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[CPAP] New CPAP user failing to get through the night, in need of guidance
#11
RE: New CPAP user failing to get through the night, in need of guidance
BeMurda, the single pressure scheme lets us isolate real central apnea from any obstructive problems. Your results with single pressure and no EPR clearly show the problem is 100% central, and you will need ASV. At this point we can safely conclude that this will not resolve with time or alternate settings and you need to get back to your doctor to discuss ongoing central events and the need for an ASV titration. Results on CPAP are marginally better than your diagnostic AHI, and you might want to look into getting a recording pulse oximeter to evaluate if the oxygen desaturation problem is improved or remains. I really think you should call the doctor's office today so you can move this forward after the holidays, or consider obtaining ASV out-of-pocket.

If you choose to buy out of pocket there are 3 used Resmed S9 VPAP Adapt BIPAP #36007 between $400 and $550 and one Resmed Aircurve 10 ASV at $1100 depending on use-hours on a site called DotMed. If interested I can help you find these. That will allow you to get nearly immediate effective therapy and will demonstrate the efficacy of ASV to your doctor which will save months of office visits, titration tests and other nonsense. I know it seems expensive, but these machines go for $2600 to $3000 new on a good day. This would be a shortcut to getting coverage, and might not be more expensive in the long-run, depending on your copay and deductible situation. To be honest, I don't even know if your health system in Canada will provide this advanced treatment device at all. The alternative is likely supplemental oxygen to mitigate the effects of the apnea.
Sleeprider
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#12
RE: New CPAP user failing to get through the night, in need of guidance
(12-21-2021, 11:23 AM)Sleeprider Wrote: BeMurda, the single pressure scheme lets us isolate real central apnea from any obstructive problems.  Your results with single pressure and no EPR clearly show the problem is 100% central, and you will need ASV.  At this point we can safely conclude that this will not resolve with time or alternate settings and you need to get back to your doctor to discuss ongoing central events and the need for an ASV titration.  Results on CPAP are marginally better than your diagnostic AHI, and you might want to look into getting a recording pulse oximeter to evaluate if the oxygen desaturation problem is improved or remains.  I really think you should call the doctor's office today so you can move this forward after the holidays, or consider obtaining ASV out-of-pocket.

If you choose to buy out of pocket there are 3 used Resmed S9 VPAP Adapt BIPAP #36007  between $400 and $550 and one Resmed Aircurve 10 ASV at $1100 depending on use-hours on a site called DotMed.  If interested I can help you find these.  That will allow you to get nearly immediate effective therapy and will demonstrate the efficacy of ASV to your doctor which will save months of office visits, titration tests and other nonsense.  I know it seems expensive, but these machines go for $2600 to $3000 new on a good day. This would be a shortcut to getting coverage, and might not be more expensive in the long-run, depending on your copay and deductible situation.  To be honest, I don't even know if your health system in Canada will provide this advanced treatment device at all.  The alternative is likely supplemental oxygen to mitigate the effects of the apnea.

Thanks SleepRider, I may be in the return window of my Vauto so I will see what the Amazon seller will do. I have already been reimbursed the cost of the unit so I might be able to net out close if I can return it. I am almost maxed out on my benefits coverage for a five year period for a CPAP anyway.

Is there a significant difference between these ones that you recommend aside from cost and use hours?

To be clear, is this that Central Apnea is only happening because of treatment taking away obstructive apnea, or is it that what was shown on the sleep tests as obstructive apnea was actually central apnea? Could I look at other options like stopping back sleep or a dental device?
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#13
RE: New CPAP user failing to get through the night, in need of guidance
First, what are the differences between the S9 Adapt and the S10 Aircurve ASV. The S9 has all of the therapy options of the current ASV with auto-adjusting EPAP. These machines are older and have more hours. The S9 humidifier is a separate unit, and while these sales include those, they are bigger in size than the S10. The Aircurve 10 ASV looks just like the machine you have now. The one I saw has 7700 hours on it which is in line with the price. My current Vauto has nearly 19,000 hours, so there is plenty of years left. I think the Aircurve 10 ASV is the best deal if you can swing the extra cost, but both are compatible with Oscar and will provide effective therapy with near-zero CAI and AHI.

