RE: Increased Pressure, now waking up a ton???
Hi all,
Sorry for the delay in my response. I've been sick for a week so unable to use machine.
Bonjour...I'm going to assume the doctor turned off the EPR when he went from APAP to CPAP.
So to recap, I was on APAP before and it wasn't great but not horrible. Then he switched to CPAP and it's bad...as I'm wakking up a lot.
I tried going back to APAP a few nights and I still woke up a lot.
Is it possible then by turning OFF the EPR, that can cause more centrals? Or more waking up? I know it's usually the opposite from what I've read, and probably why the doctor did it?
I don't know what to do and I'm so frustrated. If I go to the doctor now he will just say I didn't give it enough time.
Should I just stay with the CPAP for a few months even if it's bad.
I can't even remember how long I've given it a chance. I think only a few weeks.
RE: Increased Pressure, now waking up a ton???
Treating central on a CPAP or BiLevel wo backup is the process of avoiding them, not treating them. Traditionally this is done by first reducing PS/EPR/flex, then finally pressure, thus the tendency toward a fixed CPAP pressure.
ASV is the preferred treatment for Central Apnea which works by applying variable and high PS to maintain Minute vent on ResMed or Tidal Volume on PR machines. There is an alternative called Enhanced Expiratory Rebreathing Space (EERS). This works in all cases where the CO2 levels are causing the apnea. I suspect this is the form you have.
RE: Increased Pressure, now waking up a ton???
Greg, you have treatment emergent central apnea. It has been mentioned in this thread that the best treatment for this is ASV, and it is possible we can kludge together an enhanced expiratory rebreathing system to increase CO2 and reduce CA events. The problem with your last post is that you are assuming blame for the failure of CPAP therapy, and this blame or sense of guilt is misplaced. Your therapy eliminated obstructive apnea and replaced it with central apnea, therefore you could not achieve efficacy. It is NOT your fault, nor is it appropriate for a doctor to blame you for a failure that is fairly common, and for which there is a known solution.
The best approach is to first understand the problem, learn why insurance requires individuals with central or complex apnea to first fail CPAP, then fail bilevel, and finally receive ASV; and learn how and why ASV works for people like you. With that information in hand you will have enough information to discuss the problem with your doctor, and have a reasonable expectation to progress to the next step towards success. The alternative pathway is to simply buy your own ASV from the used or gray market. Know this, ASV will work to treat you to a near zero AHI. Let's start by reading the Justifying Advanced PAP Machines wiki
http://www.apneaboard.com/wiki/index.php...P_Machines
Understanding how this process works, you can now call your doctor's office to explain that CPAP does not work for you, and that instead of obstructive apnea, you now have central apnea and you cannot comfortably use the machine. Make the request for ASV titration. If your doctor is a good one, he will schedule an evaluation of both bilevel without backup and ASV. This should lead to approval of ASV. If your doctor blames you, then you need a new doctor. The insurance company hopes you become frustrated and will quit. Some doctors don't want to bother with patients that are more difficult to treat. Don't make their day. Stand up for your rights for good, effective therapy and better health.
