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[CPAP] Newbie with CSAs, struggling with CPAP therapy
#21
RE: Newbie with CSAs, struggling with CPAP therapy
Thank you Sleeprider! You said it much better than me. A BiPAP will only help if your "central" is really just an insufficiently strong breathing effort. The ASV takes that issue away, as it does not need to sense a trigger. Since you have always had centrals on all your studies, trying to finesse the sensing is unlikely to be sufficient. EPR on an APAP and PS on a BiPAP in your situation are half-measures (half-breaths?) to simulate a vent cycle.
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#22
RE: Newbie with CSAs, struggling with CPAP therapy
Jay51, Sleeprider, and RainbowFish, thank you so much for your replies! This really helps me figure out what I need to prioritize for my upcoming phone appointment, and what my triggers are to switch providers.

I was under the impression that ASV and BiPAP were the same thing (just called different names for patent purposes). I see I need to do some research on this.
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#23
RE: Newbie with CSAs, struggling with CPAP therapy
The titration guide I linked to in my last post should give you most of the information you need to know about the machines and how they work. If you want to, we can look at some close-up zooms of your charts and discuss the details of central apnea syndrome. We would need some zooms that include the respiratory flow rate and events at a resolution of about 3-minutes where we can see the individual breath waves and the pattern of breathing to see if there are oscillations. You should have no problem getting approved for ASV, but a competent doctor has to revise your diagnosis to acknowledge the 100% central apnea, and be knowledgeable about its treatment. I would be very blunt in your upcoming phone appointment and ask if this organization has a doctor on staff that is qualified to diagnose and treat central sleep apnea, and then if that person does exist, request your case be referred to their care. Also, request a copy of the detailed sleep report. You have a very cursory summary, and you're going to need more to take to another physician and to save for your personal records. Don't take any more B.S.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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#24
RE: Newbie with CSAs, struggling with CPAP therapy
Thank you for posting the titration guide Sleeprider. There is a lot of info in there! My provider gave me the impression that the AirCurve VAuto was a BiPAP and if one needed ASV a wholly different machine was used. I see now that at best this is an oversimplification. Are they different models or software modes of the AirCurve?
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#25
RE: Newbie with CSAs, struggling with CPAP therapy
My experience is that the sleep center tech are either poorly trained or poorly incentivized or both .  Sales through the DME distributors  and keeping the patient (client)  away from other providers rank high . They are ok in the testing phase  but not treatment Rx and follow up. Much better to go to a pulmonologist and, of course, the PA who is generally well supervidsed by pulmonologist. Costs much less than poor treatment.
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#26
RE: Newbie with CSAs, struggling with CPAP therapy
I apologize Dani.  I meant that your chart in post #13 where you had 2Liters of O2 by nasal canula looked the best (excellent from an SPo2 standpoint).  Just wanted to clarify.
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#27
RE: Newbie with CSAs, struggling with CPAP therapy
Wow, I appreciate all the replies!

Thank you for the link, Sleeprider.  I read through the titration guide carefully today, and the manuals on ResMed's site.  I still don't understand all the different AirCurve 10 models (such as S, ST, VAuto), but it looks like the AirCurve 10 ASV is the primary model aimed at CSA patients.  The hospital where I did my sleep study lost their director last year and still haven't hired a replacement, so they have a nurse trying to hold everything together.  I may see if I can get transferred to the next nearest place with a sleep center (and a present sleep specialist).  It might be out of state.  The joys of navigating health care in a rural area!
   Oh-jeez

Jay51 asked: “Do you attribute the inconsistent results simply to exacerbations of dysautonomia?  Or not?”
It’s hard to tell, but I think it may be a feedback loop.  I do suspect that some of my CSA is triggered by autoimmune brain inflammation.  For instance, I get terrible dysautonomia symptoms after I get glutened, and also pretty crummy sleep until I heal.  My latest diagnosis includes vascular damage, which can affect the nervous system.  On the other hand, my dysautonomia symptoms are worse after bad sleep, and they generally improve through the day, resetting to bad in the morning, which suggests the poor sleep and/or hypoxia exacerbates the problem.  If I can correct my sleep issues mechanically, maybe I can hold off on immunosuppressant drugs a bit longer.  

Rainbowfish, as far as I can tell, the APAP pressure doesn't seem to cause or alleviate the central apneas.  Mask leaks make them worse, as does being in a light stage of sleep.  Otherwise, they seem to cluster at the end of the night.
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#28
RE: Newbie with CSAs, struggling with CPAP therapy
Sleeprider, thanks very much for offering to look at some of my apnea details.  I'll attach two that look pretty typical of my CA pattern, and one that didn't pop any flags, but shows a sort of oscillating pattern that I see occasionally in the flow rate graphs.


Attached Files Thumbnail(s)
           
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#29
RE: Newbie with CSAs, struggling with CPAP therapy
This page is fantastic: http://www.apneaboard.com/wiki/index.php...P_Machines (Justifying Advanced PAP Machines)

I think I'll print it out and reread it before my telephone appointment on Tuesday.  

Also this one: http://www.apneaboard.com/wiki/index.php...ackup_Info (Justifying ASV Backup Info)

Huge thanks to whoever wrote these!    Thanks
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#30
RE: Newbie with CSAs, struggling with CPAP therapy
Good luck on your upcoming appointment! Be sure to update us! My experience to the south is to prioritize knowledge over distance, as most appointments are telemedicine these days.
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