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[CPAP] [mb635] - AirSense 10 Autoset to Aircurve 10 ASV
#11
RE: [mb635] - AirSense 10 Autoset Sleep Analysis
bonjour said:I wanted to see the above OSCAR results to confirm what I read on the sleep study
Diagnosis is OSA, AHI 8.2 68 events 6 Obstructive Apnea 16 'Suspected' Central Apnea so 73% central Apnea

https://imgur.com/a/92idDCQ (Sleep Test)

and without doubt the OSCAR Charts put the explanation point on the misdeed and the strong need for an ASV
I had encouraged her work on her doctor to get the diagnosis changed to some form of Central to better justify the getting of an ASV as you have described above.


Call and talk to your doctor today, tomorrow and everyday until you get action on getting an ASV tomorrow!

Alternately we can guide you to self purchasing an ASV which will get you relief much faster.

FYI IMHO SleepRider is the best at interpreting charts of anyone I know, and I know a lot of people doing it."

My Response: How would I get my doctor change the diagnosis? Like what type of evidence could I show my doctor in order to do this? I also received my other 5 out of 7 documents for my sleep report, I am going to post them here as well with everything blocked out.
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#12
RE: [mb635] - AirSense 10 Autoset Sleep Analysis
Let us know generally where you are located and we can try to direct you to a machine. As a student, are you insured under your parents, or do you have “good” insurance with reasonable copay and deductibles?  

Point out to the doctor that the majority of your events in the diagnostic sleep study were central. Also let him know you cannot tolerate the CPAP, not for lack of motivation, but because of abundant central apnea in excess of 60 per hour. You should ask for clinical titration that includes ASV, as well as a change of diagnosis to “complex sleep apnea”.
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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#13
RE: [mb635] - AirSense 10 Autoset Sleep Analysis
Talk to him, the Sleep study shows 73% of your apneas are central.  Point this out then point to the results from your ResMed.  As I said (reddit) that diagnosis that says OSA was made by the Sleep Lab, NOT YOUR DOCTOR.  Just say that you know he just wants your health to be best and you know that with this evidence, the sleep study and your ResMed charts (He really will not care about the details, just the summary table,)  Clearly show Central apnea or Complex (both central and obstructive apnea and you know you need a diagnosis that indicates Central Apnea in order to get a machine that is designed to treat central apnea.  That machine is the ASV.
As SleepRider said "You obviously have complex or predominately central sleep apnea, don't tolerate the CPAP and need to get a prescription for ASV. The adaptive servo ventilator will use adaptive pressure support to resolve the central apnea and at the same time the steady exhale pressure will maintain a patent airway avoiding obstruction. " 

The goal is to get an ASV Titration.  Ask him specifically, "How soon can WE get an ASV Titration sleep study?"

On why ASV see the below info.  Note the ASV Auto is the only mode called out to treat the types of apnea that you have.

