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ASV op BIPAP- which one?
#11
RE: ASV op BIPAP- which one?
Glamdrhel, based on what I've seen so far you probably need a bilevel with backup. You did not tolerate CPAP and your diagnosis clearly shows predominately central events. Lots of details are missing on the sleep study data posted, but fairly long apnea with oxygen desaturation into the low 80% range. Assuming these events were not improved by CPAP, then you certainly need to be evaluated for BPAP with backup such as ASV.

The "Sleep Labs" that want to sell you a bilevel machine have no standing in this issue. They need a prescription. If these labs are capable of performing a polysomnographic study to evaluate bilevel and bilevel with backup (ASV), then that is a solution. This could be just a misunderstanding. Ideally, you will have a doctor recommend an evaluation (titration study) for BPAP with backup, then you can be properly diagnosed, and setup with an appropriate machine. Are you insured for this?
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#12
RE: ASV op BIPAP- which one?
IMO While you're digging in to apnea and sleep issues, double check ALL the side effects of your medications and if they interact with one another. Sometimes individual psychotropic medications have a paradoxical effect. Look at this along with how your sleep is doing.

The neurologist coordinates with the psych drug prescriber?

Since much neurology medication affects the brain (i.e. the nerve center) I would think it comes under the label psychotropic, and falls exactly in a psych drug prescriber's area of expertise.

You might have to supervise a coordination yourself (so you use one medication prescribed by both physicians). It's possible that combined with better sleep, and a coordinated medication team, you have a very helpful combination. But, as I say, you might have to do the coordinating yourself. Good physicians who prescribe psychotropic medications should be okay with this, so you don't have one medication doing the opposite thing from another.

Sleep is also psychotropic....


In fact, on SleepRiders input, your sleep issues may fall squarely in the neurology department, since "central apnea" means your brain isn 't signaling you to breathe. This is compensated for by an ASV, but should probably also be brought to the attention of your neurologist. The neurologist might even be able to organize a titration and a prescription for you.

Hope that helps. Your next steps on this are simpler than I'm making them sound. Short version: 1. look up drug side effects and interactions, so you can take charge. 2. Get your neurologist and psych meds prescriber to coordinate. 3. check in with your neurologist about central apnea issues if it turns out they predominate. 4. Get the neurologist to stay on top of the sleep issue.
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#13
RE: ASV op BIPAP- which one?
(01-10-2018, 03:47 PM)Glamdrhel Wrote:
(01-10-2018, 02:27 PM)Shin Ryoku Wrote: I have a few questions:

1) Did you have a titration study on CPAP?

2) Do you have a sleep specialist doctor who agrees that you have failed CPAP?

3) Do you know what your AHI is on CPAP?

I would recommend against buying any machine unless you have an in lab titration study showing successful use of the mode of therapy employed by that machine... unless that isn't possible to do in your location.

hi
1) unfortunately not, did not know enough then to ask. However my "tritation" consisted of the tech putting me on an auto cpap with a full face mask, slept for only about an hour. Only saw the tech again the next morniing, she looked at the average pressure which was 7 if I remember correctly and that was it. Got a normal cpap set to 7 with a fullface mask ( no choice) , that never worked well, couldn't sleep more that an hour at a time with it.

That ended with the sleep study above after I complained treatment wasn't working. I was given the S9 auto with no tritation study done. Was just told to leave it on auto. Dont-know

2) This one is more difficult. My Pshyciatrist believe my CPAP is not working. After a telephonic conversation with a neurologist I was advised to try BiPAP or ASV.There is no doctor spesialising in sleep studies near me, the best I can do is a neurologist who is 2 hours drive away. Unfortunately my appointment with him is only in April.

3) Very good AHI , useally between 0.5 and 3. Although the numbers look good I am still waiting to wake up feeling refreshed and not feeling tired.


thanks

Given your limited sleepyhead result may be correct. I think your AHI apnea part, maybe being treated ok. Everyone here would be happy with 0.37. You need to get charts up for opinions
http://www.apneaboard.com/forums/attachm...p?aid=4108

You need to have the SD card in the machine overnight to get the detailed charts. Instructions at the top of the page, on how to lay out the chart and use https://imgur.com to upload.
new http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or charts for auto-cpap, set the min 1cm below median pressure, or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
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#14
RE: ASV op BIPAP- which one?
Hi
See last nights sleepyhead results below

[Image: zoCiw6Ul.png]

Do you think it will be worth it investing in a new oximeter to see how that looks before getting a new machine?

