(12-09-2019, 11:32 AM)ApneaQuestions Wrote: This quotation is from my verbose medical tome.
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As you can see in my earlier posts, the whole issue of CAs began to emerge. My questions became... are these treatment-induced? Will they spontaneously resolve themselves over time? Do settings need to be tweaked to make that happen or will it "just happen automatically" as I acclimatize to the PAP treatment over the first few months?
From a financial perspective, there is another question... can I get to the bottom of this before year-end while everything is free?
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I am using this thread to document what I learn as I learn it.
At the same time it is being used to adjust therapy settings (and perhaps machines) as more data is revealed.
So it is really two threads in one.
Are these treatment-induced?
Yes - the majority of the CAs were treatment-emergent (perhaps all of them?) - It was clear on my initial posting that the emergent CAs correlated with high pressures and they resolved on lower pressures.
Will they spontaneously resolve themselves over time?
Yes - the CAs (if treatment-emergent) can spontaneously resolve for many people (but not all people) within a time period of 1-3 months.
This paper is just one of many that show the acclimatization.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699163/
Quote:Conclusions:
In this large retrospective study of 1286 patients with a diagnosis of OSA, 6.5% had CPAP-emergent or persistent CSA. However, CPAP-emergent CSA was generally transitory and was eliminated within 8 weeks after CPAP therapy. The prevalence of CPAP-persistent CSA was about 1.5%. Severity of OSA, a CAI of 5 or greater per hour, and use of opioids were potential risk factors.
Do settings need to be tweaked to make that happen or will it "just happen automatically" as I acclimatize to the PAP treatment over the first few months?
The previous paper showed that the treatment-emergent CAs resolved over time without mention of any changes to therapy settings.
Using my vernacular from the question.. Yes - it can "just happen automatically".
In my particular case..
1) changing machines from APAP to the ASV was able to resolve the CAs (but that experiment was premature based on the desire to get answers and free prescriptions by year-end)
2) Dropping EPR from 3 to zero on the APAP also cleared the CAs but then we simply began to step back up to 3 again to try to assist the RERA-like flow limitations essentially ending up back where we started.
3) Doing nothing and simply waiting for the CO2 acclimatization would probably have worked too. That's also what my sleep Tech said could happen.
Tonight's data with EPR back at 3 will hopefully show insignificant CAs and the next question will be.....
What to do about any residual RERA-like flow limitations (if any)?
With just a couple of weeks left in the year, I have already requested that my doctor writes a prescription for the
Aircurve 10 VAuto in anticipation of needing pressure support that goes beyond the EPR=3 setting on the Airsense 10 Autoset.
This may be a hard sell because the Doc will now be seeing very low AHI values and may need to go outside standard protocol to justify the BIPAP machine.
However, the Doc was previously willing to bend the protocol by prescribing an Aircurve 10 ASV (prematurely?)... so we shall see.
I sent the Doc my screen captures showing the classic flow limitation waveforms (even though no RERA flags were being raised by the machine).
I hope she will accept my argument and go along with the BIPAP prescription. It all depends on how familiar the Doc is with RERA and UARS.
My third sleep study is in the next couple of days. I hope that study sees the RERA waveforms to support my request and does not end up reporting false negatives (which the Resmed APAP machine seems to be doing). I still have not found a precise definition of the Resmed scoring algorithm for RERA.
The sleep lab uses Resmed equipment too so it's anybody's guess what they will document in the report.
I'm going to see if I can get the raw data from the sleep lab so that I can see the untitrated waveforms for myself.
Meanwhile.. for tonight... EPR back up to 3