Surgical solutions are a complete crap-shoot and are more expensive than you think and I don't know if your health system covers it. Efficacy is in the range of 40 to 80 percent so there is residual apnea with hypoglossal nerve stimulation for obstructive apnea. Given the concern for oxygen desaturation in your case, I don't think that is the preferred direction.

The seller of this Aircurve i10 ASV is in Arizona and can be reached on DotMed. Please be sure to use a secure payment method like PayPal if you decide to do this.

[Image: 3749277.jpg]
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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#14
RE: New CPAP user failing to get through the night, in need of guidance
2 thoughts for 2 cents

1. I'm fairly certain dental devices or surgeries will not correct Central Apnea. Obstructive Apnea maybe at not more than 50% possibility, but CA is your issue so in my opinion not at all a good choice. Typically, CA is based off the imbalanced CO2 level. I'm not at all sure that's surgically correctable.

2. if you must buy the ASV out of pocket, using that therapy and showing how great therapy is, this builds a successful treatment history and gives proof for your medical to approve it in future. Keep your charts when you get it, and make a therapy diary.
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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#15
RE: New CPAP user failing to get through the night, in need of guidance
Thanks Dave and SleepRider. I've decided not to rush this as the Amazon seller is saying 50% restocking fee for my VAuto, haha. I guess I'll have to sell privately if that is necessary. I've ordered a Wellue O2Ring to check my oxygen desaturation with and without CPAP to see the difference. I might get an ASV eventually but for now I will try to confirm my sleep test desaturation to make sure that was accurate first - and compare what my O2 levels are like with CPAP. If you have any guidance on this sort of investigation I'd be happy to hear it. Thanks.
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#16
RE: New CPAP user failing to get through the night, in need of guidance
You will get back most, if not all of what you have in the Vauto. It will not treat centrals. I just thought if you were ready, the DotMed option would fill your needs. I know the Canadian Provincial Health system will not likely come through anytime soon. I have no problem with your more cautious approach and will be glad to help when you're ready.
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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#17
RE: New CPAP user failing to get through the night, in need of guidance
Hi there, I've been monitoring my oxygen levels with the Well O2 Ring for a while, please see the attached screenshot showing my ranges (I am scoring 9.9 out of 10 basically every night on the app, most nights my oxygen does not drop below 93% or 91%. Only once did it drop below 90% to 99% for a brief moment, and that was the same night I felt the oximeter was a bit out of place when I awoke.

I haven't been able to replicate the low saturation from my sleep tests, and believe there may have been a false reading since the finger style was shifting through the night a bit (Philips home sleep test gear) (02Ring goes securely over the thumb).

I'm wondering given my baseline energy levels don't seem bad and given the central apneas when on CPAP whether I should even bother with CPAP or only return to it if my sleep quality degrades with age as it did for my sibling.

Thanks for your input.

   
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#18
RE: New CPAP user failing to get through the night, in need of guidance
I was first diagnosed with central sleep apnea 10 years or so ago. At the time, they said I didn't need treatment.
Things are much worse for me now, than if it had been treated back then.

It doesn't mean that yours will necessarily get as bad as mine but leaving it untreated is not usually a good option, even if your oxygen levels are okay now. You will be retaining too much CO2 and eventually, that will worsen your centrals, your oxygen level and potentially cause other issues.
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#19
RE: New CPAP user failing to get through the night, in need of guidance
(01-11-2022, 10:50 AM)Ratchick Wrote: I was first diagnosed with central sleep apnea 10 years or so ago. At the time, they said I didn't need treatment.
Things are much worse for me now, than if it had been treated back then.

It doesn't mean that yours will necessarily get as bad as mine but leaving it untreated is not usually a good option, even if your oxygen levels are okay now. You will be retaining too much CO2 and eventually, that will worsen your centrals, your oxygen level and potentially cause other issues.

Thanks for the input. However I did not have any central apnea on either of my sleep tests. Only using cpap did I have any central apnea. So I’m not sure it’s a real issue in untreated sleep.
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#20
RE: New CPAP user failing to get through the night, in need of guidance
My bad. If your centrals really were only treatment-emergent, then obviously that's not going to be the same issue. But that said, any untreated apnea is still going to increase your risk for other health issues. Without knowing how many apneas you're having, it's impossible to say how likely that is, especially if you're starting to get symptomatic again. Same deal applies. If you're not breathing properly at night, you're likely to retain carbon dioxide, feel cruddy and over time, that can cause other issues.
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