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Apnaes: difference between Central / Obstructive ?
RE: Apnaes: difference between Central / Obstructive ?
How to get the ASV, addressed to the doctor. This is to be you addressing your doctor is what I mean.

Doctor I've got lots of Central Apnea that are not being treated with this current PAP machine. My health is in serious danger with poor treatment as I've been given so far. My well rested sleep state has not been found in this current PAP machine. I'm very tired, I'm feeling worse for the usage. Do you see my Central Apnea as needing to be treated or ignored? Are you ordering me the ResMed ASV, as that's the correct machine? And when? Now is a great answer, the right answer. If it's not until later then you're fired. How much longer before I'm in possession of the needed ASV treatment? When can I expect you to recognize my Central Apnea severity and that the Central Apnea needs to be treated? Are you going to treat my Central Apnea, yes or no? If yes, order me an ASV now. If no, you're fired.

That's my answer.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Apnaes: difference between Central / Obstructive ?
You might consider a two-part communication:

1. You are aware that ASV is recommended for patients with central or complex apnea, which you have. You don't really need to provide a citation, but here's one from the American Association of Sleep Technologists: https://www.aastweb.org/blog/what-is-asv, and here's one from the American Sleep Association: https://www.sleepassociation.org/sleep-a...ntilation/

2. You request either an ASV machine, which you believe is urgently needed given your AHI in the 40s, or a urgent appointment for an overnight titration that includes ASV.
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RE: Apnaes: difference between Central / Obstructive ?
OK , good ideas!
I will sleep on them... Thanks Thanks Thanks Thanks Thanks Thanks
Don't forget the obvious.[Image: bigwink.gif]
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RE: Apnaes: difference between Central / Obstructive ?
Include a shot of that flow pattern you posted in your letter. He will know what that means. Your summary statistics of AHI, CAI, OAI by date if you can do it. Oscar has that in the overview statistics, but your Weinstein machine is not as easy. If you are doing this by letter, include some images of your charts including that one you recently posted from Feb 8. Here is a thought on what to say:

I am exhausted every day in spite of using my CPAP equipment as directed every night. I can only conclude this is because my therapy results are consistently over 15 events per hour, mostly central apnea on both the Lowenstein and Resmed CPAPs. On February 7 my AHI was 44.3 with CAI of 32 and OAI of 8 and HAI of 4.6., which points to a severe problem, even with the current recommended therapy. It is clear that after this period of time and the use of both auto and fixed pressure CPAP, with and without exhale pressure relief, that this therapy strategy is ineffective and the current therapy is not and will not achieve acceptable results. Based on the fact central events are predominate in my CPAP therapy, and were present in my diagnostic test, ASV therapy is the best option. This letter is to inquire what is the procedure to for approval of ASV therapy? When can a clinical titration test to evaluate efficacy for ASV be scheduled? My health is suffering from this consistently ineffective CPAP therapy. Please help me to expedite approval of effective ASV therapy. Finally, my diagnostic test showed I have low oxygen saturation. Do you think it would be a good idea to use a recording oximeter to measure the impact of this poor therapy?

If you have the financial resources, I strongly recommend you buy the Resmed Aircurve 10 ASV (lightly used) form Supplier #2 for $1549, or ask SarcasticDave if he has one. I think you are really suffering unnecessarily and may be damaging your health.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Apnaes: difference between Central / Obstructive ?
YesSR!
You are supplying me with the ammunition I need!
I will suffer one more night with their last suggestion of 9 h2o constant. If the results are not in the area of less than three incidents par hour I will get the digital ink rolling tmr morning!
Is that a reasonable last chance ?
Don't forget the obvious.[Image: bigwink.gif]
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RE: Apnaes: difference between Central / Obstructive ?
I'm certain it will be an improvement over 44 per hour, but I am not betting on under 3.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Apnaes: difference between Central / Obstructive ?
If I were asked to bet, then I'm going to say you can't get AHI down to 10 with comfort and well rested status. Not with this setup.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Apnaes: difference between Central / Obstructive ?
I am not betting either.
Just giving them a last chance. The technician claimed I can set EPR to any value that suits me .. So I will put it on 2.
To me it seems that the EPR favors the open airway in my case, but I will go for conform at pressure 9 tonight. It will serve my cause.
Don't forget the obvious.[Image: bigwink.gif]
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RE: Apnaes: difference between Central / Obstructive ?
You have central apnea which is increased by your use of CPAP which is intended to treat obstructive sleep apnea, not central. When you use CPAP your ventilation is improved and this lowers your respiratory CO2 below your "apneic threshold" resulting in hypocapea. CO2 affects your respiratory drive through a complex chemical feedback, so more CO2 usually results in a stronger need to breathe. If you inhale more CO2 or rebreathe your own expired air in a confined space, you will start to hyperventilate. Similarly, if you hyperventilate, your CO2 will drop, and you will perhaps feel dizzy, but you might not feel the need to breathe for a while...try it. Most people are not affected by the extra ventilation of CPAP and "spontaneously" maintain a normal respiration rate and volume. You don't, in fact you have some central apnea even without CPAP. Instead, you mostly spontaneously take a breath 12 to 14 times per minute, or every 4.2 seconds, but sometimes you pause more than 10 seconds, and that is why you have apnea. Your cause of apnea is not obstructive, it is just a lack of a signal to breathe, so you don't. CPAP can't fix that, but it has mostly eliminated your obstructive events, so your current AHI, while not acceptable is lower than your diagnostic test.

With ASV, the respiration volume and rate are maintained by a combination of spontaneous effort and the machine's use of pressure support to supplement missing or low-volume breaths. When pressure support replaces spontaneous effort, that really means your lungs are being inflated by the positive air pressure from your ASV., and when you spontaneously breathe, it is your own muscular effort, expansion of your chest and diaphragm, that accomplishes the work of respiration. Until you are treated with a positive air pressure device that increases pressure support when you fail to spontaneously take a breath, this will be your problem. All the best intentions, and the best CPAP in the world can't solve that problem. You need ASV.

Once you have done something to address this need, self-advocacy, or buy your own, I will gladly help you optimize therapy. Until that happens, all I can do is to continue to repeat that you need ASV. So I will follow your thread, not much can be done until you do something about this.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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RE: Apnaes: difference between Central / Obstructive ?
This has been a great thread. So much good stuff here. I have been plagued with persistent Centrals since starting CPAP/BiPAP. I think I need to get an ASV as well. My AHI is always 4-7 with about 50% of that being CA, 20% OA and 30% H.

I keep my BiPAP at a pretty wide range for sleeping comfort, which I've learned may be part of my problem. Currently: "Min EPAP 5.0 Max IPAP 9.5 PS 2.5-4.0 (cmH2O)". It's always a battle between comfort and effectiveness, as I'm a rather light sleeper.

This is such an educational thread for those interested in Central Apneas. Many thanks to the contributors.
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