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[CPAP] New to OSA/CPAP's lots of Questions!!
#21
The good news is the obstructive apnea problem is essentially gone. The bad news is there is a lot of clear airway and hypopnea events taking place. For what it's worth, I'd trade OA for CA as less stressful. It might be worthwhile to look at the event details in Sleepyhead and confirm that those events are of short duration. It is good to see more continuous hours of therapy taking place. At this point we need to wait and see of the number of events will drop on their own. I don't see machine pressure adjustments as being needed or beneficial. In a month if the number of events does not significantly drop, we might need to raise the ASV conversation, but for now, just focus on comfort and adapting to the machine. How is our victim feeling with the therapy? Are there any complaints or indications he is more rested (or not)?
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#22
(04-19-2017, 09:04 AM)Sleeprider Wrote: The good news is the obstructive apnea problem is essentially gone.  The bad news is there is a lot of clear airway and hypopnea events taking place.  For what it's worth, I'd trade OA for CA as less stressful.  It might be worthwhile to look at the event details in Sleepyhead and confirm that those events are of short duration.  It is good to see more continuous hours of therapy taking place.  At this point we need to wait and see of the number of events will drop on their own.  I don't see machine pressure adjustments as being needed or beneficial.  In a month if the number of events does not significantly drop, we might need to raise the ASV conversation, but for now, just focus on comfort and adapting to the machine.   How is our victim feeling with the therapy? Are there any complaints or indications he is more rested (or not)?

I looked over his data from last night, he had 46 "Clear Airway" events, the longest lasting 4:11:26.  He is still not adapting well to the therapy.  He says he woke up 6 times last night feeling like he was "suffocating"  He doesn't appear to be more rested and if anything seems sleepier.  We tried raising the max pressure a bit last night but that didn't seem to be helpful so I guess we will go back to 8-10 as that seemed more tolerable.  I think we might need to bump up the C Flex as well last night we tried 1 but he has a really hard time with expiration.... Here's a screen cap of his CA events last night:
[Image: vdiaGAk.png]

And I'll add the data from his longest night (over 4 hours):
[Image: m8FnBro.png]
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#23
I don't think most of the events being flagged as OA is obstructive. That 4/18 data does not look happy at all. This may sound counter-intuitive. but I'd like to see you try fixed pressure at 7.0 for a night. CPAP mode pressure 7. By selecting CPAP mode and setting the pressure, it will be very easy to go back to Auto mode where your existing settings will not be changed. I am hopeful a significant reduction in events will occur, and he will be more comfortable.
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#24
(04-19-2017, 06:37 PM)Sleeprider Wrote: I don't think most of the events being flagged as OA is obstructive. That 4/18 data does not look happy at all.  This may sound counter-intuitive. but I'd like to see you try fixed pressure at 7.0 for a night.  CPAP mode pressure 7.  By selecting CPAP mode and setting the pressure, it will be very easy to go back to Auto mode where your existing settings will not be changed. I am hopeful a significant reduction in events will occur, and he will be more comfortable.

We tried doing CPAP fixed with 7, and at first had C Flex 1, but he still couldn't handle it so I changed Flex to 2 and then finally to 3.  He said he slept terribly again last night and he couldn't stand that pressure and kept waking up "suffocating".  Then at work today he had a seizure.... I'm really at a loss here... I called the place we bought the CPAP from and explained the situation and he recommended a few sleep doctors we should look into and also that he would take back the APAP and put the cost we paid towards a BiPAP/ASV if needed.  We see primary doc on Monday and are going to ask for referral to sleep doc, I think at this point he needs to have the full sleep study done too...  Anyways here are his results from last night:
[Image: ZyWiCYa.png]
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#25
Thanks for trying. The lower pressure resulted in more obstructive events and fewer centrals, but not an overall improvement. This is pretty common with a complex apnea, and what we'd like to see is where things balance out and become most comfortable. Your choices are to try fixed pressure at 8 cm or go back to the previous settings. I agree that bilevel ASV is almost inevitable, and I'm a big advocate of that therapy in these cases where a reasonable efficacy can't be achieved with CPAP.
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#26
(04-20-2017, 06:51 PM)Sleeprider Wrote: Thanks for trying.  The lower pressure resulted in more obstructive events and fewer centrals, but not an overall improvement.  This is pretty common with a complex apnea, and what we'd like to see is where things balance out and become most comfortable.  Your choices are to try fixed pressure at 8 cm or go back to the previous settings.  I agree that bilevel ASV is almost inevitable, and I'm a big advocate of that therapy in these cases where a reasonable efficacy can't be achieved with CPAP.
Yeah we are willing to try anything at this point!!   We tried going back to previous settings tonight (A Flex/3, started with pressure 8-9, then down slightly to 7-9) and he just woke me up saying he couldn't breathe and he felt a seizure coming on (which thankfully didnt happen)... *le sigh*  I pulled in some data from his CPAP (not much data seeing that it was only 20 mins of sleep and he was asleep in approx 5 mins) but here are the potential CA's it picked up:
[/url][url=http://imgur.com/If5EDXl][Image: If5EDXll.jpg]

and just for fun:
[Image: 0M8y9lRl.png]


So when we see the doc on Monday do you have any idea if we can bring in data from Sleepyhead?  And if so what do you think we should bring?

I appreciate your (and everyone else's) help more than I can tell you!!!!!!!
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#27
(04-16-2017, 03:32 AM)bonjour Wrote: Ok.  You have found the right forum so here is your first welcome.

