(11-15-2015 12:16 PM)DariaVader Wrote: If that is representative of a typical night on Auto, and it were my cpap I would set it 9 to 15 and see how that works. You have some CA events, and if those become so frequent or so long in duration that they require treatment then you will need an ASV, but from the data you provided I don't see that this is definitely the case......
because of this and because EPR=3 is helpful I would prescribe Bilevel if I were the doc, but I am not... On second thought - I wonder if ASV *is* what you need to help you breathe through the muscle weakness you described...
Dear DariaVader, and everyone else on the Board who was kind enough to take the time to help me to shape my case for my next doctor that CPAP/APAP wasn't sufficiently effective for me -
THANK YOU! very much indeed. A grand victory. I made my case to my muscle specialist. He kindly agreed to prescribe the Aircurve 10 VAuto (BiPAP) I asked for. However - somehow his prescription became a little <lost in translation> and the domiciliary technician actually arrived at my house with a Resmed Aircurve 10 CS Pacewave for me. I said I thought this ASV machine may be too sophisticated (and expensive) for my needs but I'd be delighted to try it (I don't have cardiac failure, so an ASV is not contra-indicated for me). He was fine with that and said if the machine was effective I could keep it. The cost will be covered by the usual system here in France i.e. National <public> healthcare cover plus some, more or less compulsory, top-up personal insurance. Mine costs 1100 euros a year.
Oooh gracious me! - I just SO wish I'd been given this machine many months ago. I have just had 14 nights of the best quality sleep for decades (and this two weeks included 5 nights of a viral bronchitis and upper respiratory tract infection). I wake up refreshed and my daytime energy has probably doubled (again, the best for decades). My *average* AHI is 0.8, in fact 0.1 last night (yes, really). I have had *zero* obstructives and *zero* centrals, just the occasional hypo. 95% flow limitation and <snore> have been zero, and during the 5 nights I wore an oximeter my average SpO2 has risen from 94% (on CPAP/APAP) to 96%. Desaturation events have dropped from 40-120/night to less than 10 (and much shorter ones). Just astonishing. I LOVE MY NEW MACHINE!
My pressure does go up to it's current maximum of 17 (the technician chose the settings for me - he clearly knows what he is doing) but only occasionally and only for a few seconds at a time. The only side effects so far are some red marks on my nose (I've had to tighten the straps to deal with leaks at these higher pressures), a slightly dryer mouth than with the Airsense, and certainly I am more, how shall we say, <windy> (but with no abdominal discomfort). But I am not complaining. I am really, really, not complaining...
I am just so cross that for ten months I had to deal with an assortment of disagreeable and ignorant doctors. I think - I can only speak for here in France - that there may be an emerging issue of non-sleep-specialist doctors starting to offer (financially very viable, I would have thought?) domiciliary sleep apnoea testing but without having the appropriate training or interest to then manage properly those patients who are failing to improve much on <ordinary> CPAP. What are Board members' thoughts on that?
And another thought - my AHIs on CPAP/APAP weren't awful, just rather disappointing + my desats ditto + flow limitation and <snore> ditto & etc. I was always tired but the doctors always blamed that on something, anything, else. My CPAP-induced centrals were never more than 5/hour. So, I didn't really fall into the category of <undertreated complex sleep apnoea>. But it looks as if my life may be transformed for the better by using ASV. How many more thousands of us with apparently just straightforward <obstructive sleep apnoea> may also actually need ASV? Food (but *expensive* food) for thought.
Thank you again to everyone who helped me with their wise advice - it gave me confidence to persist in my search for a new machine.
Would it be helpful if I posted a review of the Aircurve CS Pacewave - but it's only after just 2 weeks of use?
with my best regards and gratitude.