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ASV op BIPAP- which one?
#31
Thanks, the CMS50F it will be as its on sale .
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#32
Hi
Finally got my new sleep study report.
Based on the report below, what type of machine would you recommend me to be tritated with?

[Image: 3KK8MHVl.jpg]

[Image: C7gvmwol.jpg]

[Image: RdvJXepl.jpg]

Thanks again for everyone's willingness to help
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#33
You will probably be titrated on CPAP, however you should discuss with the doctor including ASV (adaptive servo ventilator) titration if CPAP fails to resolve the central and mixed apnea. There are health criteria for ASV including greater than 45% left ventricular ejection fraction. That will probably not be a problem for you unless you have congestive heart failure. Your AHI is extremely high and has pretty severe desaturation consequences. Many people respond positively to CPAP, while others experience a conversion of all apnea to central and hypopnea with CPAP pressure. CPAP is not intended for treatment of central apnea and is strictly a stent to keep your airway open from obstruction. The ASV provides on-demand pressure support to resolve central apnea, and maintains a steady pressure for the obstructive component. Due to the cost of ASV, most patients must complete and fail a trial of CPAP.

Since you have already used a Resmed S9 CPAP, you would have to discuss your experience in using that machine with your doctor. It's not going to get better with another CPAP. Your results have not been bad based on the machine data, and you do get borderline efficacy, with some residual centrals, particularly near the end of the night. I suspect that under the normal parameters of CPAP titration, you will pass the CPAP titration test. If you want ASV, the best path is to request bilevel (BiPAP) titration which will likely cause you to have many more central apnea without the backup rate. The test could then proceed to ASV titration. Talk to your doctor about bilevel and ASV, and make a case that your use of CPAP has been unsatisfactory. If you get the bilevel titration, that would likely lead to ASV.

By the "numbers" you have a very marginal need for ASV. We have had other members that also had similar results with CPAP that later went on to get ASV and said it was "life-changing". SpyCar i think is one of them. You will need to focus on the fact you have used CPAP and bilevel at 3 cm using EPR and failed to find satisfactory treatment that resolves your fatigue and other symptoms. There is a path to a different treatment method, but you will have to work hard with a doctor that advocates on your behalf to get there.
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#34
(03-08-2018, 08:12 AM)Sleeprider Wrote: We have had other members that also had similar results with CPAP that later went on to get ASV and said it was "life-changing". SpyCar i think is one of them.  You will need to focus on the fact you have used CPAP and bilevel at 3 cm using EPR and failed to find satisfactory treatment that resolves your fatigue and other symptoms. There is a path to a different treatment method, but you will have to work hard with a doctor that advocates on your behalf to get there.

Correct in my case. 

I was never an extreme example in terms of the numbers, and initially was consistently under 5 with APAP (but not feeling that great and not sleeping well). Then the numbers worsened to the point where I was often (but not always) over 5 (and was feeling even worse).

I had 5 nights on Bi-level, which resulted in the worst numbers I ever had (between 16 and 8 AHI) and I felt destroyed that week. It was worse than not using a machine at all. Anti-therapeutic. 

Since starting ASV in October, I've started "sleeping" again. Meaning awaking in the morning having experienced the sort of refreshing sleep that I'd been deprived of for a very long time. And I was suffering (badly) from that sleep deprivation. I wasn't sure if I'd ever have a normal night's sleep again. I felt like a zombie.

"Life changing" would certainly be accurate in my case.

I'm not a guru and not prepared to make a call. I can say that my charts looked rather like that above, and I'm beyond grateful that I found my way to an ASV device as it really has changed my life for the better.

Bill
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#35
Depending upon insurance requirements, the ASV path likely has the required stage hoops to jump through, where you fail CPAP which it looks like you probably will IMO, then a BPAP failure. That is unless your current sleep study proves enough to skip BPAP for central or mixed apnea treatment.

Best to your successes. Make sure to point out CPAP therapy is not making you feel better. Squeaky wheels get the grease.

Coffee
Dave

Even a 1,000 mile trip requires a first step. My recommended first steps are getting good shoes and 2 cups o coffee

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#36
thanks for your replies.
I since found out I also have very low testosterone levels that according to my doctor can also have an influence.
Starting testoterone therapy and hoping it will improve things.

As to the machine type my doctor fairly admits he isn't a sleep specialiast and there isn't one in town.
He is willing to send me for bipap tritration to see how it goes.
And no , there isn't an asv machine available for tritration with anyone in town.
I will have to travel 600km to have a hope for asv tritration.

The main problem is the limits on my medical is not very high for external appliances and here in south africa if they can put medical puprouse in front of something it gets rediciously expensive.

The diffrence between an bipap and asv here is about an 700 us dollar payin for a bipap and about a 4200 us dollar pay in for an asv.
i think you can undestand why I am almost paranoid about what machine to get as there is no try before you buy here.
If you used it ,it is yours for life, helping or not.

I will see if I can find a sleep lab that is willing to help me out long distance.
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