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BrentB



Joined: 15 Jul 2006
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PostPosted: Fri Aug 11, 2017 7:57 pm    Post subject: Reply with quote

Harvey

Thanks a million

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Foggy



Joined: 01 Aug 2013
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PostPosted: Fri Aug 11, 2017 8:21 pm    Post subject: Reply with quote

My gripe with the local medical "AASM OSA specialist" was there was no
consideration or even discussion of more conservative therapy (bite splint) only
CPAP as "the standard" therapy.

My take away, always ask questions, get other opinions, look around, educate
yourself.

Aye.

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hardee



Joined: 30 Oct 2006
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Vessel Name: Sleepy-C
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PostPosted: Fri Aug 11, 2017 11:46 pm    Post subject: Reply with quote

CPAP is the Gold Standard of Therapy, meaning it is, (can be) 100% effective. There are other therapies, but they usually only work in the more mild cases. Our MD was open to other therapies IF they worked and we did many studies on folks that had any number of "Bite Blocks" and some even tried special "CPAP" pillows.

The most effective oral appliance was the TAP series of dental devices, (which are up to about Series 3 by now). In some cases the dentist would send them in to us to "titrate" the adjustment.

Personally, my sleep study showed my AHI was 28, with oxygen levels going down into the 70's and the longest apneas were just over a minute long. I would wake every morning with a severe headache. One 3 hour nap "test" and waking up without a headache made me a believer. I have tested several thousand patients, and have seen much worse cases of OSA. AND I have seen many more than I could count excellent results. I have also seen folk come in, test and show severe OSA, and then refuse to do what it takes to treat it. I have seen some of them come back years later, after being referred by the cardiologist after they have had more severe complications.

Each person is entitled to manage their own health care, make their own decisions and use what they want. It just seems logical that they also would want to do what is effective, knowing they are treating themselves well.

Quote:
"My take away, always ask questions, get other opinions, look around, educate yourself."


Always a good idea.

** Read my tag line **

Harvey
SleepyCMoon Moon


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localboy



Joined: 30 Sep 2006
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City/Region: Lake Stevens via Honolulu
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PostPosted: Sat Aug 12, 2017 2:50 pm    Post subject: Reply with quote

I have recently lost 15 lbs and per The Admiral, my snoring has all but disappeared. So...
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hardee



Joined: 30 Oct 2006
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PostPosted: Sat Aug 12, 2017 10:09 pm    Post subject: Reply with quote

localboy wrote:
I have recently lost 15 lbs and per The Admiral, my snoring has all but disappeared. So...

So.... often a 10% weight loss would allow a decrease in CPAP pressures, and for some folks, a 15% would be enough to drop their AHI (Apnea Hypopnea Index) and their snoring to within the MCR guideline below the requirement for CPAP ( = an AHI below 5, or only 5 apneic periods per hour) Smile That doesn'n neccesarily mean you get to move back into the bedroom Shocked but according to the medicare folks, your health (less at risk) is not endangered. Technically, that may be so, be we always tried to have our patients at 2.5 or less. AS I said earlier, mine was 28, and with my CPAP is is usually about 0.2. The best part is not waking up with headaches and not getting sleepy in the daytime.

Mark, Good job on the weight control, it isn't easy. Keep it up. Also, sleeping on your side may help in decreasing the snoring.

Harvey
SleepyC Moon

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localboy



Joined: 30 Sep 2006
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City/Region: Lake Stevens via Honolulu
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PostPosted: Sun Aug 13, 2017 1:20 am    Post subject: Reply with quote

Quote:
Good job on the weight control...


It was quite simple. All I did was alter my work schedule to 2100 hours to 0500 hours, five days a week. Then when I got home at 0600, I slept. Wake up. Repeat. Wink Laughing

Seriously, I did lose 15 in 6 weeks and the schedule did not help. But I am eating better, eating less and my intake of un-needed carbs, aka beer, wine etc, has decreased because of it.
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Gene&Mary



Joined: 10 Jan 2005
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PostPosted: Sun Aug 13, 2017 1:12 pm    Post subject: Reply with quote

I've had my CPAP machine for 8 months now.

How does everyone clean their machine?

How many hours a night does everyone average per night? S far I keep it on between 4-7 hours, then take it off for the remainder of the night.

