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Chest/Lung Restriction - Impact on CPAP use?
#41
RE: Chest/Lung Restriction - Impact on CPAP use?
Pkersky, please provide an image of the full night details, but before taking the screenshot go to the menu/ Reset Graphs / Advanced. That will give us graphs of the events, flow rate, tidal volume, minute vent and respiratory rate.

Our CPAP trial simply proved that your central apnea and unstable respiration, characterized by alternating hyper and hypo ventilation, is actually central sleep apnea and that it is unrelated to EPR or pressure support. My previous advice stands, you must arrange for an expedited titration study that includes evaluation of ASV.
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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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#42
RE: Chest/Lung Restriction - Impact on CPAP use?
(08-17-2021, 07:46 AM)SarcasticDave94 Wrote: There shouldn't be much to scare you when it comes to pressure. Actual pressure in PSI is 0.113787 at 8 cmH2O.

EPR 1 still shows.

SpO2 was at less than 90 for 1 minute. I'd think this says possibly the Apnea drops your percentage down and needs PAP to do its job. It's not at a bad level, but it is dropping from something.

You will be hard pressed to get a night in on ASV if you can't endure 8 on CPAP for 30 minutes. Not talking down to you, but a need to face things as they are. Yes the ASV can be tamed down and still effectively treat CA and other Apnea, but it's not going to be straight 8 and EPR 1.

If you want something to be afraid of, OK here's one, 13 CA within 27 minutes, and about 9 Obstructive Apnea in that same time.

If you feel better with full face masks go get one now. You're in need of getting used to this small amount of pressure or you'll never get a single night on ASV, or even CPAP.

Hi Dave,

1) I got the message about just mentally accepting the expiratory pressure ... and please go ahead and give it to me straight!! I'm 100% committed this time to making this work. 

2) With the O2 drops, bear in mind that the Wellue ring is vibrating at 87% and below to wake me up ... so I don't really know how low and how long those O2 drops would be without the Wellue ring. That's concerning to me.

3) MOST IMPORTANT: I scheduled in an in-lab sleep study for Monday night. The scheduler said I don't need to have the physician referred me request ASV titration. What I do need to do is email my case for ASV titration aand she will give it to the doc who runs the sleep center. So, I'm working on that now. I'll post my email write-up and attachments as soon as I have it. Maybe you guys can critique it if you have time. It's already almost 3pm now, so at this point, it's probably fine just to make sure it gets in tonight.
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#43
RE: Chest/Lung Restriction - Impact on CPAP use?
Guys, here is the email I plan to send out tonight. If you have any suggestions to make it better I'd love the feedback. If you don't have time to critique it, no problem ... I'll just send it out as is. Thx!

---------------------------------

Dear XXXX,

Per our conversation of 8/19/21 discussing ASV titration for the sleep study on Monday, 8.23/21, please forward this email on to the physician who oversees the sleep studies. If the doctor concurs that I have Therapy-Onset Central Apnea, I would like to request ASV titration for my sleep study.

I have attached a copy of:

A) My most recent sleep study which shows no Central Apnea events without CPAP, but increasing Central Apnea events at successively higher pressures from 6 cm. H2O to 10 cm H2O.

B) A recent chart from Oscar software which also shows a high number of Central Apnea events at relatively low fixed pressures. The chart is for a limited amount of time because I find it extremely difficult to tolerate the CPAP machine overnight.

Please refer any response from the doctor back to me at your earliest convenience.

Thank You,
XXXXXXXX


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#44
RE: Chest/Lung Restriction - Impact on CPAP use?
change
I would like to request ASV titration for my sleep study.
to
I would like to request ASV titration be included my sleep study, possibly a split study.
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#45
RE: Chest/Lung Restriction - Impact on CPAP use?
(08-19-2021, 09:19 PM)Gideon Wrote: change
I would like to request ASV titration for my sleep study.
to
I would like to request ASV titration be included my sleep study, possibly a split study.

