Back On The Machine

[trailrider]

Well that doesn't look like it was a restful night at all. I don't think the straight CPAP is helping you, and yet you have a fancy APAP!

Here is my suggestion, for what it is worth: turn the nice capable machine you have onto autoset. Set a range of say 7.5 to 14. Try EPR of 1 or 2, and no ramp. Reduce your humidty a bit to stop the rainout or use a heated hose.

Go have a nap later today, and make sure you are comfortable with the settings (can easily breath, nothing too annoying, no rainout, etc.). Sleep tonight and tomorrow night, same settings, and add your O2. Let's look at your data on Thursday. Make sure we can see the pressure.

When it is on autoset, my machine will recognize a central (or open/unobstructed airway apnea) and will push a 0.2s pulse of air. Depending on the algorithm and what it detects, the machine may increase the pressure, or not. The Clinician's manual has a description of how the Resmed machine recognizes and deals with various conditions.

After starting apnea treatment I had a large number of CAs for about 6 weeks. Then they taper off. The theory is that your body is getting used to a new level of O2 in the body and since the CO2 is the signal to breathe, your body figures it doesn't need to. It takes a while for your brain to adjust to the new (normal) O2 and CO2 percentages it sees.

Others here may ahve a different opinion, and obviously I don't know your slep study history, but that is what I would do if I had that graph.

[storywizard]

Thanks for the reply..

Unfortunately I can't adjust the machine at present, it is a trial machine that I have on loan for two months. My stats were way worse on varied pressure, I started at 6-16 then dropped to 10 straight, which was better. Last year I spent 3 months on CPAP, same results as now, no drop in CAs though...

Will raise temp in my hose and humidity...and have a nap..

Storywizard

[Sleeprider]

Storywizard, as said before, your answer is a ASV machine. I will keep an eye out on a deal for your if you're interested. They do come up, but I don't want to tell someone you're interested, if you're not. Send me a PM with your email address, and I'll try to refer reputable private sellers your direction.

[trailrider]

But Sleeprider, his original sleep study showed no Centrals. I'm scratching my head over that. That implies the ones he's seeing are therapy induced and therefore could reduce over time as he gets used to the therapy. Straight 8 obviously isn't working.

eseedhouse can better comment on what BC's health plan covers (varies by province). Storywizard's sleep doc and the DME should be offering better counseling and helping him getting things sorted out. They get paid real $$ to do that.

[Sleeprider]

Trailrider, complex apnea can occur as a result of CPAP therapy. A sleep study will show OA requiring CPAP with no apparent central events. Once the patient is exposed to positive pressure therapy, the central events are induced and an even worse complex apnea ensues. I have the advantage here in having seen the graphs of storywizard and knowing some of his history going back to pre-therapy. About 15 percent of apnea patients will develop central apnea upon exposure to pressure, and some, like Storywizard, have severe apnea even with CPAP, but now mainly CA events. His AHI varies, but as far as I know, goes over 22 treated with APAP, mainly central events.

The O.P. failed APAP therapy on a Respironics APAP 560, and is now attempting therapy using a Resmed Airsense 10 machine. That is like trading Miller for Budweiser and expecting a different outcome. The underlying problem has not been addressed because Canada refuses to fully diagnose patients like this by separate diagnostic and titration studies. Storywizard was diagnosed with OSA, but never had a titration study. He was hoping to finally schedule a titration which would have exposed the CA resulting from pressure. Since his health system will not do the study needed to expose his problem, he is on CPAP which creates its own problem. He needs ASV that will provide pressure for his OSA, and initiate breaths when he does not due to his CPAP induced central apnea.

Take a look at these videos for some background.
https://www.youtube.com/watch?v=0WpZka7wYow

https://youtu.be/0WpZka7wYow

[storywizard]

Found a DME who may let me use their overnight test gear, which includes chest band, while I am on CPAP...

Seeing primary care doc on Friday, will take data and info and really push this.

I had a nap today, with oximeter and CPAP, oxygen was 95% no OA's and 15 CA's, what ever they are...

My sleep is disturbed that is for sure

This was last night again...



this was my afternoon nap:
[img][/img]

Storywizard

[storywizard]

I am beginning to consider that I may have sleep issues not related to apneas, that show up as events on the software...but I am sleep depraved so will wait until I can get good testing. The more reading and data I get the more it seems that there is something going on while I sleep that is disturbing the breath...

Storywizard

[trailrider]

BC may be different. In Ontario I had to have a titration study done in order to prove that the therapy was working before OHIP would pay for a machine. So we have to have two full night studies: one for initial diagnosis, and then a follow-up 2nd one which was th titration, about two to three months apart. "The system" wants a patient used to the mask and machine and to work out all the kinks so that the titration study will be effective. No money for machine nor is the final Rx written until then.

I agree that the titration study should identify the CAs occurring and identify what the proper pressures and system should be. My surprise is that the BC system has not already done this for the OP. The provinces generally follow similar health guidelines.

[storywizard]

In BC the medical plan does not pay for CPAP machines. To get a sleep study your General Practitioner can request one at one 3 labs in the Vancouver area. To get an oximeter overnight Doc can request one of the many DME style businesses to give a test then if necessary loan the machine to the patient.

I have extended self pay medical, that will pay 80% of the machine.

To get the titration study I am having to go back on CPAP and suffer the time til the sleep study can be done, although I am trying to pull a few heart strings to get things moved up...lol, printouts of last years and this years CPAP data graphs...

Storywizard

[storywizard]

So I am three weeks in on this my second go round on CPAP.

As is noted I get what look like CA's from SH and ResMed software, no argument there at all with me.

I also get a few Hypopneas's, which I would like to try to eliminate with tweaking the pressure a little, however, as I am on a loner machine I am obliged not to play with the clinical settings..

So I am thinking of buying an Autoset ASAP, my insurance will pay 80%, so I can at least try to get the Hypopnea's down...there is nothing I can do to remedy the CA's, I have a titration study coming in 3 or 4 months, nothing I can do to speed that up, as I have written before the sleep docs I have seen just don't think I have CA's, or if they do, they are hoping they will go away in time.

The last time I was on CPAP I lasted 10 weeks, I am feeling that if I can get some control over the machine this time I can make it to the titration study...

So should I buy the machine??

Storywizard