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A Lost Cause?
#21
RE: A Lost Cause?
Here are the results of the titration incrementing the low pressure from 8 to 11 cm.  AHIs are corrected, removing sleep-wake-junk (SWJ) from the score.  I've also included averages from (highly) corrected scores for 5 cm and 7 cm pressures.  That data was very contaminated with SWJ and the corrected values are suspect.  For the most part I've been able to considerably reduce SWJ in the last weeks by behavioral modifications to prevent back-sleeping:

dates  : min pressure*  :  Corrected AHI 

(1/24-2/11  :  5.0  :  4.08)
(2/13-2/20  :  7.0  :  2.85)
3/3-3/6  :  8.0  :  3.05
3/7  :  8.5  :  2.87 
3/8  :  9.0  :  1.94
3/9  :  9.5  :  0.80
3/10  : 10  :  0.62
3/11  :  10.5  :  1.14
3/12  :  11.0  :  1.15
*max pressure = 15 cm for all.

AHI:  A minimal interpretation of these data would be that increasing pressure between 5 and 9.5 reduces the AHI from 4 to 1 and thereafter it remains constant at 1.  A more imaginative interpretation is that AHI bottoms out at 10 cm then begins to increase again with progression to higher pressures.  While there is some indication of pressure induced CAs at 11.0 cm, more nights at that pressure would be required to establish this alternative conclusively.
           
Feelings:  So far as how I feel at various pressures; I think I'm still too close to sleep that is massively dominated by SWJ and am unable to discern the lighter shades of good sleep.  I have felt pretty good sleep-wise in the past week.  Possible 11 cm is a bit less comfortable.  But I still have junky experiences, and I do have bouts of extreme muscle weakness and fatigue.  One quite positive observation, really since starting with CPAP in late December (12/26/2018), is that I have had fewer leg cramps while sleeping. 

I had hoped the higher pressures would help make my flow look a bit less "tortured" but that does not seem to be the case:
   

Next:  Think I'll set the pressure back to 10.0 for a while.

obob
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#22
RE: A Lost Cause?
You have persistent flow limitation and pressure support, rather than pressure is what you need. I would love to see you on a Resmed Airsense 10 Autoset, or, even better a bilevel machine. That's not what we have.Based on your AHI, you are treated. but every inhale ends in a flat-topped wave form. If I was you and if money is not a big issue, I would self-finance a more appropriate device. Your doctor may or may not have the awareness to recognize the respiratory disturbance that is present in these charts. If you can find and obtain a Resmed Aircurve 10 Vauto or even a Philips Dreamstation or System One 700 series BiPAP Auto, this problem can be addressed. You need bilevel therapy. Can you afford to get it assuming the insurance system will not pay for it?
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#23
RE: A Lost Cause?
Thanks for your advice Sleeprider.  

My thought today is to go ahead and purchase an Airsense 10 Autoset out of pocket.  Do you have any particular advice as to particulars, best vendor, caveats etc.  I recall reading a thread by WakeTired who's sleep problems seemed similar to mine, and that there was some discussion on that thread of the Airsense 10 For Her having additional desirable properties.  Do I remember correctly? (I've tried to find that discussion, but can now only find the first page  of the thread, which doesn't get into the For Her machine.)

I haven't given up on my sleep doctor and conceivably he could be amenable to prescribing  a BiPAP machine for me.  I simply have had so little contact that I have no idea what to expect, and then his (or more correctly) his staff's evaluation seems unduly slow and superficial, which is why I ended up here for a better understanding.  Happy that I did.

obob

PS:  I called vendor #2 re the Aircurve 10 vAuto price you mentioned and they denied it.  Perhaps it was some other vendor?  In any  case there is no way I could buy such a machine at this time as I have no prescription for a BiPAP.  I'll work on getting one but it clearly will take a while.  I'll know better in a month.
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#24
RE: A Lost Cause?
Supplier #33. No questions asked, great prices.
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#25
RE: A Lost Cause?
(03-14-2019, 07:46 PM)Sleeprider Wrote: Supplier #33. No questions asked, great prices.

I agree Sleeprider, they (#33) had a used Aircurve 10 Vauto for ~$800, but I unfortunately don't have a Rx (yet or ever?  don't know) so that was that.

You suggest I might get some relief (greater than with my PR APAP) from an Airsense 10 Autoset and I have seen several listed (new or slightly used) on craigslist locally ($400-500.)  I'm currently looking into buying one.  I'm hoping that it will make breathing more comfortable (especially expiratory) and reduce the prevalence of periodicity in my night-time breathing.  Although my scores are mostly in the "cured" range now, I feel I have a long way to go yet.

(After a week at 10-15 I have been trying 11-15 for 6 days now and confirm my one-night verdict that the higher pressure of 11 cm is less comfortable than 10 cm, but does slightly improve the look of my ins flow.)

Many thanks for setting me on a productive path.

obob
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#26
RE: A Lost Cause?
obob, Supplier #33 usually does not ask for your script. The Airsense 10 does provide true pressure support (different EPAP and IPAP pressure) that that the PR cannot provide. It may help. The only difference between the Airsense and Aircurve is that the Airsense is limited to 3-cm pressure support and 20 cm max pressure, while the Aircurve can provide more pressure support and pressure up to to 25 cm.
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#27
RE: A Lost Cause?
I too would encourage you to get the VAuto BiLevel machine.  It is better than buying an AutoSet and then having to buy a VAuto because the AutoSet cannot generate more than 3 cmw Pressure Support ('cuse me, EPR).  I too see a lot of flow limitation in your charts.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#28
RE: A Lost Cause?
Thanks Sleeprider & bonjour, I understand your advice regarding Aircurve vs. Airsense but am in a bit of a bind if I wish to proceed at a reasonable pace.  My sleep clinic is set up to do things very slowly, the doctor is not very accessible and a complicated personality, so I must think twice about asking for a script or trying to reason with him.  That's why I was so happy to see a used Vauto at #33, but unfortunately they are now requiring a Rx, stated explicitly on their home page and verbally when I spoke with them  on the phone.  Too bad.  The only other possibility I can think of is that I might find one on craigslist, but haven't seen any used Vautos listed other than that one at #33.

So, the Airsense seems like a good stopgap to continue improving treatment while I wait, and hopefully convince my sleep doctor of the right choice. Figure that will take half a year or more to happen.  

Way it appears to me is that the clinic relies on the APAP to do the bulk of the diagnosis but then they don't follow through with it. (I was given the most minimal home sleep test, diagnosed and scripted.  Perhaps this is a more general problem than mine alone?) The rub is that they have all this data from my PR APAP but seem very reluctant to look at or analyze once they have it.

obob

PS:  I am scripted for the APAP but trust that cannot be used to get a BPAP?
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#29
RE: A Lost Cause?
I'm going to guess you are talking about Supplier #2. They do sell used machines and even have a offered new Vauto machines for about $799. An auto bilevel is a good choice for treating obstructive apnea and upper airway restriction. I don't understand why a doctor would not provide a prescription for this as an alternative to CPAP when the patient is buying out-of-pocket. It is a perfectly acceptable device for improved comfort.

As you said, the Autoset will be an improvement and may resolve the problem. I still don't see any medical reason a prescription for bilevel should not be provided.
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#30
RE: A Lost Cause?
If you need a further nudge towards making the Resmed change, I started on a Dreamstation and the higher pressures seem sooooo much more bearable on a Resmed machine for some reason so this might really help with your quest ?

Rob
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