The following info is from the ResMed Sleep Lab Titration Guide

* CPAP (continuous positive airway pressure) Fixed pressure delivered with optional expiratory pressure relief (EPR). It Treats OSA
* AutoSet/APAP (automatic positive airway pressure) Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas. It treats OSA
* AutoSet for Her/APAP Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas along with an increased sensitivity to each flow-limited breath, providing a more comfortable therapy for women. Increases sensitivity to each flow-limited breath, providing a more comfortable therapy for women (OK for men too). It Treats OSA
* VAuto Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas; Pressure Support (PS) is fixed throughout the night and can be set by the clinician. It Treats OSA, non-compliant OSA
* S (Spontaneous) Senses when the patient is inhaling and exhaling, and supplies appropriate pressures accordingly. Both treatment pressures are preset: inspiration (IPAP) and expiration (EPAP). It treats Non-compliant OSA and COPD
* ST (Spontaneous/Timed) Augments any breaths initiated by the patient, but also supplies additional breaths if the breath rate falls below the clinician’s set “backup” respiratory rate. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
* T (Timed) Supplies a clinician-set respiratory rate and inspiratory/expiratory time, regardless of patient effort. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
* iVAPS (intelligent Volume-Assured Pressure Support) Maintains a preset target alveolar minute ventilation by monitoring delivered ventilation, adjusting the pressure support and automatically providing an intelligent backup breath. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
* ASV (adaptive servo-ventilation) Targets the patient’s minute ventilation, continually learning the patient’s breathing pattern and instantly responding to any changes. It treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
* ASVAuto Provides an ASV algorithm plus expiratory positive airway pressure (EPAP) that automatically responds on the patient’s next breath to flow limitation, snore and obstructive sleep apneas. It Treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
* PAC (Pressure Assist Control, also known as Pressure Control) The inspiration time is preset in the PAC mode; there is no spontaneous/flow cycling. Inspiration can be triggered by the patient when respiratory rate is above a preset value, or delivered at a set time at the backup rate. It Treats Neuromuscular disease (NMD), pediatric patients
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#14
RE: [mb635] - AirSense 10 Autoset Sleep Analysis
The only thing I can add to bonjour's advise, is that there are too many sleep doctors that are uncomfortable or unfamiliar with treating central and complex apnea using advanced positive pressure devices like the ASV. There are many doctor's practices that are 100% obstructive sleep apnea, and they won't consider anything else. It is a fair question to ask your doctor if he or she is experienced in such diagnoses and therapies, and whether he can lead you forward in therapy, or if a referral is needed. There is no point in the doctor wasting your time, or you, his time, if he just isn't going to be receptive and helpful in treating your complex apnea. The next step is the ASV titration. Get it scheduled or find someone that will.
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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#15
RE: [mb635] - AirSense 10 Autoset Sleep Analysis
Okay here is my official sleep study report, could you give me any more feed back at what I should I say to my doctor specifically? I mean, I really don't want to go to another specialist unless I am forced to because of the costs involved. I hope that is relatable.
https://imgur.com/a/SpSaYFY
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#16
RE: [mb635] - AirSense 10 Autoset Sleep Analysis
The diagnostic test shows a mild AHI of 9.2, that is predominately hypopnea. The apnea index is only 3 per hour, with 2 being central. The determination of whether hypopnea is obstructive or central takes some skill and interpretation of the flow rate, but wasn't done in this case. There are a lot of people with mild apnea that don't use therapy, and that remains an option. Your OSCAR chart and data show your useage time on CPAP is generally about 1/2 hour and we can't conclusively say the large number of events are "real" apnea, but it certainly shows a low tolerance for the therapy, and we are seeing mainly central events. A titration study will start with CPAP, move to bilevel and can include ASV if your doctor orders it contingent of failing CPAP and bilevel. The objective of the study is to find a test condition that produces sleep with few events, and if that happens, you will at least have a path forward.

Alternatively, we can take a more disciplined approach to trying to find some settings that work for you. If you want to give this a try before pursuing things with your doctor, my recommendation is to use the following settings:
Mode Autoset
Minimum pressure: 5.0
Maximum pressure: 8.0
EPR: OFF

These simple settings have a decent chance of being both comfortable and effective for an individual with larger numbers of CA events. The objective is to treat obstructive sleep apnea without aggravating centrals by removing the influence of EPR.
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: [mb635] - AirSense 10 Autoset Sleep Analysis
(09-10-2020, 12:20 PM)Sleeprider Wrote: Let us know generally where you are located and we can try to direct you to a machine. As a student, are you insured under your parents, or do you have “good” insurance with reasonable copay and deductibles?  

Point out to the doctor that the majority of your events in the diagnostic sleep study were central. Also let him know you cannot tolerate the CPAP, not for lack of motivation, but because of abundant central apnea in excess of 60 per hour. You should ask for clinical titration that includes ASV, as well as a change of diagnosis to “complex sleep apnea”.

I live in New Jersey specifically
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#18
RE: [mb635] - AirSense 10 Autoset Sleep Analysis
Sleeprider and Bonjour, I want to thank you all for your help. I am going to try the last setting that was given which 5.0-8.0 pressure setting for tomorrow night.

Thank you again, and I will continue to add more points here even tho I have scheduled my appointment with my doctor. 
mb635
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#19
RE: [mb635] - AirSense 10 Autoset Sleep Analysis
Our intention is for you, actually all the users here, get the best therapy possible, and to help you along this journey with any issues that you may have.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
Post Reply Post Reply
#20
RE: [mb635] - AirSense 10 Autoset Sleep Analysis
I do want you to try using your existing machine with the low pressure settings I outline above, with minimum pressure 5.0 and maximum 8.0 and EPR off. We don't have much to work with in terms of CPAP use, and we need to see what is possible, with hopefully a longer session. If that does not work out, then we can consider ASV.

If you want to try ASV for a reasonable cost, I recommend you look at the older model Resmed S9 VPAP Adapt #36007. This machine uses the same treatment algorithm as the current Aircurve 10 ASV, but is in the older 2-part flow generator/humidifier form factor. You can find machines on Dotmed by looking under Respiratory/BiPAP and filtering for Resmed. There are machines from $340 to $500 and the main difference is run-hours, from 9630 to 370, and the price tracks hours. The Resmed S9 heated tube is difference from the Airsense, but non-heated tubes are the same. The S9 Climateline tube is $25 on Amazon. This will get you ASV therapy on the cheap, and once you demonstrate that it works, you can probably discuss a prescription change from your doctor.
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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