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Getting a machine advice
#91
RE: Getting a machine advice
I think you have arrived at the crux of the matter.  If CPAP does not improve sleep disordered breathing better than baseline, or even makes it worse, what is the answer?  In your case the answer is likely to be ASV if your doctor can wrap his mind around it.  Unfortunately, sleep professionals have a high incidence of closed mindedness.  Before you get too frustrated, remember it's only been a few weeks and your follow-up appointment is still pending. You have followed your doctor's prescription, and tried reasonable variations in an effort to optimize these results.  Aside from AHI, your most important metric to communicate to the doctor is how you feel.  If the answer is "not better", then you need to start complaining. It is the only avenue I know of other than self-funding to get to the right therapy...well there is another way and you probably have the talent to pull it off.  Your machine can be modified.
Sleeprider
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#92
RE: Getting a machine advice
I will definitely talk to my doctor when i have my appointment in 2 weeks.  

You mentioned self-funded?  How could i go about getting an ASV without a prescription if my doctor won't go along with it?  I don't think i am comfortable performing the procedure to change my machine out.  While i am an engineer I do not work with computers AT ALL.  More hands on machined component manufacturing and strictly 'by the book' aerospace.  No electronics or computers.

Second question, i did read that ASVs are not to be used with certain heart issues.  Is this something someone should be checked for before starting ASV?  I am not aware of any heart issues but I have also never been checked and have had untreated apnea for a number of years and the fact that the apneas i am having are central in nature could be caused by a heart issue, correct?
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#93
RE: Getting a machine advice
Normally you will still need a script. However, sometimes CPAP, ASV, etc. are sold on Craigslist or the like. If you're self-funding "Doc write me a script for a ResMed ASV, patient preference on mask, default pressure, Dispense As Written. I will buy it myself." We will help you self-titrate.

The SERVE-HF I think is what it's titled. You would be required to get a echocardiogram if going via insurance. Do you have known heart issues like congestive heart failure or other? You won't need to think very long, you'd know if you had something wrong. If the test is done, you must get a 45% or higher LVEF number. Mine was 55% 3 years ago and I have an ASV. The test can be described if you wanna know.
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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#94
RE: Getting a machine advice
Heart issues specifically, congestive heart failure with left ventricular ejection fraction less than 45% (LVEV<45%) was identified in the SERVE-HF study (2015) as a risk factor for ASV. A new study, not yet published, SERVE-HF, looks like it will up-end that counterindication. At this point if you benefit from ASV, it is likely there is less stress on your heart than enduring the kinds of events that were associated with the identified cohort of the heart failure study. There is a near 100% probability you are not part of that cohort, with what I have seen of your results on CPAP. Out of pocket means paying for a private party deal and not using your doctor or insurance. It is extremely common because the medical system has been designed to give you the cheapest possible therapy, and not informing patients of alternatives and frustrating them when they pursue higher cost options.
Sleeprider
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____________________________________________
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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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#95
RE: Getting a machine advice
So my CA numbers appear to be coming down.  Does this lend itself to the fact that maybe this is treatment emergent and they will keep coming down?

I definitely am getting used to wearing the mask at night.  I had a couple occasion where I woke up and thought I didn't have it on and literally had to feel my face to realize it was on.

Still not feeling a 'boost of energy'.  Still holding out for that.




.docx   Sleep Apnea Stats.docx (Size: 326.73 KB / Downloads: 9)
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#96
RE: Getting a machine advice
Improvement of CA events is not uncommon, and is the reason insurance companies insist that CPAP be tried and failed before other, more advanced machines will be approved. Improvement usually occurs in people with no diagnosis of CA and treatment emergent events, and sometimes occurs in those with mild to moderate idiopathic central apnea prior to therapy. It's not very predictable, but your use of constant pressure is helping this to progress in the right direction.
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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#97
RE: Getting a machine advice
So my numbers continue to trend in the right direction, but am still not feeling like I am getting great sleep.  Still very fatigued during the day.  It seems different from pre-CPAP.  I was more 'anxious tired' before CPAP (if that makes any sense).  Post-CPAP I am more tired, like I could actually fall asleep tired.

I do notice that I seem to wake up a lot in the middle of the night.  Prior to CPAP I would very rarely ever wake up before my alarm clock.

There is no particular reason for my frequent wake ups.  I don't feel air blowing on my face, I don't feel uncomfortable and generally I fall right back asleep.

I also cannot for the life of me sleep in past 7-7:30.  No matter what time I go to bed.  This has never happened to me before.  Prior to CPAP, If I didn't get to bed until 1-2 in the AM I would sleep until 9-9:30 no problem always got my 8 hours of sleep.  Now it is like my internal alarm is set for 7:15 and even though I am still very tired in the morning I cannot fall asleep anymore after 7:30.

Any thoughts here?  I have been trying to sleep on my side more which is more difficult with the mask on.  I was thinking of getting the Contour CPAP Pillow 2.0.

Any other recommendations?  I am still working on optimizing my therapy and will work with my sleep doc at my appointment in two weeks. 

Just wondering if anybody has any non-therapy related recommendations.
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#98
RE: Getting a machine advice
I can't think of anything to help at this time. Unfortunate, but what you're going through is pretty much par for the course when dealing with apnea and sub-par sleep. I had to deal with it before an ASV, and now that ASV isn't right for my needs I deal with it again. If you get all aspects of apnea therapy to be personally optimized, it does pay off. No comment on the pillow as I don't have a specialized one, but it's on the shop list after a new machine is delivered.
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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#99
RE: Getting a machine advice
Last night I had a total of 1 Hypopnea for the night and all the other events were CAs.  I am down to a pressure of 6 without any EPR. I was thinking about dropping the pressure down slightly to see if i can't get rid of these CAs.

Background: Diagnostic Sleep Study (No CPAP):
OA: 5.1
CA: 2.1
Unclassified: 8.8

I've dropped my pressure from 8-7-6.  Seems like the CAs dropped off from 8-7, but have stayed fairly steady at 7 and 6, maybe slowly trending downward.

 See chart attached that shows the trend for OAs and Hypopnea and Centrals.

Since i am already at a pressure of 6 I know we are probably getting into where we don't want to drop too much.  I was thinking about just going to 5.8 at least for a few nights and reevaluate.

Thoughts?

It seems this is working it is was toward ASV, but i want to eliminate all possibilities before i talk to my sleep doctor next Friday.  I just thought for sure that when I started dropping the pressure I would see the OAs and Hypopnea start to creep up but the opposite has happened which is very confusing to me.


     
.docx   Sleep Apnea Stats.docx (Size: 817.91 KB / Downloads: 0)
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RE: Getting a machine advice
In a big way, questions on comfort need to be factored in. Is this comfortable as is? What setting produced acceptable comfort levels? Was that good enough for you? Does it get better the more you're on it at whatever setting does help you feel the best? Comfort levels are personal, as in you determine if it's good enough or if it fails to meet expectations. Since doctors mostly are blind to CA, but they sometimes see and respond to comfort complaints, your focus needs to be on attainable and reasonable comfort. If you can attain a reasonable comfort level with what you have, make it so. If it's not attainable within reasonable consistency, then consistent complaints need to flow.
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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