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Chart Envy
#81
RE: Chart Envy
Hmm, so what you're saying is irrespective of good spells I really need ASV because all I have are mostly centrals ?

Some thoughts

- since raising to a fixed at or around 17, I haven't seen any obstructive apneas - since Sept
- this also coincides with a change from Dreamstation to Resmed - reading difference maybe ?
- when I've left things alone at 17 my average is well under 5
- of those, its mostly CAs with a smattering go hypo apneas
- timezone changes seem to be less of an issue with CAs
- I still wake up 2-3 times a night most nights - is this symptomatic of mixed / caused by centrals ?
- are the centrals what are waking me up ?
- I feel waaayyyy better, I don't feel weary all the time
- Has my body got to stability yet on treatment emergent centrals or are the small number every night still them - how long is long enough for a real trend ?
- anything in the exploded view suggest either treatment emergent or plain old mixed apnea ?
- I could just buy a used ASV and try it and see ?
- could I be this low and stable yet still have complex ?
- bad nights sleep do concise with when I remember waking up on my back
- I really do owe you guys beer !

Sleep rider and Bonjour - your considered opinions on these questions appreciated - thanks for killing off the positional

Rob
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#82
RE: Chart Envy
(01-27-2019, 11:14 AM)Technopauper Wrote: Hmm, so what you're saying is irrespective of good spells I really need ASV because all I have are mostly centrals ?

Some thoughts

- since raising to a fixed at or around 17, I haven't seen any obstructive apneas - since Sept
- this also coincides with a change from Dreamstation to Resmed - reading difference maybe ?
- when I've left things alone at 17 my average is well under 5
- of those, its mostly CAs with a smattering go hypo apneas
- timezone changes seem to be less of an issue with CAs
- I still wake up 2-3 times a night most nights - is this symptomatic of mixed / caused by centrals ?  Apneas, Hypopneas, and even Flow Limits
- are the centrals what are waking me up ? Could be
- I feel waaayyyy better, I don't feel weary all the time But you do feel "weary"?
- Has my body got to stability yet on treatment emergent centrals or are the small number every night still them - how long is long enough for a real trend ?  You have had high CA events dating back to June  2 months is the general waiting period for emergent central apneas
- anything in the exploded view suggest either treatment emergent or plain old mixed apnea ?  Nothing to imply treatment emergent centrals and not mixed/complex apnea in that segment.
- I could just buy a used ASV and try it and see ?  Could do.  How effective is your current therapy?  Is your current therapy adequate?  This is really based on how you feel.

- could I be this low and stable yet still have complex ?
- bad nights sleep do concise with when I remember waking up on my back
- I really do owe you guys beer !

Sleep rider and Bonjour - your considered opinions on these questions appreciated - thanks for killing off the positional

Rob

Definition Central/Mixed/Complex Apnea
Central sleep apnea (CSA) is defined as:

  1. An apnea-hypopnea index (AHI) greater than 5, and

  2. The sum total of central apneas plus central hypopneas is greater than 50% of the total apneas and hypopneas, and

  3. central apnea-central hypopnea index (CAHI) is greater than or equal to 5 per hour, and

  4. The presence of at least one of the following: Sleepiness, Awakening short of breath, Difficulty initiating or maintaining sleep, frequent awakenings, or nonrestorative sleep, Snoring, Witnessed apneas

  5. There is no evidence of daytime or nocturnal hypoventilation
Complex sleep apnea (CompSA)(also called Mixed apnea) is a form of central apnea specifically identified by all of the following:

  1. With use of a positive airway pressure device without a backup rate (E0601 (CPAP) or E0470 BiLevel/BiPAP wo Backup), the polysomnogram (PSG) shows a pattern of apneas and hypopneas that demonstrates the persistence or emergence of central apneas or central hypopneas upon exposure to CPAP (E0601) or a bi-level device without backup rate (E0470) device when titrated to the point where obstructive events have been effectively treated (obstructive AHI less than 5 per hour).

  2. After resolution of the obstructive events, the sum total of central apneas plus central hypopneas is greater than 50% of the total apneas and hypopneas; and

  3. After resolution of the obstructive events, a central apnea-central hypopnea index (CAHI) greater than or equal to 5 per hour.
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#83
RE: Chart Envy
and back to the slog

was trucking along nicely at 'sub 5' for about three weeks when in Europe then the wheels came off again - looking back 3-4 months 80% of apneas are centrals even when 5 or below.

Have an appointment with sleep do booked for next week, what should I be asking him ? Will the sleepyhead chart be enough for him to prescribe ASV or will he want another sleep study ?

Guess I should be just quoting this info that Bonjour posted previously ? Any advice on getting to correct treatment appreciated - feeling tired and irritable and sh**ty again.

