(01-31-2015 07:03 PM)Lambsydoats Wrote: Hmmm. Every time I click on the down arrow to choose what graphs to display on the overview tab, SH crashes. I checked for updates; there are none.
The last time OA was over 1.5 was on December 24, but that was a real anomaly. The time before that was December 15. The time before that was November 29.
CAs are rarely under 5.
I'll post graphs as soon as I can...with someone's help!
ResMed A10 machines will need to use (either ResScan or) SleepyHead version 0.9.8-1-testing:
USA Medicare and many private insurance companies will cover an ASV machine (which can treat both obstructive and central sleep apnea) if the CAI (Central Apnea Index, which is the average number per hour of Central Apneas while asleep) is at least 5 and makes up a majority of all apneas. I think this would apply in your case on most nights, according to what you have reported. However, some insurance companies require the CAI to be at least 10 or 15 before insurance would pay.
In any case you can ask your doctor to prescribe (and to gain preauthorization on your behalf for) an ASV titration.
If insurance preauthorizes the ASV titration and the ASV titration results show that the central apneas are being adequately prevented by the ASV therapy, I think an ASV machine would be covered.
ASV machines like the ResMed AirCurve 10 ASV or the Philips Respironics BiPAP autoSV Advanced automatically adjust the EPAP (exhale pressure) to reduce/avoid obstructive events, similar to how your present APAP machine adjusts its pressure to minimize obstructive events.
With your A10 AutoSet, when you neglect to make effort to breathe (when a central apnea is occurring) the machine does not react to the apnea, except after about 10 or 15 seconds it will let EPR end (if EPR is being used), which returns the pressure to the normal IPAP (inhale pressure). Eventually the central apnea will end (as soon as you again make effort to breathe). This is the same way your APAP machine responds to obstructive apnea, except that in the case of obstructive apneas the machine takes note of how long the obstructive apnea lasted and the machine will take this into account when deciding how much to raise the pressure after the apnea has ended, in order to help prevent a reoccurrence of the obstructive event.
An ASV machine, in contrast, would have noted within a few seconds that inhalation had failed to start and would have begun gently cycling back and forth between a higher IPAP (to cause your lungs to inhale) and a lower EPAP (allowing the air out of your lungs) in order to keep you adequately ventilated. As soon as you were making effort to breath on your own again, the machine would return to its normal EPAP and IPAP.
With an ASV machine, the difference between EPAP and IPAP is called "Pressure Support" and might normally be only around 2 cm H2O, but if we stop making any effort to breathe the ASV machine may raise Pressure Support up to 6 or 8 or 10 or higher, however high it needed to be raised in order to keep us adequately ventilated while we are making no effort to breathe.
Getting used to the ASV machine jumping in while we are still awake (when the machine attempts to end a nascent apnea which was, instead, merely a natural pause in our breathing) is one of the challenges we face when using an ASV machine, but I think we usually don't have any great difficulty learning to avoid this.
The other challenge we may face when using an ASV machine is the higher pressures needed to treat our central apneas do tend to increase the amount of air we swallow. If the amount of air swallowed becomes painful or excessive, we may need to limit how high the pressure is allowed to go, which may reduce the effectiveness of the ASV therapy. If the Max Pressure Support setting or the Max Pressure setting are set too low, perhaps the machine would only be able to change central apneas into central hypopneas, rather than completely treating/preventing the problem.