I find that using the non-heated hose doesn't use as much distilled water from the humidification reservoir as the heated hose. The result is that I wake up dryer with the non-heated hose

Imagine........ a thread about sleep apnea on C brats. What a great forum.
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colbysmith



Joined: 02 Oct 2011
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PostPosted: Sun Aug 13, 2017 2:47 pm    Post subject: Reply with quote

Gene&Mary, I use mine during the entire night. 6-9 hours. Just sleep better with it on. I clean the mask and tubing every week. Wash it in a sink with soapy water. (Regular dish washing detergent.) I clean the tiny air filter about once a month in that same sink of soapy water. The humidifier tray is also washed weekly. Maybe a few times a year I'll soak it in Vinegar. The machine itself just gets wiped down when the dust starts to show. I don't have the heated hose, and just set my humidifier to what is comfortable. That's usually a little bit higher setting in the winter when the furnace drys the house out. I also use a C-Pap when I'm staying on the boat, but without the humidifier....seems to be enough moisture when on the water. It only has an ac adapter, but I find that using a 100 watt inverter does just fine, without running the humidifier. My preferred machine is the ResMed S9. Unfortunately, my supplier no longer carries that model, and my newest machine is the Respironics DreamStation. I'm not as impressed as it's not as easy to read the information I like to see (AHI and time of use), and it's water tray is smaller. (The information stuff is probably just a learning curve...) I still have my original S9 and an older used S9 I bought outright from the supplier, that I use for traveling and on the boat. Colby
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BrentB



Joined: 15 Jul 2006
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PostPosted: Wed Aug 16, 2017 6:49 pm    Post subject: Reply with quote

Who makes a good machine? Which one are you using?
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Dreamer



Joined: 01 Jan 2006
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PostPosted: Wed Aug 16, 2017 7:31 pm    Post subject: Reply with quote

ResMed AutoSense 10 works fine for me. Quiet, Adjustable if you know the secret code! It has an SD card that records sleep data and it reports every morning so you can check online and see what your score was from the night before. I have gone from 46 episodes per hour to .3-.5. Never slept better. I can honestly say it has changed my life.

I do have a box full of full face masks that just didn't work for me. I am back to Nasal Pillows. The model is Phillips Respironics Nuance Pro.

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colbysmith



Joined: 02 Oct 2011
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PostPosted: Wed Aug 16, 2017 11:07 pm    Post subject: Reply with quote

I much prefer the nasal pillows and use the Opus headgear. And as I said earlier, like the Resmed S9 C-Pap.

For those using C-Pap, this is a great resource:

http://www.apneaboard.com/forums/

Not only can you join forums discussing C-Pap usage, but also have access to software that can download data from your machines, and provide the medical operating manuals for various machines that will provide the "secret" codes for changing your machine's settings. Colby
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hardee



Joined: 30 Oct 2006
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PostPosted: Thu Aug 17, 2017 1:47 am    Post subject: Reply with quote

Gene&Mary,

It is best to sleep the whole night with your CPAP on. If you are not, then the reason should be explored, because, CPAP should be comfortable enough to wear for the full night, and you should be waking rested and refreshed. Typical nights should be in the 7-8 hour bracket for most people.

First, your CPAP supplier should have provided you with cleaning instructions. But, if it came by UPS, the UPS driver probably didn’t go over them with you.
General Recommendations for Cleaning:
Mask; should be cleaned every day. Something between a wipe down with diaper wipes to a full vinegar soak. Soapy water is good, rinse and air dry. Mask, daily.

Hose; once a week, unless you turn off your machine before the hose is completely dried out. (If there is water in the humidifier chamber, there is moisture in the hose also.

Humidifier; a vinegar solution soak somewhere between once a week and once a month. This frequency depends on use. IF you run the chamber dry every morning, then 2 – 4 weeks should be adequate. On the other hand if you still have water in the chamber when you get up and turn the machine off, It needs to be emptied and dried.

The humidifier; should always have distilled water only. The water chamber should never be left sitting with water from on night to the next. (That would be like an incubator chamber for bugs.)

The Filters; Oh yes, your machine has filters and they do need to be changed, occasionally. Some are foam and washable, some have 2 parts, a fine (HEPA) filter and a foam (Hair) filter. The changing frequency is entirely dependent on your living conditions. An unchanged filter will shorten the life of your machine, may lower your pressure, and may contribute to foul odor through the machine.

Some folks prefer to run without a humidifier on the system. In some cases, some folks (your truly is one), use a different machine on board the boat, and because the humidifiers take up considerable battery power we opt to only run the compressor (CPAP) and not include the humidifier. If you are using that approach, sometimes a saline nasal spray helps to moisten the mucosa before and after the CPAP therapy. (Saline nasal spray is not a prescription medication, and is easy to use and (for me) makes my dry CPAP nights tolerable.