Rob

Definition Central/Mixed/Complex Apnea
Central sleep apnea (CSA) is defined as:

  1. An apnea-hypopnea index (AHI) greater than 5, and - check


  2. The sum total of central apneas plus central hypopneas is greater than 50% of the total apneas and hypopneas, and - check


  3. central apnea-central hypopnea index (CAHI) is greater than or equal to 5 per hour, and


  4. The presence of at least one of the following: Sleepiness, Awakening short of breath, Difficulty initiating or maintaining sleep, frequent awakenings, or nonrestorative sleep, Snoring, Witnessed apneas - check, wakening a few times a night


  5. There is no evidence of daytime or nocturnal hypoventilation - check

Complex sleep apnea (CompSA)(also called Mixed apnea) is a form of central apnea specifically identified by all of the following:

  1. With use of a positive airway pressure device without a backup rate (E0601 (CPAP) or E0470 BiLevel/BiPAP wo Backup), the polysomnogram (PSG) shows a pattern of apneas and hypopneas that demonstrates the persistence or emergence of central apneas or central hypopneas upon exposure to CPAP (E0601) or a bi-level device without backup rate (E0470) device when titrated to the point where obstructive events have been effectively treated (obstructive AHI less than 5 per hour).


  2. After resolution of the obstructive events, the sum total of central apneas plus central hypopneas is greater than 50% of the total apneas and hypopneas; and - check


  3. After resolution of the obstructive events, a central apnea-central hypopnea index (CAHI) greater than or equal to 5 per hour. - check
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#84
RE: Chart Envy
I don’t think you will do any better on your current machine go back to your sleep dr but be aware you will likely be prescribed a BiLevel machine next which may or may not have a backup rate, it is likely not to solve your issues and make your symptoms & sleep worse so if you get prescribed a BiLevel ensure you have a 30day follow up booked so that you can get an ASV after that 30 day trial
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#85
RE: Chart Envy
The goal is to get your doctor to move.

from a previous post
Your CPAP was never intended to and doesn't treat Centrals.  With a CPAP CA levels will be inconsistent consistently.  This is fodder to talk to your doctor about.

Make a list of days where your Obstructive numbers (AHI-CA) are under 5 (treated) and your CA is over 5.  (I would note the event break down)

The common path is to 
fail CPAP
fail BiLevel
fail BiLevel with Backup
finally get ASV
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#86
RE: Chart Envy
Man reading this so reminds me of me.....!      I too was on a Cpap when in fact needed an ASV also.

My sage started 3+ years ago here on a diff forum and here too.   

Good luck,   going to read thru this entire thread,  just reading the first few posts I had to reply.   Sleep and others know what they are doing,   your in great hands.   I see your in Canada -  unsure the hoops you have to go thru,  but lord did I have to jump thru a bunch getting the ASV
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#87
RE: Chart Envy
Its not a medicare situation so I really hope he just gives me a prescription as they have 'new' open box ones just now at supplier no2 for two grand which I'd happily just buy if its going to fix things as been feeling really sh**ty the last few days and want this fixed in a less haphazard way.
'
Willpower will only take me so far .......... :-) Willing it not to be mixed hasn't worked so well though.

I take it I must have an ASV prescription to be able to buy from an online supplier as if not then I can just go ahead regardless ?

The thing he seems to get hung up on is that there has tp be a medical reason for me to have complex apnea and reasons don't show up anywhere else which I think is why he's so hesitant - is this normal ?

Appointment it Tuesday so here's hoping........

Rob
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#88
RE: Chart Envy
Tell him the condition is 'idiopathic' --- that means "we don't know why it's there, but it certainly is there" Perfectly good diagnosis!
Apnea Board Monitors are members who help oversee the smooth functioning of the Board. They are also members of the Advisory Committee which helps shape Apnea Board's rules & policies. Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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#89
RE: Chart Envy
I use the term idiopathic all the time, just not to sound like an idiot. Now you've given it away. Indeed it is idiopathic central or complex apnea, and the correct treatment will resolve as ASV.
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#90
RE: Chart Envy
Soooooooo sleep doc session today provided an insight I hadn't thought about before.

Let me first say that I do actually trust my sleep doc and he is well respected locally, he made a few mental jumps that I hadn't thought about before.

1) Calgary where I live is at altitude, my house is probably at about 3700 feet - he has seen instances of CA based on re-acclimitization to altitude, he says he sees it in his 'snow birds' fairly regularly when they return from warmer climes in the spring.

Note :- earlier I noticed a 'treatment lump' on travel in both directions which I attributed to timezone change but then was only seeing it on return home so gave up on that theory but there may just be something in it as the lumps do seem to be whenever I return home - have a look and see what you think ? I've moved the timezone of the machine up closer to AHI so its more obvious ?

2) He said it could be the 'home' machine wasn't working properly - I use one for travel and a second one for home - have swapped them over and will check over next few nights.

He agrees that idiopathic is a thing but in his mind is basically a failure in medicine as in his experience there has to be a reason for such things and wants to understand.

He looked at the trends and did think the Centrals looked like centrals from a waveform perspective and surprise surprise he wants me to try an ST machine as wants to try a Bipap with a 'puff' whenever my body doesn't initiate a breath and thought in my case it would do the same thing as ASV without the extra cost. They have a loner ST machine which they are going to loan me to try out - he just really wants to understand cause and hasn't made an idiopathic Complex diagnosis before so is open to it but wants to understand it. 

We spent quite a bit of time looking at sleepyhead charts and waveforms, he suggests setting the Bipap to IPAP 19, EPAP 15 to get my 17 average and set the respiratory rate to 11 as my average seems to be around 13.5 - thoughts all ?

Delusional or worth chasing these angles ?

Rob
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