Got it. thx!
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#46
RE: Chest/Lung Restriction - Impact on CPAP use?
Hi. So I have a bit of an update. I had a long talk with the sleep lab director and she said it would take two nights in the sleep lab because they would need to step me thru CPAP (see if I fail) then BIPAP (see if I fail) and finally ASV. I don't particularly want to go thru that process. A) I don't know that I can sleep there B) I'd rather wait for this wave of Covid to die down.

SO, I have another idea: I found a local sleep doc covered by my insurance that is willing to do Telehealth and has availability for near term appointments. I was thinking of telling them I have access to an ASV thru a family member (this is true enough for me to say it). My idea would be to ask them if (based on my 2018 sleep study and my recent Oscar chart) that ASV is safe and makes sense to try.

If they agree, I'd go ahead and acquire an ASV, which I might sell later on down the road. I'm willing to take a financial hit just to get going with this ASAP.

I feel very confident that you guys are steering me on the right path ... but I have high anxiety and would prefer for an MD to direct me with the ASV.

Do you all think a Sleep MD would agree with this plan based on the attached data?


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#47
RE: Chest/Lung Restriction - Impact on CPAP use?
Likely yes, if they're a good doctor.
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#48
RE: Chest/Lung Restriction - Impact on CPAP use?
Okay, I have an update:

I spoke with an NP in the sleep clinic and she had spoken with the Dr concerning my opinion that I have Treatment Emergent Central Apnea.

What she told me is that they have completely stopped prescribing ASVs to their patients in the last year, due to concerns about sudden cardiac arrest ... even in  patients without any observable pre-existing heart conditions.

She did say that the medical literature is conflicting, but their concerns are strong enough to warrant their stopping ASVs.

I took some notes, but may have these wrong. What I think she said is 1) Hyperventilation can lead to 2) Respiratory Alkalosis which can lead to 3) Electrolyte abnormalities which can lead to 4) Arrythmias which can lead to 5) Sudden cardiac arrest.

In my case, she suggested a BiPap titration study. As I mentioned previously, I don't want to go in for a study and I want to fast track my treatment.

I'm curious to get your thoughts on this on what she said about ASVs.

Also, I have a totally separate appt tomorrow, scheduled with an NP at a different sleep clinic. I'm not going too mention the concerns the first sleep clinic brought up and I'll report back.
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#49
RE: Chest/Lung Restriction - Impact on CPAP use?
The SERVE-HF study was extremely flawed and set the basis for identifying a high risk group of individuals with left ventricular ejection fraction (LVEF) less than 45% as a conservative screening level of concern for sudden cardiac death from ASV. The SERVE-HF study used an older generation of ASV machines on a cohort of heart failure patients without a titration protocol or compliance tracking. A newer study, ADVENT-HF has failed to replicate this risk on a cohort of 800+ more severe heart failure patients using modern ASV machines, properly titrated to the patient and tracked for use since 2016. This study has not yet been published, but preliminary results do not confirm the risks identified with SERVE-HF and suggests significant benefits for heart failure patients with central and CSR symptoms.

Basically the cohort tested in SERVE-HF were terminal and some died during the study, but while the potential cause of death has been speculated, none has been verified, probably due to serious flaws in the study which was not designed for this end-point. I think your sleep clinic and insurance is uninformed and you should immediately seek help with a group more acquainted with the progress of research and that more narrowly defines the risk group of concern. There is nothing you or I can say or do to change this policy. You now know what studies to research to learn what you need to know.
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: Chest/Lung Restriction - Impact on CPAP use?
ResMed is designed to maintain your 90 second average minute vent. It will adapt.

A standard BiPap such as the ST will apply a fixed amount, a constant PS which a cause for hyperventilation.

When you get down to it even a fixed pressure CPAP improves your breathing, isn't this too a hyperventilation.

The path described by you NP is IMHO a possibility with any pap machine.

Any luck with a pulmonologist?
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