressures of CPAP. I use this device, (which resembles a twin block), each night along with my CPAP. He permanently changed my bite (lower jaw drawn forward into a position that relaxed the TMJs) through the use of crozats, upper and lower, which were worn all day, even when eating, for about two years. I removed the daytime devices at night. I've worn the nighttime device from the beginning (5 and one-half years now). This maintains my jaw in the corrected position. I will wear this at night for the rest of my life. The nighttime device is maintained about twice per year. This treatment immediately relieved my pain, plus it improved my appearance and enabled me to use and benefit from my CPAP therapy. I was blessed to have found my TMJ dentist when I did.
See the link below for some assistance in understanding the sleep study report and the severity classifications.
Sleep Apnea Report - Understanding the Results
On my sleep report it indicated that a CPAP is the preferred therapy, and dental appliances should only be considered if the AHI is <15 (mild), and there is no other co-morbidity.
In the health system that I'm a part of here in the states, the medical professionals offer CPAP first if the AHI is <15 and greater than five. If the patients balks, they then suggest a dental appliance. However, the health insurance will not cover the dental appliance, nor will they cover the follow up sleep study to see how well the appliance is treating the apnea.
My TMJ dental appliances and treatment cost around $5,000.00, but the expense keeps on above and beyond that due to the necessary maintenance biannually. That was all out-of-pocket for me.
I didn't get these appliances to treat my apnea, but a subsequent sleep test at home showed that my AHI had been reduced by 12, down to twenty-four. My health insurance covered that second sleep study because they wanted to get a base-level reading with my new appliance to see what AHI level remained and whether my CPAP treatment would reduce those remaining apneas down below an AHI of 5. It was an eureka moment. My AHIs today are usually in the 0.5 range.
I was truly out of options. I needed the CPAP, but couldn't do that because its' pressures produced TMJ in me and the pain from that was overwhelming. I had to have the TMJ Disorder treatment in order to tolerate the CPAP. The problem was solved my first night of dental appliance therapy with CPAP. No pain. I knew I had made the right choice for me, but it was a guessing game up until that point.
The trouble with the standard dental appliances issued for sleep apnea is from the constant moving of the lower jaw forward each night and then trying to coax it back into it's original position during the daytime and then repeating this with the each following night of therapy. This puts incredible strain on the TMJs and the whole musculature supporting the jaw. The muscles go into spasm and the pain from that is enough to keep you from eating and even from talking. So you go along hungry and isolated. But you lose weight...in some cases a lot of weight. Then, your brain becomes confused and begs an answer to the question; "Where does my jaw belong?". Your jaw seems to be floating in an empty cavern. Our brains crave a norm of some kind. So, the bite gets thrown off. Teeth get cracked and broken (our bites are powerful) with some teeth needing extraction. And the patient is left wondering; "How did this ever happen?" "Could my dental appliance treatment for sleep apnea be causing this?" And no one seems to know.
Perhaps you're an anomaly. No... you're not. You're just one cog among many, caught up in the machinery of the industry. Your solution in the end is to just take the thing out of your mouth. But the pain doesn't go away while your jaw is floating around in never, never land. Your bite never seems to find "home base" and you're left at ground level once again, with sleep apnea and no treatment and dental bills to boot. This happens more often than anyone is yet really aware of. If you have Medicare and have "failed" (non-compliant) the first go at CPAP therapy, Medicare no longer wants to invest at all in your treatment and you are left on your own. We have to be strong and advocate for ourselves in this sleep apnea business.
So, "B" follows "A" and "C" comes after that. When the dental profession finally catches on to this, there will surely be a revolution - and for the better. But, I'm not going to risk my health and well-being in the meanwhile, as the figuring-out process is going on.
I am a dentist working in dental sleep medicine. SnuzyQ, your post is substantially correct, but let me clarify a few points: 1. At this time, more and more medical insurances ARE paying for oral appliance therapy. In addition, once the appliance is placed, most do allow for at least a home sleep test to verify efficacy. The reimbursements are generally at an out-of-network rate but tend to be between $800-$1200. This is a recent improvement over the past few years. 2. The vast majority of people CAN successfully and comfortably wear mandibular advancement devices without significant long-term TMJ problems. I can verify this anecdotally from my own practice as well as from numerous published studies. The incidence of TMJ problems is definitely over-rated. Having said that, if a patient with TMJ problems is improperly selected for oral appliance therapy, BIG TROUBLE can ensue, as you have so correctly pointed out. As to the statements from your TMJ specialist, I have no doubt that this is exactly what he has observed. You must remember, however, that the patient population that he is seeing are the ones who have experienced the TMJ problems and that is a skewed sample. The same thing happens in my practice. My patients almost all complain bitterly about CPAP, so I could observe how much people don't like it. But I recognize that it is a skewed sample and I know that many, many people, probably the majority, are tolerant or actually happy with their CPAPs. You can't generalize from a specific kind of practice. Arthur B. Luisi, Jr., D.M.D.
