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Chest/Lung Restriction - Impact on CPAP use?
#51
RE: Chest/Lung Restriction - Impact on CPAP use?
Quack

No I don't have congestive heart failure, my required echocardiogram in '17 showed 55% LVEF. I got an ASV that year.

They'd rather be cautious about some condition that showed in a flawed study than to treat you. FIRE EM. Guess I'm pessimistic, but IMO you'll never get ASV with this bunch of Quackers.
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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#52
RE: Chest/Lung Restriction - Impact on CPAP use?
Hi Guys, I'm back after a long hiatus from this thread. So, I never followed thru with the sleep study I mentioned earlier.

It took me several months, but I got in with the top sleep doc in my area (not a major city, so it's doesn't mean he's a good doc) and he concurred that I might have treatment emergent central apnea (as we discussed before). He arranged for a two night sleep study, where the idea was to step me thru CPAP, BiPAP, then ASV.

So ... I went in for the first night of the sleep study this past week. The tech seemed competent, best hospital in the area. I couldn't really fall asleep, so I took ambien (which I haven't taken in many years). Tech comes in after several hours and tells me I'm not having any apneas!? He tells me to sleep on my back, which I managed to do for at least a little while. Tech comes back in about an hour before the sleep study is scheduled to end and tells me even on my back I had minimal apneas, so he didn't see any cause to put me on CPAP. At that point, I asked if there was any reason to continue and he said no, so I went home.

I'm shocked by the results. My in home and in lab sleep studies in 2018 showed AHI over 30. How the heck do I not have apnea now???

He suggested it was because I was at 5000 ft elevation in 2018 ... and now I'm at sea level. But I think my sleep studies showed obstructive apneas, not central apneas??

In the chair as he was hooking me up I started to fall asleep and make the chk-chk choking sound. I can't fall asleep sitting up at all. On my back I frequently choke awake immediately (though I've noticed I can occasionally sleep for a bit on my back these days, not well though.)

 I wake up almost every morning with a migraine. Multiple neurologists have told me it's likely from SA.

Anything else I write would just be speculation. One thought is that I was keeping myself from sleeping in the fetal position for years because I though it was bad for my kyphosis (I have ankylosing spondylitis). These days I sometimes allow myself to sleep in the fetal position and I believe I did sleep in the fetal position during the study.

I'm pretty darn sure I still have SA! How could I have gone from severe SA to no SA???

I haven't got the new study results yet. I should very soon. I'll post them as soon as I get them. I thought about not posting this until I got the results, but I wanted to be armed with any info you guys can give me before I see the sleep doc again.
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#53
RE: Chest/Lung Restriction - Impact on CPAP use?
The longest chart we have ever seen was 1:18 and had an extremely high CAI, however we can't say what your therapy would be if you actually slept, or what it is without CPAP. You have a home sleep study at over 30 AHI and this observed study did not reveal enough to justify CPAP let alone ASV. It seems you sleep without CPAP most of the time, so you are not changing much. Maybe use a soft cervical collar to prevent positional (chin-tucking) and see if you feel better. It's possible your apnea is inconsistent and the study environment was unable to reveal what was going on. When you get the results we can look at some variables like arousal and flow limitation to see what might exist other than obstructive sleep apnea.
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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#54
RE: Chest/Lung Restriction - Impact on CPAP use?
Sleeprider, thank you. As soon as I have the new sleep study report I'll post it.

I think I understood your reply, but not 100% sure I understood everything ... maybe you are already taking this data into account ... but I do have my 2018 sleep study that was in a lab. I'll post it again here, just in case.
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#55
RE: Chest/Lung Restriction - Impact on CPAP use?
I had forgotten about the other sleep study. It seems unlikely that you did not experience sleep disordered breathing in the new study, and without the results, we don't know what sleep stages you attained or whether there were arousals or even hypopnea that did not meet a desaturation criteria. What we know is that central apnea is consistently inconsistent and may not have shown up with a fragmented sleep study. In the older sleep study, most of the events were hypopnea with arousal until CPAP pressure was applied, then we saw therapy onset centrals. If the current study used a criteria of 4% desaturation to score hypopnea, or did not score the arousals, that would explain the discrepancy. We really don't have any good examples of your therapy results since you have never tolerated CPAP.
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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#56
RE: Chest/Lung Restriction - Impact on CPAP use?
Got it. Thank you!

Based on what you wrote, I wonder if the tech was only thinking in terms of whatever criteria insurance might use to consider me as having SA. This is too important to me to leave for insurance criteria. Seems like my mental and physical health would depend on treating whatever SDB I have. I'm willing to pay out of pocket if necessary and beneficial.

As soon as I have the new study results, I'll post them here!
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#57
RE: Chest/Lung Restriction - Impact on CPAP use?
Hi Guys, I finally got the report for the 1st night of the sleep study. Since they never put me on CPAP, I don't know how useful this is.

The 2nd night of the study is scheduled for the first week in April. The doc said they would try me on CPAP, BIPAP (if necessary) and then ASV (if necessary). So I'll post those results then. Hoping that will lead to be finally getting proper treatment!


Attached Files
.pdf   Sleep Study Feb 2022 Pages 1 to 3.pdf (Size: 901.23 KB / Downloads: 5)
.pdf   Sleep Study Feb 2022 Pages 4 to 6.pdf (Size: 620.5 KB / Downloads: 3)
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#58
RE: Chest/Lung Restriction - Impact on CPAP use?
Your test shows 4 CA and zero OA, but the events counted as obstructive hypopnea make up the majority of events. It's difficult to distinguish obstructive from central hypopnea, so I think the multi-mode titration is important. The hypopnea events may become CA with PAP therapy. The problem is that CA can be inconsistent over the period of a test and lead to a false finding of efficacy at some random CPAP pressure. We will want to look for a linear relationship of pressure and events. A non-linear result where apnea is apparently controlled after steadily increasing with pressure is a flag for a problem.
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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#59
RE: Chest/Lung Restriction - Impact on CPAP use?
I understand. Thanks.

Do you think that at the 2nd sleep study, it might help to show the tech my previous in lab study that indicated treatment emergent CA? With the goal being that I alert him so that he hopefully doesn't miss it.

I could also tell him I am considering purchasing an ASV outright if we can't get insurance to cover it ... so hitting the numbers to qualify for insurance to cover ASV is not the only goal.

Separate but related question ... is there any real reason I couldn't buy an ASV outright and self-treat? I'm almost tempted to buy one in case ww III breaks out. I have a migraine every single morning and I have to know if SA is the culprit.
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#60
RE: Chest/Lung Restriction - Impact on CPAP use?
ASV will solve the problems immediately as long as you don't have some kind of restrictive pulmonary disease we should be aware of. I forget why this thread has the title chest/lung restriction, and need to review. Anyway, we want to be sure there is no COPD, neuromuscular disorder that restricts thoracic function or obesity hypoventilation. If those are not issues and you are not in heart failure with left ventricular ejection fraction less than 45%, we can start looking for ASV and see how it works out. The price of entry can be more reasonable than you think. There is a RESMED S9 VPAP Adapt BIPAP #36007 Bi-level PAP Listing: #4270242 on the DotMed marketplace for $550 with 1,926 hours. This is the S9 generation ASV auto that has all of the same features as the Resmed Aircurve 10 ASV. With under 2K hours it is a fantastic deal. You could put all of the issues from CPAP behind you by early next week.
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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