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Dr wants me to do another Sleep test
#11
RE: Dr wants me to do another Sleep test
[attachment=32395 Wrote:Gideon pid='395522' dateline='1621628503']Likely because of the centrals.  These are like treatment-emergent central apnea.  If so they should go away in 2-3 months.  We should be able to improve them in short order.

We only need the first chart, the one with the sidebar.  We need a closer look at the central to confirm, a 10-minute view will do nicely.  Just click on the cluster of central until you have about 10 minutes showing on the flow rate chart (the duration is left side just on top of the flow rate curve). Screenprint and post it.

If I'm correct decreasing EPR will help, so please set EPR = 1 (currently EPR=3)tonight and post again in the morning.

Thank you Gideon for the help.  I am sorry but I might need some further explanation on getting it to show 10 minutes. ?‍♂️

(05-21-2021, 03:45 PM)SarcasticDave94 Wrote: OK, in this case there is merit in that other sleep test if the CA are the reason. As Gideon says, reduce EPR to 1 to attempt to address CA. You may want to increase Min pressure from 5 to 6 or 7 to address Obstructive events. Last, your Ramp is too low on pressure and is too long a time. I'd limit it to 10 or 15 min at most, but I have noted on others the Ramp can affect CA also. Best case on the Ramp is to turn it off.

Thanks SarcasticDave I will turn auto Ramp off tonight, change min pressure to 6, and as Gideon says change EPR to 1.  I will also study up on OSCAR so I can talk and answer better. Thank you much!


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#12
RE: Dr wants me to do another Sleep test
Try this, starting at an identical OSCAR view you've posted, notice the Events tab next to the Details tab. This is above the orange AHI number. Click on Events, there's a slider for the time amount of chart zoom.

Or

if you click on the chart then drag to highlight, you should be able to use left/right arrows to move the highlighted area across the chart and up/down arrows to zoom in or out. Example to show 10 minutes, zoom in to have 10 minutes worth highlighted.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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#13
RE: Dr wants me to do another Sleep test
Read this
http://www.apneaboard.com/wiki/index.php...Chart_View
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#14
RE: Dr wants me to do another Sleep test
    Thank you for your patience and walking me through it.  I have changed to 10min.
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#15
RE: Dr wants me to do another Sleep test
I had the worst night yet since starting treatment, but still got a little of 3 hours for you to view. Not due to any setting just could not get comfortable and ended up taking mask off. Its the first time I have done that.

   
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#16
RE: Dr wants me to do another Sleep test
I don't think this is treatment emergent central apnea, and you will be in need of ASV therapy. The question is, do you have insurance, or are you going to need some help to source an advanced PAP machine like ASV. ASV stands for adaptive servo ventilator. It work to treat both obstructive and central apnea. Unlike CPAP, it uses "adaptive" pressure support (the difference between inhale and exhale pressure) to maintain a steady respiratory rate and volume. During central apnea, you simply don't take a breath. This form of apnea is not the result of airway obstruction, but can arise from many different neurological problems, as well as happen to perfectly healthy people with no real cause for the apnea (idiopathic). The ASV detects that a breath is not occurring, or is not the normal volume, and increases pressure during inspiration to cause a full normal breath. It does not interfere with spontaneous breathing. So it helps when needed, and stands back when not needed.

It is important that your discuss your results with any prospective doctor, including the fact you need to arrange a titration evaluation that moves from bilevel to ASV. Otherwise you could end up with endless studies and no solution. If you don't have good insurance, the cost of the studies and the machine will quickly become unaffordable. Let us know. This problem of complex or central apnea is surprisingly common, and many members on this forum use ASV therapy. We can help you. ASV works automatically to nearly immediately solve all apnea problems like this resulting in AHI less than 2/hour. Most doctors will require an evaluation of hearth heath, specifically that left ventricular ejection fraction (LVEF) is greater than 45%. This is a measure of heart failure and is routinely done because a study of heart failure patients in 2015 SERVE-HF concluded that there was a risk of cardiac arrest in a statistically significant part of their cohort and the test was terminated, and this precaution widely adopted. Subsequent studies have pointed to poor study design, titration errors, poor patient compliance and older technology is likely to blame, and this risk has not been identified as an issue in the ADVENT-HF study.

There is a Craigslist listing for a Resmed Aircurve 10 Vauto for $350 where the seller indicates they also have a Resmed Aircurve 10 ASV for $375. This is in Red Oak south of Dallas, TX listing 7314844094. This is an immediate solution if you need it.
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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#17
RE: Dr wants me to do another Sleep test
Thanks Sleeprider for all the details. I do have good insurance so I should be good there. I will continue learning from this forum and keep my appt. with the doctor. Thank you for all the help!
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#18
RE: Dr wants me to do another Sleep test
Sounds great. You should be very direct that it appears your failure with CPAP, and strong presence of central apnea will require ASV. Try to have a discussion with your doctor concerning his plan to document and diagnose the issues, and move in that direction. Specifically ask about his experience with central apnea and ASV. There are a number of doctors that are uncomfortable with anything other than obstructive sleep apnea, or that will not prescribe ASV, even when appropriate. It's best to just get that concern out of the way. You may as well know that many doctors poorly acquainted with central and complex apnea will try to prescribe ST bilevel therapy (spontaneous timed). This is not an appropriate therapy, and if it comes up, we will discuss that in more detail.

This link is for the Resmed Clinical Titration protocols, and will help you understand the titration process, as well as the different types of machines and how they work. https://document.resmed.com/en-us/docume...er_eng.pdf As you have time, please read and ask any questions you have. Doing this homework will prepare you to discuss these issues on a completely different level with your doctor.
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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#19
RE: Dr wants me to do another Sleep test
Agreed, and I've not mentioned, start making a daily sleep log including CA causing unrest, fatigue, and whatever other symptoms you've got. Best answer is you'll suggest to doc you need ASV titration and you get it. This leads you to choose the ResMed AirCurve 10 ASV. BTW whichever mask you want works with ASV, so you don't need to mask search all over.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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#20
RE: Dr wants me to do another Sleep test
(05-22-2021, 11:42 AM)SarcasticDave94 Wrote: Agreed, and I've not mentioned, start making a daily sleep log including CA causing unrest, fatigue, and whatever other symptoms you've got. Best answer is you'll suggest to doc you need ASV titration and you get it. This leads you to choose the ResMed AirCurve 10 ASV. BTW whichever mask you want works with ASV, so you don't need to mask search all over.

Thanks SarcasticDave I will start tomorrow with a sleep log.  Great idea.  Again I really appreciate you all guiding me through this.
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