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Help for father
#21
RE: Help for father
Yesterday afternoon my father and I met with his doctor.  I am starting to think he is a very good doctor.  He was happy to see the OSCAR stuff I had emailed him.  He likes data.  He liked to see the SpO2 in particular.  

He asked us to bring the physical machine and he made changes to it in the office (usually the DME does it through the modem).  He started with what I had good luck on - 13/8 and Trigger = high, Cycle = low.  He put the machine on VAuto mode.  (I don't know if that is useful in this case but it is worth finding out.)

He knew about SleepyHead to some extent, which I guess is the old name for OSCAR?

He asked me to collect more data and come back in 2 weeks.  He likes the details from OSCAR much more than what he gets through the DME - he showed me the plots from the DME.  I am to bring my father to the appointment if he is not feeling well, but otherwise just come alone with data.

He said not to make changes more frequently than every 2nd or 3rd day, but if I see obstructive apneas to increase the EPAP by 2, and if I see hypopneas but no obstructives to increase pressure support by 1.

He also said if we want to try ASV he can order an ASV sleep study to see if it works.  I did not discuss iVAPS because I simply forgot.  I am upset with myself about that.  I shall discuss that next time.  I suppose the approach might be ASV titration first, iVAPS if that is unsuccessful, but I am just guessing.

There is a continued unsteadiness in my father's breathing.  I liken it to someone periodically revving a car that is idling.  This is explained by SleepRider in his 08-18 comment starting with the words "The zoomed images above ..."

The doc said it can take up to a couple weeks for people to acclimate to higher pressures and for centrals to drop.  He also said for complex cases like my father he is generally OK with AHI up to 10 if the oxygen looks good.  My father had AHI = 1.2 last night on the new settings.  

I will probably post more plots in 5 or 6 days and ask for opinions, but I want to let things settle for a bit at the new settings.  

We are not there yet but this doctor is willing to work with us and, between that and this community, I am feeling optimistic that we can (eventually) arrive at a good treatment for my father.  Thank you all!
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#22
RE: Help for father
A doctor that listens and takes an interest in improving therapy is solid gold. Sounds like a very productive visit. ASV and iVAPS are two different flavors of adaptive pressure support, with iVAPS offering much greater control, allowing the tidal volume and respiration rate to be set, while ASV uses a moving average of the patient's respiration rate and volume to set the backup automatically. This can result in inadequate treatment for individuals with COPD and other pulmonary disorders.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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