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Chart Envy
#41
RE: Chart Envy
Sleep Doc update from Titration test, doc is 99.9% convinced I don't have complex apnea, he talked me through the report and gave me a copy to peruse.

From his analysis he prescribed 17cmO2 fixed with a ramp from 9.5.

I have been reticent to try higher pressures as had very bad experiences when using nasal pillows of leaks etc and mouth breathing but have to say last night with my cervical collar and my trusty Resmed F20 FFM it was quite a revelation and probably the longest period of unbroken sleep I've had and half decent numbers - this surprised me as first night after any change is normally hideous as my body reacts but this was one of the cleanest charts I've had overall - posted below. 

One comment he made kind of made sense, give yourself a ramp and then the pressure doesn't matter providing you can breath against it - you're asleep !

As i've said before one swallow doesn't make a summer so will post again in a few days time but I really expected more pressure to result in a solid line of centrals and it didn't...............

He also said he would be happy to prescribe a BiPAP for comfort if I can't cope with the higher pressures but last night seemed fine with only minor leaks so here's hoping for a simple and somewhat unexpected fix.

Will think about a shorter ramp over next few nights and maybe a higher stat pressure for ramp

Can post some of the study if anyone wants to see it and interested in thoughts on the chart ?

Rob
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#42
RE: Chart Envy
In spite of the slightly higher event rate, this latest chart resolves snoring and flow limits you saw earlier. When you were at 9.5, it was pretty clear you were headed to a higher pressure. Glad to see the improvement of results, and nearly complete elimination of CA events.
Sleeprider
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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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#43
RE: Chart Envy
Hey all,

So this is a turn up for the books, see attached graphs - 17 seems to be doing it. Really very surprised that the centrals have largely resolved.

Have been traveling for the last while so haven't been able to upload to Sleepyhead but have now been over two weeks at 17 and things seem to have stabilized at an average below 5 !

Feeling pretty rough in the mornings but beginning to feel less tired during the day I think but the extra pressure takes a bit of getting used to. My sleep doc would be happy to prescribe BiPAP for comfort and I'm wondering would this help - I haven't claimed a machine on insurance yet so wondering if I should upgrade to a Resmed machine ? Also I'm in the US just now and can see a few Resmed Airsense machines cheap and wondering if I should give their machines a shot ?

So a couple of questions for you......

Should I be feeling lighter than air by now ?

Should I go for BiPAP - what would it help with ?

If not then even at fixed pressure would a Resmed CPAP be any better than the Dreamstation  ?

Should I be concerned with leak rates ?

Any other comments / advice from here appreciated

Rob
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#44
RE: Chart Envy
Your remaining events are nearly all hypopnea.  Read this titraton protocol and tell me what you should do.

[Image: attachment.php?aid=4203]

If you're answering "increase pressure support or IPAP pressure" then you are correct, and that requires bilevel. It would likely lower your EPAP pressure as well. On the other hand, if I'm your doctor and concerned about insurance approval, my reply would be, your results look great. Why are you asking? What is your expectation and how are you feeling? If you are sleeping well these events are pretty minor, and you have nights that are nearly perfect. If you're uncomfortable, and fatigued, only you can decide if it's worth pursuing a higher level of therapy.
Sleeprider
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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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#45
RE: Chart Envy
So............as I'm on 17, I should increase to 18 to reduce hypo apneas ?

Hey I got it right without first seeing your answer at the bottom as missed that initially !

As I said, Doc said he was happy to prescribe BiPAP, says its no issue with insurance companies for comfort at pressures above 15 so BiPAP it is then - which BiPAP would you all recommend ?

Glad I haven't claimed a machine already

Rob
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#46
RE: Chart Envy
Sleep rider - only saw the first couple of lines of your reply - yes I think its worth pursuing a higher level of treatment as not feeling great yet, especially as a life of timezone changes doesn't seem to be changing any time soon.

Have looked at the three Resmed Aircurve (non ASV) machines and just don't know which one would be best bet for me - any benefit for me of the ST or VAuto over the simple S ?

Others advice on a bilevel machine ?

Rob
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#47
RE: Chart Envy
Recently your events have been mostly hypopnea, and that suggests using some pressure support (difference between IPAP and EPAP) to support inspiratory respiration. It is a concern that you have had some pretty high central apena in the recent past as that problem may re-emerge with pressure support. To treat obstructive apnea and hypopnea, my recommendation is for the Aircurve 10 Vauto, and I think starting at EPAP min 12, PS 4, IPAP max 22 is in the neighborhood, and we can make adjustments once we see results. If central apnea does return, then the only appropriate therapy would be the ASV. The ST has a backup rate, but uses a fixed pressure and fixed pressure support. It is primarily for people with obstructive or pulmonary restriction including hypo ventilation, and as far as I know that does not describe you.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
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Soft Cervical Collar
Optimizing Therapy
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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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#48
RE: Chart Envy
SR, just to clarify for readers,  The VAUTO, ASV and the ST are all BiLevel machines for treating three different conditions, they are NOT interchangeable.  They are not a choice between the three to treat a single condition.

They should be chosen to treat the specific condition that the user has, 
To treat obstructive apnea and hypopnea, my recommendation is for the Aircurve 10 Vauto
To treat central apnea, the only appropriate therapy would be the Aircurve 10 ASV
To treat  obstructive or pulmonary restriction including hypo ventilation, would be the Aircurve 10 ST
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#49
RE: Chart Envy
Thanks as always Fred! You’re the best and have a knack for making this understandable.
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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#50
RE: Chart Envy
Thanks sooooo much both, I really thought they were luxury models of the same thing - an Aircurve with 'air and leather' if you will - totally understand now and appreciate the clarity.

Rob

Log note to myself - last night I was above 10 for the first time in a couple of weeks where the only change was a medium pillow rather than a soft one and as a result I think I slept on my back.
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