Using a heated or non-heated hose is a matter of preference. Most machines have an adjustability to allow you to have as much or as little amount of moisture as makes you comfortable. The settings vary considerably depending on where in the country, how warm or cool your bedroom is, the season of the year, and the type of mask you are using. Even the auto adjust features have some adjustment settings to start with. Check out your instructions, or your DME provider.

Hope that helps some,

And to all a Good night, always.

Harvey
SleepyCMoon



Last edited by hardee on Thu Aug 17, 2017 2:16 am; edited 1 time in total
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hardee



Joined: 30 Oct 2006
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PostPosted: Thu Aug 17, 2017 2:12 am    Post subject: Reply with quote

BrentB wrote:
Who makes a good machine? Which one are you using?


Brent, For the most part, any of the machines will work, but, from history, the Respironics were the best for a long time, (and you could plug them into 12VDC with a Cig lighter plug), and ResMed made the best masks.

Over the last 10 years, ResMed machines have gone leaps and bounds, and now they are the easiest to work with and get info from, and in the mask department, they are all over the place.

The best mask, bar none, is the one that works for you. That means it has to fit perfect, snug, and NOT LEAK, or the CPAP is just blowing into the room. So make sure that is what you have. Wear the mask, with the machine on, NO LESS than 15 minutes, then take it off and look at your face in a mirror. That is called the face print, and it should be even, all around where the contact with the mask was. IF it is not, it needs adjusting, and you need to do another 15 min session.

My personal belief is that the best mask universally, is a full face mask BECAUSE in 90% of obstructive sleep apnea cases, it is worse in REM sleep. That is due to the total relaxation of the body (neuro muscular disconnect) which happens in REM. It is when the mouth drops open, the airway collapses and the OSA flourishes, and the AHI climbs, and if the CPAP is just blowing in the nose, and the mouth is open, then the air will blow out of the open mouth, where the system is not a closed circuit. That equals CPAP failure and a higher AHI.

There are some smaller, more portable machines on the market. I have no experience with them except the Transcend, and it is one that I use. It is small, about the size of a Coke can, (with out the humidifier attachment) and it plugs directly into the 12VDC or into a battery for one or 2 nights use between recharges. The travel system I use includes a battery, 12VDC connector, the hose, mask and machine fits into a bag about 6" by 7".

http://www.mytranscend.com/

Hope that is some help. PM me if there is something more I can help with.

Harvey
SleepyCMoon

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hardee



Joined: 30 Oct 2006
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PostPosted: Thu Aug 17, 2017 2:29 am    Post subject: Reply with quote

Yes, you can get the "secret codes" and make adjustments on your machines. it is possible, and yes, most of us are smarter than a box of rocks, so doing it is not impossible. I would just caution that in some cases, making changes could be detrimental to ones health. Most times the Sleep Physician will adjust the setting to be at the lowest efficacious setting. Most self adjustments are to lower the pressure settings and in doing that, the AHI (Apnea Hypopnea Index) goes up, which increases the workload on the heart. Some setting changes could affect the Medicare requirements and lead to loss of payment by MCR.

Most of the non-threatening adjustments, (heat, humidity, Expiratory Pressure Relief, Auto ON or Off, etc) can be adjusted without getting into the clinical menus.

I would caution to be sure you have a good understanding of your diagnosis, your sleep study report, and your machine functions before making changes.

Have a great night, and always, keep breathing.

Harvey
SleepyC Moon

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colbysmith



Joined: 02 Oct 2011
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PostPosted: Thu Aug 17, 2017 2:34 pm    Post subject: Reply with quote

As an end user, I tend to agree with Harvey's comments. Especially about the settings part, and even the forum site I highlighted above makes a disclaimer about that. None the less, while I DON'T advocate messing with the pressure settings, there are some settings that still are not available in the general user setup, such as the machines automatic on or off. Ideally, those things should be left to the user, but at least on the ResMed and Respironics machines I have, they are not, unless you know how to access that "clinical" setup. As to the need of cleaning, go back and read my comments in my earlier post. I think if most followed the recommendations of cleaning daily, it would get old and turn folks away from using. I can say my routine has worked well, and I have yet to encounter any sterilization or cleanliness issues with my units. (And I've heard from my Doc that I'm doing better than most. Wink I do use only distilled water, but fill the chamber full and the water remaining stays in it until gone, several days later. The bottom line is at least in my case, the C-Pap was a definite help, and with some reasonable care and cleaning, it does it's job without a lot of upkeep from me. Colby
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