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[CPAP] Newbie ready for guru input
#41
First there are quite a few members on this forum that share your dilema, and they may offer some thoughts.

I think with the sleep study results in hand, you know that your apnea before treatment is predominately central with some significant obstructive events. While CPAP and BiPAP predominately treat OSA, many patients do achieve significant improvement and efficacy on a trial with these machines. You're not one of them. Your untreated AHI was in the mild to moderate range at 11.1 overall. In your case most apnea occur during N2 sleep which is 50% of your sleep. Your sleep study shows the only time you don't have apnea during bilevel titration is when you're awake. your event rate appears higher with treatment than without, and only the period between 4:30 and 5:00 shows some relief at pressures ranging from 15/10 to 17/12. This is following a long period of arousal and prior to light-on, so is far from conclusive.

I would call the doctor's office and inform them that your event rated according to the machine data remains very high with mixed events. The machine data suggest your results are much worse than your untreated AHI. You should tell them you have looked at the results of the tests and don't really see how it was determined (1) that you have obstructive apnea, and (2), how it was determined that you had a "good response" to bipap pressure of 15/10. At 1:15 at 14/9 and 15/10 shows central abundant apnea (approximately 30 AHI to numerous to count). At 1:45 to 2:15 15/10 was tried for 30 minutes with 11 apnea (AHI 22) with the longest apnea of the night at 2:00 at 15/10. A final period of 15/10 was tried at about 4:30, lasting about 15 minutes (deducting for wake) with 2 OA events (AHI 8) No sustained period of efficacy (ahi<5) was found. Your ongoing machine data confirm any efficacy found during the titration study may have been coincidental or an anomaly. You should flatly say in your opinion BiPAP at the prescribed pressures is not working, and explain any symptoms you feel (fatigue, frequent awakenings, whatever).

Continue your discussion, with the fact you have researched complex and mixed apnea, and learned about the use of adaptive servo ventilation. Have some Resmed studies in hand to cite. Ask your doctor if he has a plan to investigate ASV, or should you request a referral to someone that will pursue effective treatment for you. I would give him an opportunity to lay out his plan. Complex apnea is not that uncommon, and he should be familiar with it. Ask him specifically if he has treated other cases and prescribed ASV. If not, look elsewhere. If so, you should be on your way to the ASV titration.
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#42
Thanks very much on that. It really helps to clarify my actions on this. BTW I just talked to my current DME, I discovered if my script specifies ResMed, that's what they would supply. Otherwise its Respironics, as they have a contract with them. Given a choice, ResMed 1st choice in my opinion. Not that I do not like Respironics, but Sleeprider's assessment of ResMed has swayed me to want ResMed as choice 1.

Warning Apnea Board land, another hoser going postal in near future. I likely will get 2nd opinion on the diagnosis, pushing for ASV and hopefully via the ResMed brand. Great day to all. And have a  Coffee with me sometime. OOohh yeah make that virtual  Coffee

As results come in, I'll keep y'all posted.
Sarcasm is a hobby of mine. I am not sarcastic on serious issues, implied or otherwise.
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#43
Dave, I think the bottom line is the titration study accurately predicted that at 15/10 your AHI would be in the low 20s average. Look at the data. I think going in with the idea that the results on BiPAP are exactly what the study suggested they would be may win some points.
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#44
Yes, that is a good point. Thank you. As I mentioned before, I'll keep y'all updated. There does come a time that no isn't an acceptable answer, meaning that I didn't have to accept this is as good as it gets in treatment, and this is one of them. Can't say it enough, thanks for viewing the report and describing it so I can understand it better. Action on that info to follow very fast on my end. Wishing a great day to each here.
Sarcasm is a hobby of mine. I am not sarcastic on serious issues, implied or otherwise.
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#45
FWIW on an update: saw primary care doc this afternoon. We discussed my sleep study, my researching regarding CA, OA, CPAP/BiPAP vs ASV and that my BiPAP isn't helping. I asked for new referral to get 2nd opinion pulmonary-wise and his office is working on it. He and I agreed as well to continue working for now with current pulmonary doc to see if he would begin process towards ASV. I consider this educational, so when I get actions, etc. to report, I'll share the progress to y'all. So sit back, relax, have a great virtual  Coffee on me. Happy Friday evening to y'all too.

PS I talked to my current DME, she said they default to Respironics as they have a contract with them. If I present a script that specifies ResMed, they will honor it and supply ResMed. Cool.
Sarcasm is a hobby of mine. I am not sarcastic on serious issues, implied or otherwise.
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#46
Hello folks,
Here's an update:

1) I talked to my medical insurance company, 2nd opinion needs handled as was my initial sleep study procedure request, starts with primary care doc pre-authorize then referral to new doc

2) seeing current pulmonary doc's PA with doc on call tomorrow instead of April 20th when the pulmonary doc is next available, as my primary doc and I discussed last week exhaust all current pulmonary doc options first BUT he is doing the 2nd opinion request now as well to go instantly-ish to plan B as needed

This news brief was brought to you by your local attorney team of Dewey Cheatum and Howe, formerly on CarTalk. As more becomes available, I'll give a shout. Hoping soon I'll be getting info about ResMed Aircurve 10 ASV, that's my soon-to-be-requested machine AND heated tube. Wishing all a great Monday, was already a  Coffee  Coffee day

Sleep-well
Sarcasm is a hobby of mine. I am not sarcastic on serious issues, implied or otherwise.
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#47
It shouldn't be this hard, but it is. Continued good luck to you sir.
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#48
Thank you, very appreciative of your help and to all others as well. Seems good on my part, at least I'm DOING something to get onto an ASV. This just happened to be the week pulmonary doctor takes vacation. Guessing his crystal ball told him to get outta town for a while.  Too-funny

Some of the best news is my insurance is on my side, they represent the $$. Good day to y'all.
Sarcasm is a hobby of mine. I am not sarcastic on serious issues, implied or otherwise.
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#49
Hehe what a day it's been already.  Coffee at 0730 on the way to see the pulmonary doctor, was one filling in for other doc I've seen as he's on vacation. Doctor today suggests changing BiPAP settings to fixed 12/8 as 15/10 were creating high central counts in sleep study.

She said she wanted me to contact DME to adjust the machine to the new script when I said "I can set it to that." The doc was like "You know how?" "Sure I've reset it some time in the past after 15/10 was giving bad AHI numbers and according to the sleep report was a bad setting choice." Doc seemed surprised a bit but didn't comment. She then handed the script to me for DME. Then says I, "I am a patient that likes to research and be informed of what I'm dealing with. My research of the high apnea count, especially my central apnea, does this indicate we are headed towards an ASV device?" Doc "It looks that way from what I'm seeing."

BTW: the DME call was me informing them of new script numbers. Girl on phone said she'd see if she could remotely make the setting adjustment when I'd said I'd already programmed that in. DME girl "OK I guess I don't need to do that." Then I passed on the pulmonary doc request for a 30 day report sent to them before my next doc appointment next month.

BTW 2: even these new settings aren't likely to help me very much. As is, I know ASV is best answer. So that's the news from current pulmonary doc. Referral to new doc/sleep study as 2nd opinion is still waiting on result from primary care contact with 2 other facilities that are in insurance network. This is just in case doc 1 isn't buying into the ASV.

SarcasticDave94, reporting live from PA.  Cool Coffee
Sarcasm is a hobby of mine. I am not sarcastic on serious issues, implied or otherwise.
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#50
Ya done good! Keep them on their toes.
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