For someone who is claustrophobic the Amara View is an excellent full face mask.  For a different mask try nasal pillows with the ResMed P10 highly recommended by many here as a minimalist design.  Get the fit kit as it contains am med and large pillows for your first time.  Masks are typically an issue so I put together a Mask Primer to help.  See my signature and please read that.

To really help you we need to see your SleepyHead charts. Could you please post them.  Again see my signature.
This will tell us what is going on and allow us to really help you.

Thanks

Fred

Thanks for the welcome!!!! And for your mask suggestions...
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#28
Your husband needs a clinical titration that includes evaluation for BiPAP ASV. There really is no question that there is a serious complex apnea problem, and in this case the home sleep study saved a few bucks, but was a real dis-service. He is clearly not going to benefit from CPAP therapy and can't tolerate the number of events he has.

What I want you to do is to study the approval criteria under Medicare (and most other insurance policies) for a bipap with backup rate; aka ASV. The device has a HCPCS Code of E0471 and includes a family of machines including ST and ASV. You definitely want ASV (adaptive servo ventilator) rather than ST (spontaneous/timed), which is an older technology. These devices are relatively expensive, and there are many forum members that have been through the process of getting ASV, and several that are actively going through it now. Anyway, insurance is going to require a polysomongraphy study that documents his central apnea. It may only show up when challenged with CPAP pressure, so you need to discuss with the doctor a referral for diagnostics to evaluate why your husband does not tolerate CPAP. The data and charts will let him see the severity of the problem. You must understand how the medical system and insurance reimbursement works to have a chance at advocating for this therapy. Here are a few links to get started.
http://www.resmed.com/us/dam/documents/a...F_RADs.pdf
https://www.bcbsnc.com/assets/services/p...evices.pdf
https://www.cms.gov/Outreach-and-Educati...905064.pdf
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#29
(04-21-2017, 10:09 AM)Sleeprider Wrote: Your husband needs a clinical titration that includes evaluation for BiPAP ASV.  There really is no question that there is a serious complex apnea problem, and in this case the home sleep study saved a few bucks, but was a real dis-service.  He is clearly not going to benefit from CPAP therapy and can't tolerate the number of events he has.  

What I want you to do is to study the approval criteria under Medicare (and most other insurance policies) for a bipap with backup rate; aka ASV.  The device has a HCPCS Code of E0471 and includes a family of machines including ST and ASV. You definitely want ASV (adaptive servo ventilator) rather than ST (spontaneous/timed), which is an older technology.  These devices are relatively expensive, and there are many forum members that have been through the process of getting ASV, and several that are actively going through it now.   Anyway, insurance is going to require a polysomongraphy study that documents his central apnea. It may only show up when challenged with CPAP pressure, so you need to discuss with the doctor a referral for diagnostics to evaluate why your husband does not tolerate CPAP.  The data and charts will let him see the severity of the problem.  You must understand how the medical system and insurance reimbursement works to have a chance at advocating for this therapy.  Here are a few links to get started.
http://www.resmed.com/us/dam/documents/a...F_RADs.pdf
https://www.bcbsnc.com/assets/services/p...evices.pdf
https://www.cms.gov/Outreach-and-Educati...905064.pdf

Yep I totally agree with you, when we see the doctor on Monday I've told my husband that he has to be super clear (not exaggerating the issue but not minimizing it-as he has a habit of doing) how terrible he is feeling! He hasn't had a good night since he started the CPAP and of course the data backs up his claims. We've printed out the reports from Sleepyhead to bring with us, are there any other Sleepyhead documents I should bring?  And do I bring up that I am concerned about his number of CA events, or should I just let the data do the talking?  Also for the type of PSG it would be Polysomnography w/Titration?

As far as insurance goes I know it will be an uphill (upmountain?) battle (they already won't cover the home sleep study) but after discussing it I think it will be more cost efficient to not deal with insurance for the CPAP/BiPAP/ASV.  The CPAP we already bought was from an out-of-network DME supplier (had we known how complex his case was going to be we might have considered something else but c'est la vie) and the $850 we paid he will transfer towards the cost of a different machine (he quoted me $1300 for BiPAP/$4500 for ASV). I don't want to lose the money we have already spent (I have a feeling if we sell it we won't be able to recoup much of that cost?).  When I had spoke to a in network DME a month ago she warned me how expensive it would be... with the monthly rent for 3 months, the PSG, and even if we hit our deductible they will still only pay for 50% of DME, I honestly think we will spend a bit less by not going thru insurance (I priced out cost of PSG with insurance and it looks like we will have to cover most to all of the cost but I will double check on this with insurance) do you think its fine to go a private sleep lab or would be better served by getting it done in a hospital?  Thanks for all the links too... I read through them yesterday so I feel much more informed and ready to advocate for his health!!!! Okay
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#30
Quote: And do I bring up that I am concerned about his number of CA events, or should I just let the data do the talking?

It's been my experience (and observation on the forum) that many doctors have a blind spot about central apnea. I would certainly raise it with them, and show the chart you posted above with the duration of the events.

I'll let the American members talk about insurance requirements etc. However ASV machines are about the same price in Australian dollars here as they are in US dollars over there. And the Australian dollar currently buys about US 75c, so if you can't get your insurance to play ball it might be worth checking out the Australian on-line suppliers. ie If it costs US$4,000 there, it will be AU$4,000 here, but that's only about US$3,000. ASV machines are the one thing we can get cheaper here - everything else is bloody expensive. Some of the dealers might be reluctant to ship the device as Resmed usually have an in-store only clause in their supply agreement, but it's worth asking the question.
DeepBreathing
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www.ApneaBoard.com


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