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Here are my first night results
#11
RE: Here are my first night results
I don't like to prematurely call these cases, but you will likely end up using adaptive servo ventilation (ASV), and until your get this higher level of positive pressure therapy (PAP), your apnea results will remain predominately central and very inconsistent. Or as I have often said, complex apnea is consistently inconsistent. You should start doing your homework on what it takes to obtain advanced PAP and plan on this being a significant project to self-advocate for the therapy that will work and give you the sleep and results you expect.

Somewhere between 8 and 15% of our members end up needed ASV. We wrote a wiki to help guide you on how to justify advanced PAP http://www.apneaboard.com/wiki/index.php...P_Machines
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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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#12
RE: Here are my first night results
I'll point out that the first step in justifying an ASV is to titrate to eliminate the Obstructive Apnea, then see where the Central Apnea is.

It is VERY important to keep a log of your symptoms along the way, (we have a tendency to skip those that we see most often)
Documenting the journey is important.

Complex Sleep Apnea[edit]
For Complex Sleep Apnea the Medicare requirements for issuing an ASV machine.

  • Titrate to minimize OSA, that is the obstructive AHI to less than 5 per hour. This typically is raising EPAP or pressure until obstructive AHI is less than 5 per hour, we expect this to make the Central and Complex Apnea worse thus failing the current treatment

  • Record the central apnea-central hypopnea index (CAHI) (looking for greater than or equal to 5 per hour and greater than 50% of total AHI)

  • Document the presence of at least one of the following symptoms: These symptoms are specifically noted by Medicare. These are key symptoms that we look for by asking "How do you feel?". Do not limit your answers to the following and do not fabricate the answers.

  1. Sleepiness, "How do you feel?"

  2. Awakening short of breath, "How do you feel?"

  3. Difficulty initiating or maintaining sleep, "How do you feel?"

  4. Frequent awakenings, or "How do you feel?"

  5. Nonrestorative sleep, "How do you feel?" Nonrestorative sleep is defined as the subjective feeling that sleep has been insufficiently refreshing

  6. Snoring, Can be documented on OSCAR

  7. Witnessed apneas Most of us have this one with our significant others
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#13
RE: Here are my first night results
Thanks for the feedback. Very helpful!

Now that I have 11 full nights under my belt I thought I would share the results/observations.

   

Observations:
1)      Choosing a nasal mask was a mistake because apparently I breathe through my mouth, as well as my nose.
2)      The only nights where I was able to get my AHI under 5 were nights that I took a sleeping pill.
3)      Nasal breathing, without the ability to mouth breath as well, makes me feel like I’m suffocating.
4)      I have enough data to surmise that my apneas are more complex in nature, not merely obstructive.
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#14
RE: Here are my first night results
Could somebody please help me with this?

I think an ASV would be the answer for me but I just wanted someone to verify this once and for all.

I'm also questioning why me CAs go down when I'm taking a sleeping pill. Is that normal?
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#15
RE: Here are my first night results
What kind of sleeping pill did you take? I've heard that Ambien can reduce CA's, but it had a caution about people with low ventilation. I can't find the particular thing I read before off hand but found another note about it:

"The use of zolpidem (Ambien) and triazolam (Halcion) may be considered for the treatment of primary central sleep apnea syndromes only if the patient does not have underlying risk factors for respiratory depression. (Option.) There is limited available evidence for this recommendation. Use of these medications may produce adverse effects, such as respiratory depression, and should be considered only as a last therapeutic option if other options are unsuccessful. Close clinical follow-up is required for patients using these hypnotic agents."

- https://www.aafp.org/afp/2012/1115/p968.html
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#16
RE: Here are my first night results
15mg of Temazepam (Restoril)
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#17
RE: Here are my first night results
Your results continue to reflect the results of your diagnostic sleep study in that you experience central apnea events at a rate nearly 5-times the rate of obstructive apnea. You have given CPAP a reasonable trial and failed to achieve efficacy. Your trend for AHI appears to be slowly decreasing, but results are very inconsistent, which is oddly consistent with central and complex apnea. I don't think there is a consistent relationship between AHI and taking a sleeping pill, however your need to cope with the continuing high AHI by taking a sleeping pill is unsustainable, and is something to discuss with your doctor.

I said over 10 days ago you need ASV, and see no evidence that would change my mind now. I think these facts need to be discussed with your doctor to determine how long he is going to continue to use a therapy that does not treat central apnea, when it was a prominent component of the diagnostic sleep study and continues to dominate your AHI and prevent efficacy with CPAP. Ask for a prescription for a Resmed Aircurve 10 ASV, and see what he says.
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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#18
RE: Here are my first night results
(07-22-2019, 09:42 AM)alshayed Wrote: What kind of sleeping pill did you take? I've heard that Ambien can reduce CA's, but it had a caution about people with low ventilation. I can't find the particular thing I read before off hand but found another note about it:

"The use of zolpidem (Ambien) and triazolam (Halcion) may be considered for the treatment of primary central sleep apnea syndromes only if the patient does not have underlying risk factors for respiratory depression. (Option.) There is limited available evidence for this recommendation. Use of these medications may produce adverse effects, such as respiratory depression, and should be considered only as a last therapeutic option if other options are unsuccessful. Close clinical follow-up is required for patients using these hypnotic agents."

- https://www.aafp.org/afp/2012/1115/p968.html

I added this to http://www.apneaboard.com/wiki/index.php...tral_Apnea wiki and added as a link in Central Sleep Apnea http://www.apneaboard.com/wiki/index.php...tral_Apnea

We are neither Doctors nor Pharmacists. Please talk to your doctor/pharmacist about all meds, both changes and new.


Central Apnea[edit]
"The use of zolpidem (Ambien) and triazolam (Halcion) may be considered for the treatment of primary central sleep apnea syndromes only if the patient does not have underlying risk factors for respiratory depression. (Option.) There is limited available evidence for this recommendation. Use of these medications may produce adverse effects, such as respiratory depression, and should be considered only as a last therapeutic option if other options are unsuccessful. Close clinical follow-up is required for patients using these hypnotic agents."
https://www.aafp.org/afp/2012/1115/p968.html (Updated Guidelines from AASM for the Treatment of Central Sleep Apnea Syndromes)
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#19
RE: Here are my first night results
Thanks you so much for your advice. Great response that I can take to my doctor and hopefully work with him
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#20
RE: Here are my first night results
(07-22-2019, 09:51 AM)Croweater Wrote: 15mg of Temazepam (Restoril)

I am not a doctor/pharmacist, but from what I am reading online and what appears to be happening with your sleep so far this also has potential to reduce central apneas. You should approach it carefully and consider if it has the potential to disqualify you from ASV or other advanced PAP treatment if you take it too often. If your goal is to get to ASV as quick as possible you probably don't want to use it, but I totally understand wanting to sleep better "right now".
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