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[CPAP] Beyond ASV with Overlap Syndrome!
#71
RE: Beyond ASV with Overlap Syndrome!
Here's an update without resolution as yet:

I had a new PSG a few weeks ago, have had initial pulmonary follow-up but the PSG data wasn't updated into my patient chart. The doc and nurse couldn't discuss that data as it wasn't available to them or myself. Doc suggested to get the DME to make sure the ASV is functioning properly. I did that with the local Apria RT earlier today. She sees an ASV that does in fact make me breathe in an inverse I:E ratio. She said the ASV is mechanically sound, which I already knew that was the case. Her opinion is that she would suggest the Respironics Trilogy; that's the next machine Apria can offer apparently.

When the PSG is available, it will be posted in detailed and redacted form.

Doc is of the opinion it was a mechanical or psychological problem. Not buying into that.

If I switch to Lincare, they have ResMed ST-A or Astral as my only alternatives beyond ASV.

I think switching DMEs isn't a fight I want to take on. I might need to get the Trilogy assuming the RT can convince the Doc to script it and insurance to pay for it. As is, I cannot use the ASV. I've attempted to maintain use, but it's far too disruptive to sleeping or hoping for some semblance of rest. It sounds bad, but it is where I am better without ASV, so you can hopefully understand just how very bad it has become.

Bottom line is either doc and insurance gets me a new and currently correct tool or I approach my PCP and see if he'll script me the ST-A and I'll buy one online. Better for my limited budget for insurance to pay for it, but I must replace the ASV.
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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#72
RE: Beyond ASV with Overlap Syndrome!
Can you post an example of this inverse I:E ratio? I tried looking through some of your older posts but wasnt seeing it.
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#73
RE: Beyond ASV with Overlap Syndrome!
If I were to show any OSCAR data, as has been discussed and known to be less than accurate, it wouldn't likely show much I can point to. The inverse I:E ratio mentioned was what the Apria RT was seeing live, although in an awake state, at the Apria office. Relying on her professional RT opinion may be somewhat questionable to the life experience Apnea Board members demonstrate here. So there is that caveat. However, the RT is in position to have her opinion be accepted by the doctor and insurance. In that scope, I'll accept her opinion.

The evidence I could show is from earlier in this thread where OSCAR left bar data shows Inspiration and Exhalation numbers of Inspiration being a bit longer than Expiration. The RT knew how to interpret my explanation of complications and came up with the conclusion of inverse I:E and possible stacking being involved. Either or both of these cannot be addressed with setting edits on my ResMed AirCurve 10 ASV because that involves timing settings like Trigger and Cycle. This ASV lacks those controls. The RT mentioned she likes to see I:E of 1:2 or better.
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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#74
RE: Beyond ASV with Overlap Syndrome!
Dave, you probably know the Trilogy is a life-support ventilator used for both non-invasive ventilation and trach patients that require full-time ventilation. It costs about 3 to 4 times the price of ST-A and is a ridiculous choice.

I was unaware of the inverse I:E ratio, but the ST-A can preserve expiration time in ways the ASV cannot. It has Ti controls, iBR and trigger cycle sensitivity that were for some reason left off the ASV. It is specifically capable of preventing the common problem with ASV where hyperinflation of the lungs (stacking) prevents appropriate volume exchange. With COPD, you need to protect expiration as much as you need ventilation support, so the ST-A is starting to make more sense.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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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#75
RE: Beyond ASV with Overlap Syndrome!
Sleeprider,

Yep, I think the Trilogy is called an NIV. It does have AVAPS mode, the reason Apria RT wants me on it.

I think you and I are on the same page that the ST-A (and preferably ResMed as the manufacturer) would be the best machine for me now. My only problem is trying to get insurance to switch machines; so it is best for the money aspect to get insurance to pay for it. However, if insurance refuses, I'll will have to make the ST-A purchase from for example Supplier #33 after I get a proper script to go with it.

BTW my Medicare A and B start this May. Any insight on how that may change my machine purchase situation?
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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#76
RE: Beyond ASV with Overlap Syndrome!
Inspiration and exhalation times are often misreported in OSCAR and I would not use them to come to any conclusion. These times can be easily calculated by looking at your OSCAR data and that is what you should be looking at if you think this might be a problem. You also can't make any reasonable conclusions off of wake breathing so that test with the RT was useless and I would ignore any recommendations based on that test... 

When inverse I:E ratio was brought up earlier in the thread Sleeprider got you to post some examples of breathing and after you did so he confirmed that the numbers in OSCAR are WRONG and that your breathing does NOT have an inverse I:E ratio. Here is one of your examples posted and you can clearly see I:E is ~ 1:2 just as it should be.

   
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#77
RE: Beyond ASV with Overlap Syndrome!
Been following your journey to replace your ASV Dave.
Eat-popcorn

It's so valuable to have the knowledge you have acquired on AB to guide you in the direction of the best machine for your evolving needs.
SHa_clap2 Grouphug3 

I wish you all the best in your next machine and insurance assistance to get whatever you need.  
Banana Thumbs-up-2
RayBee

  
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#78
RE: Beyond ASV with Overlap Syndrome!
Here is an example of a single breath and how both the OSCAR inspiration and expiration times are WRONG. In each case I highlighted the section of time that OSCAR is claiming to be either the inspiration or expiraton time and you can clearly see it does not match the breath waveform and it also leaves a portion of the breath unaccounted for. I don't know if OSCAR calculates these times or if they are reported by the machine but they are wrong because they screwed up by cardiogenic oscillations (and any other thing that causes flow rate to change direction when it shouldn't).


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#79
RE: Beyond ASV with Overlap Syndrome!
Thanks RayBee.

And thanks as well Geer1. I knew OSCAR data on I:E was off a bit. I only really mentioned it today because that RT is building a new machine case including the I:E ratio she viewed while I was there in mask on status. She also mentioned my ASV lacks timing controls to fix the problem; I knew this already. She'll be useful only if she can get insurance to replace the ASV. The catch is she'll hand me a Trilogy ventilator, AKA overkill.
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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#80
RE: Beyond ASV with Overlap Syndrome!
Timing controls to fix what problem? I:E is not a problem so you don't need timing controls to try to fix it.

I'll dig through more of your thread/data to try an understand what the issue is.
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