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Bi-Level, S, ST, ASV??
#11
RE: Bi-Level, S, ST, ASV??
My understanding regarding COPD and LVEF is that you get a BiLevel machine to not only control your breathing while asleep but also to provide relief while you are awake. I'm happy to be corrected if you think this is wrong.
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#12
RE: Bi-Level, S, ST, ASV??
(10-18-2019, 03:29 AM)holden4th Wrote: My understanding regarding COPD and LVEF is that you get a BiLevel machine to not only control your breathing while asleep but also to provide relief while you are awake. I'm happy to be corrected if you think this is wrong.

I think in this case we're talking about CHF and LVEF rather than COPD.  Both conditions could co-exist.  While noninvasive ventilators could be used full-time, I think that use is rare, and might be more suited to iVAPS/AVAPS, or more likely one of the hospital level ventilators we don't often see on the forum.
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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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#13
RE: Bi-Level, S, ST, ASV??
I really appreciate all of the feedback.

My family member had an updated sleep study... during first one, they did split. First half confirmed predominant OSA. Second half tried various pressure levels and they said it gave no relief... so they did a second full night study. I wish I had a copy of the report BEFORE the second study, since it basically showed AHI of 67 on back and 13 on sides... (untreated), but during first split study, they did all pressure tests on back. I think the sleep study places want to try to go for the highest numbers to justify treatment... but I would have preferred reality. During second study, they were able to use lower pressure with side sleeping to treat it very well and get AHI <5.

So, this is pretty extreme situation... when on side, apnea is fully treated at low pressure... when on back, pressure up to 15 and still AHI in 60's... many OSA convert to CSA because of higher pressure. So, they will need to learn to sleep on their side to be treated properly. I know most peoples are worse on back than side... but this seems extreme where no treatment works on back... and critical to not sleep on back. I am guessing the heart failure is contributing to the higher pressures failing to treat the apneas creating CSAs, and why no treatment works while on back.

Is there any information out there about raising the head of the bed (with adjustable base), and if past a certain angle helps eliminate what the back position creates with the extra apneas, and may be as good as sleeping on side? If not, it is just figuring out ways to keep them off their back.

Also, their cardiologist had recommended that O2 supplementation may be helpful even if CPAP treated O2 levels to not get dangerously low... just to ensure they stay high enough and the extra O2 could help with the heart failure. Anyone on here on O2 supplement with heart failure (low EF) and did it help?

Thank you!
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#14
RE: Bi-Level, S, ST, ASV??
jtech1, positional apnea is not always what it seems, and people may have it for various reasons. While sleeping supine is usually associated with higher rates of obstructive apnea clusters, it may not be because the "tongue relaxes into the throat". On Apnea Board we have observed hundreds of cases that can be resolved by simply wearing a soft cervical collar to prevent the chin from tucking to the chest. Here are a couple wiki articles:
http://www.apneaboard.com/wiki/index.php...onal_Apnea
http://www.apneaboard.com/wiki/index.php...cal_Collar

Your friend can try a simple experiment by relaxing in a chair and letting the chin drop, or just press very lightly upward on the tissues at the back of the jaw or front of the throat. If the airway occludes, then chin-tuck is a very likely cause. It is very inexpensive and simple to fix this, and the solution has worked for many members here. Beware of using pillows that are too tall and bend the neck forward. I suspect that your family member may be using multiple or tall pillows, and that is almost a sure cause of positional apnea.
Sleeprider
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____________________________________________
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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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#15
RE: Bi-Level, S, ST, ASV??
(10-22-2019, 07:47 AM)jtech1 Wrote: Also, their cardiologist had recommended that O2 supplementation may be helpful even if CPAP treated O2 levels to not get dangerously low... just to ensure they stay high enough and the extra O2 could help with the heart failure.  Anyone on here on O2 supplement with heart failure (low EF) and did it help?

Good call Doc.  

I have family with CHF.  I highly support this recommendation.   

xPAP is hard enough to adjust to when we are young and healthy.  The extra O2 effectively means they will enter adverse apnea event with a higher starting SpO2 and therefore the treatment will not need to be as patient aggressive to prevent desaturations.  

Also, if they happen to recommend an ASV, I think the supplemental O2 is even that much more advisable.  The ResMed Aircurve 10 ASV specifically is great for CSA but of all the advanced xPAP may have the least algo+settings ability to ensure desaturations do not take place. 

