In late Nov. I went in for a sleep study (overnight). Because the sleep specialist (MD) was booked up, the clinic could not schedule me for a visit with the doctor until later this month (2 months post sleepover study).

A day or so before 12/25 (one month after study) I got a call from another doctor in the group, informing me that I have sleep apnea, and should call the technical medical supply group to get a CPAP machine and learn how to use it. The only thing mentioned in the phone discussion of the sleep study results was that I did have up-to 40 incidents (quit breathing) per hour (not sure if he meant one time or every hour throughout the night or what???), and should consider the situation as serious. He said he would call in to the tech office and provide a prescription for a CPAP machine, and I should call that office when they would be open (after the holiday week end) to arrange an appointment for picking up a machine and training on its use.

It seems to me to be a bit on the unprofessional side, to call me over the phone and tell me this information without first scheduling an immediate visit with the (any) doctor or even the clinic nurse or a diagnostic tech to review what was seen in the study results. Keeping in mind the diagnosis phone call was one month post the study and there was no attempt to move up a scheduled appointment with the sleep clinic doctor for still another month (meaning it will be over 2 months after the study that I will be seen - {for the very first time} by the attending sleep clinic doctor). I am a bit upset with the situation relative to what has transpired in the last couple days (*denoted in marked paragraph below).

I know my health concern should come first; however the night of the sleep study and somewhat regularly as of late, my nose and or sinus passages (which air for breathing with mouth closed goes through) have been blocking or closing at night. As soon as I get up in the morning, within a few minutes they open up. I feel this has had a lot to do with the apnea situation... anyway; the night of the sleep study was no different.

So, in mid study the tech came in and put a nose mask on me. Obviously this did not have much of an effect other than I ended up breathing through my mouth the same or more, as air was not getting into my lungs via nose.

A few hours later, the tech came in (just about the time I seemed to be falling into a reasonable deep sleep) with a full face mask (nose and mouth) and said "Can't you close your mouth and breathe through your nose?" I really did not offer him an answer that I recall, or I may have said my nose is mostly plugged, but anyway after that all I could seem to do was still breath through my mouth, for which all the air was pressurized now.

I do not know about anyone else, but it seems to me that the pressurization of the full face mask made me fight the machine just to exhale (again everything through the mouth). Every time I tried getting air through my nose, I would end up short of a comfortable maximum breath volume.

I know a few times, I could subconsciously feel myself holding my breath, simply because my throat passage was getting extremely dry, and the only way I could sooth it was to hold my breath for a second or two and swallow a few times to try and get enough saliva to moisten the tissues.

I have nothing against going on a machine, however it seems a bit on the negligent side to tell me I have to get on the machine before I have any kind of knowledge of what the study indicated along with the chance to talk to the physician (face-to-face) about the experience, O/2 blood levels, and any other factors the study my indicate or show- at least to tell him/her my nose was partially to completely plugged (not by mucous) due to whatever reason.

*Last evening when I got home from work, I had a phone call from the sleep clinic telling me they are going to cancel my appointment with the sleep clinic physician, if I do not go and get my CPAP machine and start using it.

Certainly, my sleep situation has reached a point where I have to be doing some things differently, or treating what ever may be diagnosed as the abnormality by whatever means is necessary (probably in multiple ways - diet, habits, exercise, diag/treatment), but does anyone else out there have the experience where the doctor put you on a CPAP before ever having any kind of consultation regarding the results of the sleep study (besides a phone call from a resident in the department) or does this seem medically / ethically reasonable?

I know I have been told that everybody has problems getting used to the CPAP machine, however, if my nose being plugged a large percentage of the way and time, how effective can a CPAP machine be in helping me get more sleep if I am fighting it to breath (exhale or keep my throat from getting sore - as bad as snoring) because I can't breath through my nose and mouth at the same time (currently) at night in bed. So, I am trying to weigh how much of my frustration in this situation is reasonable with the medical diagnosis and consultation process, verses just being afraid or bullheaded about getting a machine.
A closed nose (of any degree) is no better for the situation than a closed mind (of any degree), but reason and common sense (with or without a CPAP) should lead to the best solution.

Thanks for allowing me to vent. I am really teed off by this last phone call from some innocent little clinic associated staff person or operator, when I feel I am being diagnosed with a lack of respect and consultation which would seem to be normal or reasonable.

Any thoughts or comments???

givemeabrache

Welcome to Apnea Board, givemeabrache.

I think that many of your questions will be resolved once you've had an opportunity to speak to your doctor.

I'd like to offer a few observations.

First, nasal congestion is a common issue with PAP therapy. Your sleep doctor may wish to refer you to an ENT to try and discover the cause. For me, it turned out to be allergies. I take Clarinex daily and use a steroid nasal spray at night, and as a result, I'm able to get by with a slightly reduced average PAP pressure.

Second, it's common practice to get the patient on CPAP as soon as possible after a confirmed OSA diagnosis. In most cases, it really isn't necessary for your doctor to review the results of your PSG. The typical sleep study includes a PAP trial, and it's usually immediately apparent whether it helps you or not. If it doesn't, they won't recommend it; if it does, you should begin therapy as soon as possible.

In terms of mask selection, keep in mind that PAP therapy is very much a work in progress for most OSA sufferers. I remember someone telling me years ago that "every CPAP user has a drawer full of masks", and in my experience, it's true. Many of us experiment with different interfaces and sometimes, even machines, until we find the combination that gives us optimal therapy. It may be unrealistic to expect comfortable, effective treatment from the first mask and machine that you try.

Drying can be addressed with a heated humidifier. Your doctor can usually write you a prescription to add the humidifier if your machine does not include one. It may seem unlikely now, but most folks gradually get used to the feeling of exhaling against the pressure of PAP therapy. If you're having an especially hard time of that, you might want to try a machine that will offer some relief on exhalation, such as a BiPAP, autoPAP, or a Respironics-brand CPAP with C-Flex.

The good news is that technology is on your side. The first CPAP machines were just reversed vacuum cleaners, and early masks were only able to provide a seal against the lowest pressures. Modern PAP machines and masks can often provide effective therapy where it wouldn't have been possible to do so as recently as ten or fifteen years ago.

Good luck with your therapy, and be sure to let us know how it goes!

Carl