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How to identify central or complex apneas using software
#51
RE: How to identify central or complex apneas using software
Hi Sleeprider....   Thanks

I concur with all of the points you've made - no argument here.   Out of all of them including the primer, another change of mask is all that remains.  I do agree that everything at the moment hinges on stopping leaks and gaining mask pressure.  Unfortunately, except for once last night I was not aware of any leaks occurring.  That only means I was not aware of leaks.  It is very frustrating.
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#52
RE: How to identify central or complex apneas using software
Hi Sleeprider. I have read and re-read the fitting primer and have readjusted / refit the F20 Air Touch mask once again. The ResMed Mask Fit utility shows good - it has done that in the past also. I'll see what those changes product tonight. TNX, c! / clif
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#53
RE: How to identify central or complex apneas using software
Night of 05/27/2019 too poor to post.   I have exchanged mask for larger mask  for use tonight.   AI last night 18.6, AHI 28.4.   Stay tuned until tomorrow.
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#54
RE: How to identify central or complex apneas using software
Sorry, I have not been following through the Memorial weekend very closely. Good luck with the adjustments. I can't say if the problem is mask size or shape (model), but leaks are not the end of the world if you don't even notice them. My priorities for your treatment would be to get mask fit as good as possible, but more important is to start working the doctor towards ASV therapy. I just don't see how this ST is going to do the job.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
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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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#55
RE: How to identify central or complex apneas using software
Change of full face mask from medium to large did not improve results.   ResMed Mask Fit showed fitted.  Perceived good fit with no major leaks.   Showed following results.   5/27 = medium mask / 5/28 = large mask.

5/27/19 = 18.6 AI  10.2 HI  28.8 AHI  Medium mask

5/28/19 = 18.3 AI  9.3 HI  27.6 AHI    Large mask

No significant differences in leaks between medium or large mask.

Results using ResMed Air Touch on par with using Respironics DreamWare mask.

Sad   c! / clif
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#56
RE: How to identify central or complex apneas using software
As you know, the ultimate answer appears to be ASV therapy.  You most effective "gatekeeper" to being approved for ASV will be your pulmonologist rather than a sleep lab, particularly as you have indicated the doctor is a reclusive, disinterested money monger.  You were clearly prescribed the wrong machine, and your pulmonologist has more history to backup the argument that there is a medical need to change treatment approach, or can help document health changes that support that view.  The sleep studies you have already completed document central apnea as a prominent feature of your sleep architecture.  These PSG studies really need to be consolidated into a meaningful record that you and your pulmonologist can share at any time, so be sure you both have complete detailed study results.  Again, the sleep center has not demonstrated the ability to correctly identify the most effective treatment for the conditions they diagnosed.  

It would be an excellent idea for you to go to the Resmed Titration Guide which I think I linked to earlier https://www.resmed.com/us/dam/documents/...er_eng.pdf , and print the sections of ASV pp 28-31 vs ST and iVAPS pp 33-40, then highlight the intended uses for each device (Which Patients is ASV suitable for?).   Then write a brief discussion of what you think the correct therapy approach is, and why ST is the wrong choice.  Also include the titration protocol for ASVauto. It is really simple as shown below.  I think you should create a two-column check list comparing the conditions intended to be treated by ST and those treated by ASV, and you and your doctor can put the checks in the correct column. For example ST treats, COPD, Obesity hypoventilation, Thoracic paralysis or disease, vs ASV for central apnea, complex apnea, cheyne-stokes or periodic breathing. Compare your charts to what is discussed in the Titration Guide.

Encourage your pulmonologist to prescribe the ASV with the default titration settings of EPAP min 4.0, EPAP max 15.0, PS min 3.0, PS max 14.0. You can use the OSCAR or Resscan software to make decisions on optimizing the therapy according to the titration decision tree below.  You can discuss with the pulmonologist how you have used the titration guide to try to make ST work, but of course since it is the WRONG therapy, you could only get so far. The use of ASV and adjustments of settings are simple, so you and your doctor can figure this out using the auto algorithm and data, without enlisting the sleep lab at very high cost.

[Image: attachment.php?aid=4210]
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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#57
RE: How to identify central or complex apneas using software
As an update, after another sleep lab titration session, I was diagnosed with CENTRAL SLEEP APNEA code G47.31.   A ResMed ASV (Adaptive Servo Ventilator) was delivered this morning.  Tonight will be the first test and use.

As the Rx calls for:  EEP 9,  PS Min 6, PS Max 12.

It has been a long 11 months since the anesthesia of hip replacement surgery did a "number" on and what had been favorable apnea treatment using a ResMed BiPap ST.

I will report back after I've been able to use the ASV for a few days.   

Thanks for all of your comments, guidance and suggestions.  Clif
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#58
RE: How to identify central or complex apneas using software
As an update, after another sleep lab titration session, I was diagnosed with CENTRAL SLEEP APNEA code G47.31.   A ResMed ASV (Adaptive Servo Ventilator) was delivered this morning.  Tonight will be the first test and use.

As the Rx calls for:  EEP 9,  PS Min 6, PS Max 12.

It has been a long 11 months since the anesthesia of hip replacement surgery did a "number" on and what had been favorable apnea treatment using a ResMed BiPap ST.

I will report back after I've been able to use the ASV for a few days.   

Thanks for all of your comments, guidance and suggestions.  Clif
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#59
RE: How to identify central or complex apneas using software
WELL DONE. I'm glad it's sorted for you.
EEP is the epap. With epap9 the ST was a long way out in it's settings. epap9 ipap upto 21 could have been it.
They need the largest minPS that the machine can give. min PS6
Max PS12 vented the lungs enough for further obstructive and CA during the study.

You have the machine in ASV mode and I would leave it there for a month. To let everything settle down and just focus on resolving any leaks. There is also ASVauto for later.
Another school of thought to consider later. Is to have the max PS at the machines max, giving a full range for a bad night. The machine will use what it needs
For ASVauto
min epap 9
max epap 15
Min ps 6
max ps 16 (giving the machines 25cm available epap9 + ps16 = 25cm)
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#60
RE: How to identify central or complex apneas using software
(06-24-2019, 08:40 PM)biz1219 Wrote: As an update, after another sleep lab titration session, I was diagnosed with CENTRAL SLEEP APNEA code G47.31.   A ResMed ASV (Adaptive Servo Ventilator) was delivered this morning.  Tonight will be the first test and use.

As the Rx calls for:  EEP 9,  PS Min 6, PS Max 12.

It has been a long 11 months since the anesthesia of hip replacement surgery did a "number" on and what had been favorable apnea treatment using a ResMed BiPap ST.

I will report back after I've been able to use the ASV for a few days.   

Thanks for all of your comments, guidance and suggestions.  Clif

You will find the ASV much nicer than the ST, however if you have been using the ST for a long time you may feel a lack of air to start with hopefully the min PS of 6 is enough to get over that. Your settings could be tweaked later as the ps max looks low I would expect that to be higher at 15.
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