Regardless of machine, I think supplemental O2 and a for me personally 2-3 Pulse-Ox devices that alarm on low SpO2 and that you can gather data from via bluetooth ( 50F?   The new Wellue products that are easier to wear?).    

Why Pulse-Ox quantity of 2-3?  Having played this game if you have too few it is a challenge to always have enough charge in the Pulse-Ox to last through the night, through the day, etc.   

Why the all day and all night Pulse-Ox Alarm is a must?   The poor patient is just miserable and keeping that O2 and / or mask in place 100% 24x7 just might not always be a priority.

WillSleep

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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#16
RE: Bi-Level, S, ST, ASV??
Thanks!

I use the Dreamstation... but the sleep center he went to used ResMed... so that may be what they put him on... I believe the AirSense or AirCurve (whatever they put him on) does support O2... where does it connect in?  At the CPAP end of the hose or mask end?  Do these devices support integrated O2/pulsox sensor also?  And does it have an alarm on the cpap unit when there is low O2 (like the wrist and O2Ring devices do)?  I want to make sure that he gets everything he could possibly need for safest treatment... especially since insurance is paying for it.

I have an O2Ring and really like it... one thing I am questioning is in the O2Ring manual, it says to not use it with a defibrillator... I assume it means that a defibrillator shock could damage the ring... not that the ring would in any way interfere with an external or internal defibrillator... anyone know?
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#17
RE: Bi-Level, S, ST, ASV??
ResMed 10 series machines do have a connection for their oximetry module on the left side under a separate door near the filter. It's quite expensive whether we're talking about just the connection module or the kit (not really surprised). I think I saw that module for about $200 and the kit for about $950!
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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#18
RE: Bi-Level, S, ST, ASV??
(10-22-2019, 09:05 PM)SarcasticDave94 Wrote: ResMed 10 series machines do have a connection for their oximetry module on the left side under a separate door near the filter. It's quite expensive whether we're talking about just the connection module or the kit (not really surprised). I think I saw that module for about $200 and the kit for about $950!

Thanks Dave!

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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#19
RE: Bi-Level, S, ST, ASV??
(10-22-2019, 08:14 PM)jtech1 Wrote: Thanks!

I use the Dreamstation... but the sleep center he went to used ResMed... so that may be what they put him on... I believe the AirSense or AirCurve (whatever they put him on) does support O2... where does it connect in?  At the CPAP end of the hose or mask end?  Do these devices support integrated O2/pulsox sensor also?  And does it have an alarm on the cpap unit when there is low O2 (like the wrist and O2Ring devices do)?  I want to make sure that he gets everything he could possibly need for safest treatment... especially since insurance is paying for it.

I have an O2Ring and really like it... one thing I am questioning is in the O2Ring manual, it says to not use it with a defibrillator... I assume it means that a defibrillator shock could damage the ring... not that the ring would in any way interfere with an external or internal defibrillator... anyone know?


O2 for ResMed Aircurve machine..  ClimateLineAIR OXY ~$60-65   https://www.google.com/search?ei=drivXcn...ineAir+xoys

   




"I have an O2Ring and really like it.   

Yes, exactly.  I have an earlier wrist mounted version of the product, or um, three.   I love the product but wish for a better sync with OSCAR.   I would recommend the Wellue wrist version rather than the ring because it is less likely to be in the way, and hook on things and it also looked like it has one stronger feature, maybe more battery life.   

"I assume it means that a defibrillator shock could damage the ring... "  Just a guess .. I would expect that anything electronic not designed to take the hit (e.g. ECG, etc) would at risk of being destroyed ... and also might interfere so is probably normal to try and take it all off before they hit the juice.  

WillSurf

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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#20
RE: Bi-Level, S, ST, ASV??
OK. So... script says only BiPAP 16/7. So if I am understanding this correctly, I should be making sure he gets the ResMed AirCurve 10 S or VAuto unit... along with ClimaLineAir Oxy, Air10 oximeter adapter, and third party oximeter (ResMed does not make one, right?).

Just to confirm... the VAuto does everything the S model does and adds the auto feature, right? VAuto will do fixed 16/7 mode, right? But will have the additional flexibility for the Dr to use Auto mode later if they want to... am I correct in this? Anyone using the VAuto in fixed mode?

Thanks!
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