purplefan100, My recommendation is to start taking charge of your therapy from the beginning. The first step is to get a copy of your sleep study. Start by looking up each of the terms/values and finding out what these mean to you. Asking others to tell you what to think or say isn't going to help if you don't know the state of your own sleeping and health. The lingo used on the report is confusing but if you take a bit of time to research can help you make your own decisions. Once you know what is what, then ask folks for clarification or tips but until YOU know, it is mainly a waste of everyone's time.
I think wiredgeorge is giving you great advice. You have to ask for a copy of your sleep study.. you paid for it! Read it, google the things you don't understand and educate yourself! Doctors today are so busy that you have to be your own advocate. The more you know the better you will feel. This forum is a good place to learn. I love my dental device and that is that!
I had to have my insurance company who paid the sleep clinic tell the sleep clinic to send me a copy of the report. They didn't want to. They had faxed a copy to my PCP and thought that was the end of the story. My primary care physician was not conversant with CPAP stuff and really the only thing she did was give me a referral based on a video my wife made of me stop breathing during sleep then wake momentarily with a gasp. I didn't remember this happening and only believed when the video was stuck under my nose by a concerned wife.
I also requested a sit down with the sleep doctor at that clinic. Never happened as he was too busy. He didn't see patients. He wrote prescriptions and washed his hands of further contact. Couldn't even get through via phone call. I got my report. Didn't understand much but saw the SPO2 at ~70 for extended periods. Not good. This is where I decided I needed to know what was happening to me and not rely on someone else. Google and forums like this are good for learning about what that report means!
The experience that you report is truly pathetic. You have every right to have a copy of your report(at least in Florida, where I live, you do) and you also have every right to have it explained to you. If I were in the situation that you had, with a totally non-responsive sleep specialist and a family physician without a clue, the next people I would try to get help from would be a physician's assistant, if the sleep office had one, and/or the sleep tech that did your recording or the head sleep tech that runs the sleep lab. You shouldn't have to resort to this, but any port in a storm. Arthur B. Luisi, Jr., D.M.D..
so update if anyone that comment and comes back and visits
i got sleep apnea machine. i used it over the weekened . felt nice to get some restful ish sleep. i been having chest pain , it feels like having a 10 pound baby on my chest for 5 hours. i got a full face mask, and it is comfortable, but i get hot, so my skin starts sweating where the mask touches around my mouth. and the seeating makes it hard to sleep. ]
also the lady at the sleep apnea machine place told me to stop using my machine since im getting chest pain.
As an aside. This is one of the very positive benefits of using an oral sleep apnea appliance. Since you are breathing normal unpressurized room air, there is no strain on the chest muscles or the alveoli in the lungs. This can be important for relatively frail people who have difficulty breathing against the CPAP pressure and for people with COPD. Arthur B. Luisi, Jr., D.M.D.
Am I missing something here? Did purplefan post somewhere about the severity of her apnea?
Actually, I was not addressing purplefan's problem specifically, I was just talking about the general problem of sore chest muscles due to CPAP. You could make the point that, since it was her post, I should have addressed her problem, but I was just looking for a teachable moment here. Point well taken. Dr. Luisi
You make a good point. The pressure during the inhale part of your breathing cycle (IPAP) does nothing but help you get air in. More pressure makes it easier. However during the exhale (EPAP) your body has to work against the CPAP to get the air out. I have seen the case made that having a higher EPAP is good for you as it makes the muscles used for breathing stronger and fitter. For that reason it would be helpful to know what kind of pressures are being used. And, of course to rule out any issues with the heart a medical doctor should be consulted. Women in particular are known to be more susceptible to "silent" heart attacks.
It would be helpful to know what make and model of machine you have, and what your AHI was at diagnosis? Also what are the pressure settings on your machine. Ramp start pressure? Minimum Pressure? Maximum Pressure?
