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Appreciate help adjusting settings (UARS)
#41
RE: Appreciate help adjusting settings (UARS)
Thank you @slowriter. Have you found any good research on the efficacy of the Aircurve 10 vAUTO vs ASV for UARS?

I found this study last night: https://www.sciencedirect.com/science/ar...via%3Dihub
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#42
RE: Appreciate help adjusting settings (UARS)
If I understand his basic argument, it is that:
  1. UARS patients benefit from high(er) PS than the typical OSA patient, and bilevels provide much more flexibility of PS than CPAP
  2. but the PS required to eliminate RERAs and "normalize airflow" (round those curves, per earlier discussion) introduces in some patients CAs that are counterproductive; they simply can't tolerate bilevel either.
So, for example, I am now at a PS of 6 on a bilevel, but really don't appear to have any problem with CAs. I can't imagine I'd benefit from a (much more expensive) ASV machine then.

YMMV of course.
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#43
RE: Appreciate help adjusting settings (UARS)
Oh, and to answer your specific question, I think he's the primary person promoting that argument; I've not come across others.
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#44
RE: Appreciate help adjusting settings (UARS)
Ok that is super helpful, thank you. Do you know how many CAs are considered problematic?
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#45
RE: Appreciate help adjusting settings (UARS)
The official answer is 5 per hour by the medical community. Note that some people are more sensitive than others and documentation of there symptoms is how they achieve machine and or treatment changes.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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#46
RE: Appreciate help adjusting settings (UARS)
Hey team,

On the vAuto now. Here is my first night. Please let me know any additional charts that would be helpful. Could you please help me update settings?

Full view: https://drive.google.com/open?id=1tBVmBM...h_PNP_RpQ8
Full view advanced: https://drive.google.com/open?id=1TFL1WA...1IeLYZjaDp
Wakeup 1 - 1 hour (when likely was awake?): https://drive.google.com/open?id=1Yp6Hgj...m54itLoFL6
Wakeup 2 - 10 min: https://drive.google.com/open?id=1zHOpF3...Itfm1W6Qui
Wakeup 3 - 10 min: https://drive.google.com/open?id=1Yp6Hgj...m54itLoFL6

I asked my doctor about a titration to get them right, but she said the machine will titrate itself. I asked the DME, and she said I really need to seek the opinion of a pulmonary sleep specialist (my doctor is a neurology sleep specialist). I am seeing a pulmonary sleep specialist in a week. Should I push for the sleep lab again (insurance rejected last time) or anything else when I meet him?

Huge thanks!
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#47
RE: Appreciate help adjusting settings (UARS)
I'm sure this is a gross over generalization but in my very limited experience, pulmonary types tend to focus on obstructive apnea and for central & mixed apnea you're better off with a neurologist with credentials in sleep medicine.
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#48
RE: Appreciate help adjusting settings (UARS)
That's awesome!

To be clear, I pushed for the titration study because I thought it was the only way my doc was going to get me approved for insurance coverage with it.

Beyond that, the only value of it was confirming I was close to where I needed to be, and that I needed a higher PS than expected.

Your doc is partially right, except for the critical PS part, which is fixed. So you may need to experiment with that a bit.

In short, I wouldn't worry about it; just get feedback from your doc and people here.

PS - my sleep studies were way more expensive than the hardware. Should be easier to get insurance coverage on a bilevel than it often appears to be.
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#49
RE: Appreciate help adjusting settings (UARS)
(09-14-2019, 10:26 AM)cmcphee Wrote: Hey team,

On the vAuto now. Here is my first night. Please let me know any additional charts that would be helpful. Could you please help me update settings?

Full view: https://drive.google.com/open?id=1tBVmBM...h_PNP_RpQ8
Full view advanced: https://drive.google.com/open?id=1TFL1WA...1IeLYZjaDp
Wakeup 1 - 1 hour (when likely was awake?): https://drive.google.com/open?id=1Yp6Hgj...m54itLoFL6
Wakeup 2 - 10 min: https://drive.google.com/open?id=1zHOpF3...Itfm1W6Qui
Wakeup 3 - 10 min: https://drive.google.com/open?id=1Yp6Hgj...m54itLoFL6

I asked my doctor about a titration to get them right, but she said the machine will titrate itself. I asked the DME, and she said I really need to seek the opinion of a pulmonary sleep specialist (my doctor is a neurology sleep specialist). I am seeing a pulmonary sleep specialist in a week. Should I push for the sleep lab again (insurance rejected last time) or anything else when I meet him?

Huge thanks!
Your obstructive events are managed.  You have just under 4 (3.64) CAI (Central Apnea Index).  It is likely that you were awake for the period that you mentioned.  If you eliminate that period your centrals come down to a reasonable level.

The best choice of action is to monitor, wait and see.

If NOT:
To qualify for an ASV, (the most expensive of the CPAP machines so expect a bit (ok, more than a bit), of resistance, and by the book you will need a history of exceeding 5 CAI or a lot of complaining on your part.

The only Sleep Lab you could need, IMHO, is an ASV Titration study to prove that an ASV treated your apnea.
Doctor wise, at this point you want a doctor that specializes in Central/Mixed Sleep Apnea unless you have underlying breathing issues.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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#50
RE: Appreciate help adjusting settings (UARS)
(09-14-2019, 11:19 AM)bonjour Wrote: Your obstructive events are managed.  You have just under 4 (3.64) CAI (Central Apnea Index).  It is likely that you were awake for the period that you mentioned.  If you eliminate that period your centrals come down to a reasonable level.

I had persistent reported CA events exactly like that (clustered right around wake events), even before I switched to the vAuto. It got worse for maybe a week after I switched to the VAuto, but now is gone, so that AHI is usually under 1.

Not sure if just coincidence, but a dramatic improvement in those numbers corresponded for me with a mask change.

But could be adjusting to the new machine too.  Dont-know

In any case, I support @bonjour's suggestion to monitor at this point, and also don't overreact to those CA numbers.
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