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High CA in PSG and with Bipap
#31
RE: High CA in PSG and with Bipap
(11-07-2017, 11:29 AM)J Duffy Wrote: Hello Dave,

How did you resolve your high CAs?

Thanks,

Joe

After failing BiPAP earlier this year, I had another PSG for an ASV machine. I'm on an ASV machine now, running EPAP 9-13 & PS of 3-12. Average AHI is 2.0 or a bit less. I've chosen ResMed ASV BTW.

Dave B Coffee
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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#32
RE: High CA in PSG and with Bipap
Awesome, Dave!

https://imgur.com/Rh8Wppz
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#33
RE: High CA in PSG and with Bipap
Well, usually we celebrate a 50% reduction in AHI. You still have a way to go to be under 5 AHI.  We can let this go another day, or cut PS to 2-3.  You will probably need ASV to completely knock this out, but at least events look a bit more reasonable here, and no periodic breathing in this chart.  I think the hypopnea and CA are about equal, and that may be as good as it gets. 

[Image: Rh8Wppz.png]
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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#34
RE: High CA in PSG and with Bipap
In the interest of full disclosure, and for improvement sake, I did have AHI under 5 on 11/3/17 and 10/29/17.  In both cases, and most days, the CAs and Hyps are nearly equal.
I will try another couple of days with the PS at 2-4, and then try to adjust again.
Any other tweaks to try will be helpful.
I have had some really good days in the last 1.5 months.  Many with 0 OSAs and CAs and Hyps in the teens, but I got impatient when the trend changed.
I guess I always expect straight line change, but like weight loss and most other things, the change is a jagged line.
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#35
RE: High CA in PSG and with Bipap
https://imgur.com/tQ0Yub3
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#36
RE: High CA in PSG and with Bipap
My experience with central apnea and profiles similar to yours is that results are consistently inconsistent. It is hard to draw any collation between settings and consistent therapy results.

For individuals on CPAP I have observed that most do best with fixed low pressure, no Flex or EPR, and for BiPAP, basically the same thing using CPAP mode or no pressure support. I don't know if you're that adventurous. The thing is, CPAP and BiPAP are treatment devices for obstructive apnea. Some central apnea patients do get some relief,and a few even demonstrate efficacy. Those results are unpredictable, and you never know who it will be. I tend to see you as someone that has to fail at bilevel to reach the next stage of treatment, which is ASV, so the objective is to be as comfortable as possible. I'm not confident that you have a supportive medical team, and that is something you have to give some consideration to changing.
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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#37
RE: High CA in PSG and with Bipap
Sleeprider,

I REALLY appreciate the guidance.  I will push hard for ASV when I see the provider on 12/3/17.  I am happy to know that I can modify the settings on the Dreamstation, unfortunately I have a lot to learn!  I think FLEX is turned ON, but I don't know what that is.  I am adventurous and willing to modify all the settings in the interest of reducing the AHI.  Although the PS of 2-4 and the other setting changes did not have an immediate drastic effect, I think I slept more comfortably, but who's to say if that was placebo effect.
1. If you have more setting changes, such as Fixed, etc., fire away.
2. What are Flex and EPR?
3. Can I purchase a used ASV without prescription? (and do you recommend such?)
4. How well does Inspire reduce AHI?  Any people on apneaboard with it?
5. What does no PS mean, and is it recommended?

Thanks,

Joe
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#38
RE: High CA in PSG and with Bipap
Joe, I don't have the depth of knowledge as those whose advice you should listen to in order to maximize your therapy.

All I have is my personal experience, having charts during my short-lived (5 night) Bi-level trial that looked very similar to yours, with a similar mix of apnea types and a similar range of AHIs (from about 16-8).

I don't know how you feel on Bi-level with all those Centrals, but for me, it was murder (perhaps I'm just sensitive?). I was happier on APAP (not that it was a solution).

Getting ASV has made a huge difference for me. For the first time in memory, I feel I'm getting restorative sleep. This positive experiences certainly biases my response when I see charts that remind me of my own. But....

Bill

ETA: We cross-posted. In a similar position, I pushed. I expected the sort of resistance you may get, but when I had the second sleep study (using ASV) all doubts were erased. Best wishes to you!
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#39
RE: High CA in PSG and with Bipap
Joe, it would be good to see a baseline result in CPAP mode. This is really easy, but if you find it uncomfortable or your events are higher, just switch back to Bauto. To do this, just switch your machine mode to CPAP, and set the pressure at 6.0. It may be better or worse, but we try it to get it out of the way as a simple pressure solution.
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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#40
RE: High CA in PSG and with Bipap
Thanks for your input, Bill!
I welcome anecdotal evidence.  That is what I'm here for.
When people on this board tell me that ASV is relevant to my Sleepyhead data, I will follow up on that.
I have confidence that this issue will get solved.  I will continue to work at it.
I am interested in Inspire, but I don't know if it lowers AHI to under 5.

Joe
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