You should see your medical doctor about the chest pain and get their opinion on what may be the cause.
i have a dream station auto cpap i believe. it just does the pressure automatically. and i got my sleep report. :D so i can actually answer the question. lol
ahi during sleep study was 28.6 . i had 14 obstructive apneas and 1 central apnea. and 30 snoring events . it took awhile for me to get comfortable to fall asleep. kept readusting. i have alot of hypopneas. i guess that means i have obstrutive apnea ? my pressure range is from 5 to 20. but my pressure hasnt gone past 6 . I used it friday night and when i woke up saturdayi had bad chest pain. like i had a weight on my during the night
That is moderate apnea and with the low central apnea incidence should be easy to treat with a CPAP. A maximum pressure of 6 cm is very low, and normally shouldn't cause any significant breathing effort issues. Best to talk to your doctor about the cause of the pain. Also ask about using the Flex setting on the Dreamstation to reduce breathing effort. It may be possible to treat your apnea with a fixed pressure of 7 cm and a Flex setting of 3, for maximum comfort and minimum breathing effort.
the maxiumum pressure is 20. but in the data it guess my body doesnt need higher. my mean pressure is 5.2 and the peak average pressure is 5.5 . i ahve no idea what is the flex setting. i have never heard of that. i have a auto cpap.
The Flex setting controls the amount the pressure is reduced on exhale compared to inhale. On the ResMed machines it is called EPR and the setting corresponds to the pressure reduction in cm of water. On the Dreamstation it is not an exact one for one pressure reduction and depends on your flow and pressure. However, generally setting it from nothing or off means no reduction, and 3 means full reduction. See the bottom of page 13 at the link below. Your provider may not have turned the Flex option on, but you could ask them to turn it on. Then you can set it. The Flex setting may reduce the effectiveness of your treatment slightly, but it is something you could use initially until you get used to the CPAP experience, and then reduce it or shut it off later on.
is the provider the office where i get the machine ?
Hi purplefan100:
What is the status of your chest pain? Have you checked in with your doctor yet about it?
Really, your other questions about CPAP can and should wait until you've taken care of this.
For women of any age, the sign of chest pain can be deadly because.....we women tend to dismiss it and by the time the cause is found, well...it's too late..
If you are in the US I am not sure how it all works. I guess the technician that gave you the machine? In Canada we either go to a sleep clinic, or just do it ourselves.
i asked the office where i got it, but they said i need to ask the sleep doctor for that. and the sleep doctor says oh its not a prescription, its just a request for the office where you got the machine to do it. >.> i am not trying to be difficult. i just want to sleep and wake up semi comfortably. sighs
snuzy Q i already spoke to the sleep doctor, he told me its already at the lowest at 5. however when i went to the clinic where i got the machine, (needed a different style mask) they told me the lowest is 4. :/
Anything below about 8 cm is low pressure in my opinion. The difference between 4 and 5 is pretty insignificant, and in fact both pressures are so low that it may feel like there is not enough air when you have the mask on. All machines should go as low as 4 cm, but it is not necessarily going to feel comfortable. Do you have any difficulty breathing? Does the mask feel like it is restricting air flow? It is possible you may need a little higher pressure.
Hi I'm new to the forum. People with sleep apnea can really benefit from allergy shots to clear up sinus and throat congestion. Also seeing a snore and sinus doctor can help too. I have suffered with sleep apnea since I was a teen. I have helped myself find answers more than sleep studies and sleep specialist have. After many ENT's etc I went to a Snore and Sinus doctor who was the first to take a CT scan of my sinus cavity. He reported to my that I had a deviated septum and very large turbinates along with a thick toung and very narrow throat due to large tonsils. Therefore my CPAP was not helping me even at a high pressure, no where for the air to go 😔 I had my deviated septum fixed and turbinates removed. Now my passages way is wide open. What helps me with my mouth dropping at night while sleeping is breathable tape 😊 Placing it over closed lips provents dry mouth/throat which caused me to cough all night. Also eliminate "chipmunk" cheeks☺️ and leaks. I started with a full mask, now I can use a nose mask since I don't need air pressure in my mouth. I have no leaks and it much more comfortable, feels like a have nothing on my face. 1: allergy shots if you suffer from congestion. 2: CT scan of sinuses to check for blockages. 3: Breathable Tape. 4: Test different mask. (I went through 4 types to find the best for me) Hope this helps. Sincerely.
how do you know you need to get your sinus cavity checked out ? just congestion and dry mouth ? im curious. also i suffer from dry mouth. lol . its pretty bad,
Do you have the sleepyhead application yet? You can get it for free online. Sleepyhead will allow you to see your own sleep data so you can determine whether your dry mouth is caused by mask leaks. All you will need is an SD card and an SD card reader to interface with your home computer and the sleepyhead App. Your CPAP machine may already have an SD card.
