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[Diagnosis] New, confused , Clueless
#1
New, confused , Clueless
Hello, My name is Eric And I have just been diagnosed Where is central nervous system Sleep apnea And secondary obstructive sleep apnea. I have been reading through some of the posts on this board And frankly just very confusing There's so much information I don't know where to begin. I will be attaching my sleep study If anybody wants to look at it I don't care if you are doctors or not. Feedback would be appreciated. I do not have insurance and I may be able to get a decent price on an older generation Respironics Bipap auto SV. One of the things that I am most curious about this moment Is can you use nasal pillows This type of machine Or does it have to be a full face mask. Thank you in advance for any help that you can give. 
Eric


Attached Files
.pdf   sleep study_01212019.pdf (Size: 280.76 KB / Downloads: 58)
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#2
RE: New, confused , Clueless
Welcome to the forum.

If you have a copy of your diagnostic study please post that.
This study is a summary, the full study should have charts with it.

As summaries go this is one of the better ones.  It does  describe the Central Apneas starting at 6 cm and apparently absent at 4 and 5 cm
This does indicate a Treatment-Emergent Central Apnea.  Frequently these will diminish within about 2 months.  Seeing you full diagnostic study would indicate if you had any Central Apneas then.  If you had them it throws a question on this being Treatment-Emergent.  The Diagnosis on your original study indicates Obstructive Sleep Apnea and no mention of Central.  Frequently on review we see significant Central Apnea with Obstructive being more dominant. In other words, the summaries frequently do not tell the whole story.

Note the Diagnosis from this study is Obstructive Sleep Apnea.

The Sleep Clinic is on your side, they recommended an Adaptive Servo-Ventilation, the correct class of machine for Central Apnea, Even suggested that you titrate at home.  This is good because it spares you the cost of another Sleep Study.  

Their conclusion was OSA and Treatment Emergent Central Apnea which is the current term for Complex or Mixed Sleep Apnea complete with an additional diagnosis code.  This is good.

You want a machine that is compatible with Sleepyhead.  So please get the model number of your "older generation Respironics Bipap auto SV" and ask here if it is compatible with Sleepyhead.   Most here prefer the ResMed Aircurve ASV.  They will help you find a good priced compatible machine.

Fred
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#3
RE: New, confused , Clueless
Thank you for getting back to me so quickly. I have attached the first study that I had done. I'm not sure if this is correct but did you say that there might be somebody here on the form that can help me procure a machine? Looking at my first study it says there are only two central apneas. So if I'm to understand correctly that treatment-emergent apneas mean that they would not have been found without treatment? I will get the model number of the machine tomorrow and hopefully find out if it's compatible with sleepyhead. Thanks again.
Eric


Attached Files
.pdf   PSG_01212019.pdf (Size: 214.43 KB / Downloads: 33)
.pdf   bipap rx_01212019.pdf (Size: 110.22 KB / Downloads: 27)
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#4
RE: New, confused , Clueless
I'm going to have Sleeprider double check your doc and Rx but it looks like you are good.

Your initial study had a total of 6 central events, you did not count the Mixed but that is an insignificant amount of centrals.

Could you redact (if you care) and re upload your docs.  I don't like the idea of full name and birthdate existing on the net.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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#5
RE: New, confused , Clueless
Eric, your study clearly calls for ASV as the best option, and I agree. An ASV bilevel can provide therapy to prevent obstructive apnea using enough exhale pressure (EPAP) to keep the airway patent. It then uses a minimum  pressure support for comfort, usually 3 cm and acts like any bilevel until a central apnea or hypopnea or other volume variation occurs; at that point it can provide much more pressure support to support the breath or even cause a breath.  The titration protocols are pretty simple and I'll include one below.  The question on a mask is the easiest. You can use what works best and is most comfortable. Do not listen to the fable that ASV requires a full face mask. Many of our ASV users have the Respironics Airfit P10 pillows mask and it works fine.

The problem with ASV is the cost. Going through DME channels you could pay $4000, but fortunatly, depending on your budget, there are alternatives.  You mentioned a BiPAP Auto SV.  I will assume this is a System One (DS960) auto ASV and while it does provide good treatment for complex (mixed) apnea, I have dealt with many people and machines starting on ASV and I tend to see much better results with the Resmed machines.  If you will be specific on the costs you are seeing, let me know and I can probably tell you if it's a good deal.  If you go this route, we can help you get setup and optimized.

You can get a brand new Resmed Aircurve 10 ASV from Supplier #33 and Supplier #2 for less than $2K.  Both of those suppliers also sell guaranteed used machines. Supplier #2 is quoting $1749 on a lightly used Aircurve 10 and $2149 for new.  You can call Supplier #33 for a quote.  The Resmed S9 VPAP Adapt SV Auto is also a good machine, but you must get model 36037 which is automatic, not the older 36007 fixed ASV. Either vendor will take that sleep study in lieu of a prescription, or if your doctor is willing to write the script,  that also solves the problem.

Here is the titration protocol, and don't hesitate to ask any questions you might have.

[Image: attachment.php?aid=4210]
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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#6
RE: New, confused , Clueless
Good morning, I have received my machine and still getting used to it. I downloaded sleepyhead.  After transferring data to the computer, reinserting the card, I have to erase the data. Is that normal? I have tried different cards. Also, I am using a Micro sd with the adapter. Would that make a difference?  I have the resmed s9 auto. this is the file from the 16th I was able to manage 4 hours of sleep. I took a screenshot. Is that how you are supposed to do it?
Thanks, Eric
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#7
RE: New, confused , Clueless
The Resmed S9 does not tolerate system files that Windows writes to the SD card and forces a reformat to remove them. This issue does not exist with the S10 and other machines. You must lock the SD card before inserting it into your computer. There is also a way to prevent the computer from writing system files. Crimson Nape may be along to remind us how to do that.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files

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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#8
RE: New, confused , Clueless
Ok, thanks. I did lock it, but that did not help.
I have a Dr appointment this week and he wants to bring my card. I guess I will just print the reports I have.
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#9
RE: New, confused , Clueless
(02-17-2019, 12:02 PM)shrty Wrote: Ok, thanks. I did lock it, but that did not help.
I have a Dr appointment this week and he wants to bring my card. I guess I will just print the reports I have.

Shirty, I use the following windows CMD file to 'Clean UP' my SD card before inserting back into the S9 It assumes my SD card is the D: drive and I call the Batch file 

SD Cleanup.cmd

the contents of the CMD file is as below double click the cmd file with the SD card in your PC remove when prompted (Just pull it out don't eject the card)

@echo off
echo This will Remove hidden files from the D Drive
pause
D:
rmdir /Q /s "\System Volume Information"
echo Now pullout the SD card
pause
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#10
RE: New, confused , Clueless
I am sorry, I have no idea how to do that. My sd card shows up as "F" is this some kind "dos" thing?
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