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Having Centrals but not Diagnosed with Centrals, also having CSR's
#71
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
CSR is consistently inconsistent and numbers can vary wildly night to night with no changes. The only way to get consistent numbers is with an ASV machine we can tweak position pressure and EPR but not make a reliable impact. Before I moved to an ASV machine my AHI varied nightly between 1 and 30 depending on what type and duration of periodic breathing I had
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#72
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
I’ve supposed to go in for a new lab test; I just don’t know why ot hasn’t happened yet; it was kind ordered 2 weeks before I started the thread and it’s still not happened yet so... I have no options other than what I’m doing as I still am waiting on confirmation when the lab test is still going to happen.

That’s the only path except buying it outright and it’s been 3 months so far I’ve been waiting.
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#73
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
The goal of a sleep study at this point should be to prove that an ASV will resolve your condition. I the use of an ASV being requested for thin upcoming study?
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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#74
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
I saw my doctor the last on the 1st of July & I saw her again 3 weeks before the last appointment..’

At the first appointment, she said tha the algorithms in the machines are not reliable and that I’m not having Centrals because my  “at home sleep study” (set up by the hospital, I just had to wear there machine and 50 cables at home while I slept) didn’t show centrals apparently. 

At that time I only had the Resmed data on me and she refused to look at the data through Oscar or rescan because her software “does some cleaning up of Artefacts that shouldn’t be there”.

So I booked in 3 weeks later and took in (because I back every thing up) 6 SDCards with each different machine I’ve had on them separately to load into her system.

Her response was that my Centrals are not “clinically relevant” and are probably a fault in the machine (replaced it 3 times; the latest Philips is unopened in its box).

So instead she has booked me in for a “titration study” - because again, my doctor doesn’t believe that my centrals are “clinicially relevant” or evening perhaps real.

So yeah no, it’s not got anything to With use of an ASV machine...

Hurts waiting this long and nothing happening, she won’t even return my emails with so the above graphs of central dominant sleep apnea..

but no, titration study - if it even happens.
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#75
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
I would tell this doctor that these CA are in fact relevant in that they disrupt sleep. You are the patient not her. So when she says "CA doesn't matter" is the part that isn't relevant. If you're able to change docs this sounds like a good idea. CA blindness is a common disease with "sleep expert" doctors. The amount of decisions with these experts is up there with the weather man guessing at the snowstorm that never develops. Except with these doctors guessing and stumbling around is that your health is at risk. If me, I'd throw a big red challenge flag and make the doc prove the CA doesn't hinder your sleep. Better is to hit the EXIT door and don't look back. See ya Dr. Quack!
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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#76
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
Also, if you had a home sleep test without CPAP, you may well be experiencing complex apnea (pressure-induced centrals) now that you're on CPAP. Those wouldn't have shown up before. They should show up in a titration study.
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#77
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
(08-08-2020, 12:16 PM)sawinglogz Wrote: Also, if you had a home sleep test without CPAP, you may well be experiencing complex apnea (pressure-induced centrals) now that you're on CPAP. Those wouldn't have shown up before. They should show up in a titration study.

After the testing @SleepRider and I have done - the fact I’ve had Centrals for... since I started CPAP more than 300+ Days ago and have always been central dominant... 

My understanding is that if it was pressure induced, we should have seen a big reduction as my pressure reduced or it should have reduced over time. Neither of those 2 things happened.

I get your point about the doctor; at the moment I don’t know what to do. But thanks for sharing.
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#78
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
Primalyogi, we have done what we can to optimize CPAP by reverse titration. The time has come to make a decision. You can buy the Resmed Aircurve 10 ASV from Supplier #2 for about $1349 USD plus $99 shipping. It will solve all these problems. I don't know what your costs of more testing and failures will be, but that is the best deal I can point you towards. Since you are in AU, they are not going to be concerned about prescriptions or other crap. If you just want this to end well, then pull the trigger and enjoy the right decision. Your doctor is completely ignoring the many studies that have compared PSG to the machine efficacy data. It is indeed accurate. There are some misses from time to time, but you have consistently had central events. This is a message neither your doctor or you should ignore. In the following references "ApneaLink" is Resmed efficacy data transmitted to DMEs and has less resolution than the SD data you are using. In other words, the CPAP data is accurate as compared to PSG.
https://link.springer.com/article/10.100...014-1048-z
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1978315/
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#79
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
Thank you for that; I’m going to have a look at those studies so I can come prepared to my next appointment - with my current or with a new doctor.

I can’t buy an ASV without a prescription I’m told; I checked that out when I bought the resmed (as I had a prescription in order to purchase the CPAP and asked if I could just get an ASV and was told that I could only get it by prescription)

So anyway; I have to do a lab study and hope for the best.

Machine History
[attachment=25409]
+ the Resmed Airsense Autoset 10 for the last 52 days

Dreamstation (266 days)
[attachment=25407]

Resmed (52 days)
[attachment=25408]
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#80
RE: Having Centrals but not Diagnosed with Centrals, also having CSR's
(08-08-2020, 07:28 PM)Primalyogi Wrote:
(08-08-2020, 12:16 PM)sawinglogz Wrote: Also, if you had a home sleep test without CPAP, you may well be experiencing complex apnea (pressure-induced centrals) now that you're on CPAP. Those wouldn't have shown up before. They should show up in a titration study.

After the testing @SleepRider and I have done - the fact  I’ve had Centrals for... since I started CPAP more than 300+ Days ago and have always been central dominant... 

My understanding is that if it was pressure induced, we should have seen a big reduction as my pressure reduced or it should have reduced over time. Neither of those 2 things happened.

I get your point about the doctor; at the moment I don’t know what to do. But thanks for sharing.

Pressure-induced centrals can happen at very low pressures. If you're getting too little CO2, your respiratory drive falls off a cliff. For people who have this issue, it doesn't take much to throw it off.

As to whether the machines are accurate, the biggest discrepancy between a machine-scored "clear airway" apnea and a true central has to do with your sleep stage. If you have a pause in breathing due to sleep transition, that wouldn't be scored as a central apnea in a PSG (since they can see your EEG), but a CPAP has no way to tell that, so it would flag it as a CA. Their distinction between CA vs. OA/H is quite good.

Unless you're waking 6 times an hour, your CA rate suggests actual centrals.

If you're considering ASV, you should definitely make sure you don't have a cardiac contraindication. EERS is an option if ASV is ruled out.

And, ultimately, if doesn't matter if the machine says your numbers are good: if you're not getting restorative sleep, you need a change in treatment!
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