I am seeing my gp today to get him to send my for a new sleepstudy and titration.

thanks again for all the advice
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#15
RE: ASV op BIPAP- which one?
Those centrals in the last few minutes of your sleep may be what I call “snooze alarm centrals”.  See how you have a “mask off” right before that cluster? The alarm goes off, you hold your breath while you roll over and smack the snooze button. Doze off. 6x. Voilà 6 centrals. All jumpstarted with a “mask off” which may be you deciding momentarily that you’re awake or almost.
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#16
RE: ASV op BIPAP- which one?
(01-11-2018, 12:23 AM)HalfAsleep Wrote: Those centrals in the last few minutes of your sleep may be what I call “snooze alarm centrals”.  See how you have a “mask off” right before that cluster? The alarm goes off, you hold your breath while you roll over and smack the snooze button. Doze off. 6x. Voilà 6 centrals. All jumpstarted with a “mask off” which may be you deciding momentarily that you’re awake or almost.

I'm interested in those end of night centrals. My chart is very similar to the OP in that many nights I have 10-15 centrals in the last 30 minutes of the night. Earlier in the night, I might only have 3 or 4 all night. I do not use an alarm clock and just awaken.

Is it the general case, that CA's occur in the waking up process and are not real or serious? Do you think I can exclude that last 30 minutes from my SH DATA?
Began APAP 11/28/17
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#17
RE: ASV op BIPAP- which one?
(01-11-2018, 02:24 PM)Allessio77 Wrote:
(01-11-2018, 12:23 AM)HalfAsleep Wrote: Those centrals in the last few minutes of your sleep may be what I call “snooze alarm centrals”.  See how you have a “mask off” right before that cluster? The alarm goes off, you hold your breath while you roll over and smack the snooze button. Doze off. 6x. Voilà 6 centrals. All jumpstarted with a “mask off” which may be you deciding momentarily that you’re awake or almost.

I'm interested in those end of night centrals. My chart is very similar to the OP in that many nights I have 10-15 centrals in the last 30 minutes of the night. Earlier in the night, I might only have 3 or 4 all night. I do not use an alarm clock and just awaken.

Is it the general case, that CA's occur in the waking up process and are not real or serious? Do you think I can exclude that last 30 minutes from my SH DATA?


Possibly relevant quote from page 3 of this article:

Quote:That is, the combination of a predisposition to sleep transition apnea and a low arousal threshold may be sufficient to facilitate a repetitive CSA cycle as the individual oscillates between wake-fulness and sleep.


I don't know if that means that they are not real or serious, but it seems like a possible explanation for what you are describing.
-Amin
Nothing I say on the forum should be taken as medical advice.
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#18
RE: ASV op BIPAP- which one?
I think what it means is that they aren't going to spend big money on a machine to fix 15 minutes of sleep wake junk. A member here had an issue with the SWJ with some minor desaturation under 88% The lab and doctor dismissed it.
new http://www.apneaboard.com/wiki/index.php...re_success
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
From machine or charts for auto-cpap, set the min 1cm below median pressure, or 2cm below 90/95%. max at 20cm for now. Forum will help you fine tune settings
Post Reply Post Reply
#19
RE: ASV op BIPAP- which one?
(01-11-2018, 03:06 PM)ajack Wrote: I think what it means is that they aren't going to spend big money on a machine to fix 15 minutes of sleep wake junk. A member here had an issue with the SWJ with some minor desaturation under 88% The lab and doctor dismissed it.

So I should conclude that this type of phenomena is inconsequential to your health? Is the doctor right? Do you experience these end of night 'junk' centrals jack?
Began APAP 11/28/17
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#20
RE: ASV op BIPAP- which one?
(01-11-2018, 03:57 PM)Allessio77 Wrote:
(01-11-2018, 03:06 PM)ajack Wrote: I think what it means is that they aren't going to spend big money on a machine to fix 15 minutes of sleep wake junk. A member here had an issue with the SWJ with some minor desaturation under 88% The lab and doctor dismissed it.

So I should conclude that this type of phenomena is inconsequential to your health? Is the doctor right? Do you experience these end of night 'junk' centrals jack?


If I had a string of centrals shortly prior to waking up each morning, I'd be interested to know how much oxygen desaturation was occurring with them.
-Amin
Nothing I say on the forum should be taken as medical advice.
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