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Getting a machine advice
RE: Getting a machine advice
My understanding is that EERS use is an attempt to bring your CO2 level closer to proper balance and hence eliminating CA from happening. At least to lessen frequency.

Stoppage of breathing to wait on CO2 to build up is a CA.
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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RE: Getting a machine advice
All that makes sense. 

I guess my question is why do the Centrals cause an arousal?  Why doesn’t the return of adequate CO2 bring breathing back without having to wake me up or disrupt my sleeping?
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RE: Getting a machine advice
I guess that becomes a $64K question. I wish I had the answer for you. Apparently the CA affect you in different ways than mine do. I guess my arousal rate is lower.
Dave

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Standard OSCAR Chart Order
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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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RE: Getting a machine advice
Why do the centrals cause an arousal?

We're speculating just a bit here, but the way I understand it, with the additional ventilation of CPAP therapy, your CO2 level slowly drops and reaches the apneic threshold. Your respiratory drive diminishes or stalls. CO2 builds pretty rapidly as you stop breathing and it doesn't have to get too far out of balance to not only turn your respiratory drive back on, but also give you a nice jolt of adrenaline to force a recovery breath and cause an arousal. This stuff is not perfect and while you gradually stop breathing with this kind of idiopathic CA, the re-start can be accompanied by a bit of wheel spin. With EERS we try to keep enough CO2 in the system to avoid the shutdown, and the need for a re-start.
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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RE: Getting a machine advice
what 's the machine
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RE: Getting a machine advice
Last nights results attached.  Terrible.  I am going to call and see about getting my appointment that is scheduled for Friday moved up.  This obviously isn't working.  I feel way worse than before starting CPAP.  It has been almost a month now.

When I talk to the doctor to shoot for ASV ASAP, I know he is going to say, during your sleep study you had almost all Hypopnea w/Arousal and the machine has fixed that, now I am getting almost all Centrals.  This must be treatment emergent and we need to give it more time.  How do I respond to this?

SleepRider mentioned that he thought that the Hypopneas during the sleep study were actually Central in origin and not Hypopneas and that seems to be the case.  I need to be able to talk to this point. 

Any other recommendations?  I know I will mention how tired i am during the day (worse than before starting CPAP) and that my numbers are not good at all, what else is there?  That should be enough and it may be enough i just want to have as much in my back pocket as i can.

If he mentions BPAP I will make sure he know that my numbers shot up during the sleep study when they switched to BPAP, and I have those numbers.

I do like the sleep doctor, he took a lot of time with me and seemed very knowledgeable.  But I have not talk to him since i go the results from my original sleep study and that was back in January.

   
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RE: Getting a machine advice
I will let others with more experience in the intersection of ASV, doctors, and insurance address that, but I'll just mention a tack I took with a related issue.

When doing my APAP trial, I came to the strong belief I would do better on a bilevel. 

When I met with the doc, though, she was dismissive, largely because of my really low AHI. 

After an unproductive back-and-forth, I asked about the feasibility of doing an in-lab titration study, that would include assessment of bilevel. 

That broke the log-jam, and she agreed that was a sensible approach. The study demonstrated objectively that I would benefit from the bilevel.

You might keep that as an option, then. Explicitly ask them to titrate to eliminate RERAs (because your ongoing fatigue leads you to believe they are not currently), and to evaluate bilevel and ASV to see which best does that without causing centrals.

If you need ASV, that study will almost surely show that bilevel can eliminate the RERAs in a way the CPAP cannot, but that in doing so, your CAs will go way up. That would provide justification for ASV, I would assume.
Caveats: I'm just a patient, with no medical training. And my first experience with xPAP was fairly recent. So I'm somewhere along the path of a steep learning curve.
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RE: Getting a machine advice
Oh, you already did a titration study, I guess. Not sure how that would change the options for you. Maybe a specifically ASV study, to see if better results?
Caveats: I'm just a patient, with no medical training. And my first experience with xPAP was fairly recent. So I'm somewhere along the path of a steep learning curve.
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RE: Getting a machine advice
Maybe a titration that involves some time on BPAP (which I predict will look nasty due to CA aspects) and ASV time on the same test.
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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RE: Getting a machine advice
I would estimate at least half of all members wtih this problem obtain their first ASV machine via private party purchase and then show the doctor the results they couldn't seem to come to grip with. Your discussion with the doctor should start with the certainty that these results are real, as are your perceptions of the therapy ineffectiveness. If he cannot chart a path to ASV, you need to go elsewhere because his problem won't change, and it IS HIS PROBLEM not yours. You can totally pull out the stops and ask him how many or what proportion of his patients are treated for central or complex apnea, and what therapy he prefers for those cases. You can assume he will use the same approach for you, if and when he makes the logical leap a change in therapy is needed. If he says he has no or very few patients with complex or central apnrea, or if he says he prescribes BiPAP ST, hit the door, he's hopeless and cannot help you. I hope you hear the right answers. You know what they are. Now you have to ask the right questions. As an overarching observation, your sleep under CPAP therapy has not improved from pre-therapy conditions. That is a failure and deserves reconsideration of the approach. You are looking for your doctor's path forward on the approach to be used and how to get there. A good start would be scheduling ASV titration.
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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