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Just diagnosed but headed back for 2nd study. Advice?
#21
Both the Dreamstaton auto and the Philips Respironics 60 Series BiPAP auto are very good machines. I have the PRS1 BiPAP auto. I picked it up off Craigslist locally for $300 with fewer than 300 hours. I used it until I was provided my current machine through insurance, and now it s a backup.

The auto BiPAP in auto mode provides variable EPAP and pressure support up to the max IPAP limit of the machine. This means you can set the EPAPmin pressure at an effective level and set a range of pressure support for comfort and therapy. The machine should increase EPAP in response to OA and snores, and will increase PS for flow limitation and hypopnea. Like APAP, the pressure is adjusted according to your need to prevent events, so you don't have to spend the entire night at maximum pressure. A fixed PS can be achieved by setting PSmin and PSmax at the same value.

The BiPAP-S (or pro) is a fixed bilevel with set EPAP and IPAP pressure. It acts just like fixed CPAP

We might as well cover the Aircurve 10 vAuto. It is an auto-bilevel that uses a fixed PS. It can do everything the Auto-BiPAP can do, but it does not change pressure support through the night.

Your best bet for a discount is the PRS1 BiPAP Auto DS760.
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#22
I am unsure what the second study is for. Is it to determine the best pressure setting? If so it isn't really needed because the machine in auto mode can adjust pressure based on your needs, so I would find out. You may not need to spend the money on it. My sleep study was supposed to be a split, but I could hardly sleep in that lab setting. So the doctor wrote the RX for an auto machine so that I didn't have to go back. These studies are super expensive, after my insurance paid I still owed $900 out of pocket. I still needed to get a CPAP as well and that cost me another $780 out of pocket. Just some food for thought. I had such a bad experience where I went I will never go back there. If I need a new one done I will opt for the take home test this time. I wish you luck with your new CPAP and hope it works well for you.
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#23
(12-30-2016, 10:58 AM)Adoniscmj Wrote: I am unsure what the second study is for. Is it to determine the best pressure setting? If so it isn't really needed because the machine in auto mode can adjust pressure based on your needs, so I would find out. You may not need to spend the money on it. My sleep study was supposed to be a split, but I could hardly sleep in that lab setting. So the doctor wrote the RX for an auto machine so that I didn't have to go back. These studies are super expensive, after my insurance paid I still owed $900 out of pocket. I still needed to get a CPAP as well and that cost me another $780 out of pocket. Just some food for thought. I had such a bad experience where I went I will never go back there. If I need a new one done I will opt for the take home test this time. I wish you luck with your new CPAP and hope it works well for you.

They didn't have enough time to figure out my pressure during the split. The real issue is that it was borderline bipap settings. The split concluded with me being on a 16 and 20 pressure but was only at that setting for 15 minutes. I guess the 2nd study was to see if bipap was necessary for the higher pressure.
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#24
I picked up a copy of my first sleep study. I'm not sure if you can glean anything from this or not but I'd be interested in knowing.

I don't think I'm allowed to post links yet so you will have to work with this: dropbox.com/s/hu3dqgsdmtkm37s/sleepstudy1.pdf

I'm a beginner here and don't know a lot yet but I'm very confused. Things looked good at 17 pressure so I don't understand why they kept pushing higher. Once again on the 2nd study, I woke up with a pressure of around 20. Any thoughts?
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#25
Fascinating study. You had some mixed apnea and abundant hypopnea at your first diagnostic study with an AHI of 67.5, and minimum SpO2 of 86%. You had no Stage 4 or REM sleep.

The CPAP/BiPAP study shows your problem was markedly worse with CPAP pressure with most events manifesting as central. Your minimum SpO2% dropped to 76%, but you actually had 45 minutes of REM sleep. Your best results were at pressure 17/13 where you had 93 minutes at zero AHI/RDI. Above that pressure, hypopnea increased proportionally with pressure, same as lower than that pressure. Your worst results are at fixed CPAP of 13.

I think you will clearly get a prescription for bilevel pressure of 17/13, but I think there is a possibility you will eventually develop complex apnea syndrome, which is predominately central in nature. I think you've got to go with these conclusions and either succeed or fail on bilevel before considering that ASV may be the next step. The pressure suggested by the study can be accomplished by a fixed or auto bilevel, but it does not appear you will tolerate pressure shifts well since your event rate increases rapidly in either direction from the 17/13 best result. I think the clinic has shown it has doubts that this titration is conclusive, and I agree. What I disageee with is the conclusion that the underlying cause is obstructive architecture. I think there is a complex mixed apnea lurking here, that ultimately responds to ASV, which can resolve the numerous hypopnea with lower base pressures. The obstructive component of your apnea appears to resolve at relatively low pressures.
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#26
Thank you for taking the time to review the study. I understand your explanation and what you've said makes sense to me. It does make me feel a bit better about why the 2nd study was ordered.

If I pick up the Dreamstation bipap auto and the Dr comes back with an Rx of apap/CPAP I'm at no other disadvantage than the extra money spent, have I understood that properly?
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#27
If you look on page 8 of the study, you can see the table of titrated pressure. You were trialed on CPAP from 5 to 15 cm pressure, with the worst results at 13/13. You had no REM sleep with CPAP, and your overall RDI was pretty bad with the possible exception of 5/5 pressure, which also had the best SpO2 for CPAP. I think it is notable that results are steadily worse with higher pressure, but no evidence of OA is present. This again points to complex apnea, where respiratory pressure support for hypopnea may be indicated.

When they shifted to bilevel at 17/13, you had the best results of all, but it was only for 15 minutes. I would have really liked for them to hold this pressure longer, and they should have; there were no events. Results deteriorate with increased pressure to 22/18 which they held for 28 minutes.

You will get a bilevel machine of some kind, but it wouldn't hurt to ask if ASV might be better to resolve the hypopnea. This does not look obstructive to me.

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#28
You are awesome.Thanks

Since my issue is more complex, I'll sit in the holding pattern for the results from the 2nd study.

I'll post an update when I have one. Thanks again.
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#29
Adding to my comment above. Tell the doctor, you are self-financing this equipment and need to expedite finding an appropriate solution. The sleep study and follow-up titration clearly show a failure to benefit from CPAP. The BiPAP titration point to a possible narrow window of efficacy, about which, the doctor has clearly expressed his reservations. "Optimal pressure was not achieved due to severity of events".

Ask the doctor to talk straight to you about adaptive servo ventilation. These machines do come up used and at discounts fairly frequently. You need him to give his best professional opinion on how to proceed, assuming you are at the end of your financial rope for more studies. The modern bilevel ASV machines are very capable of treating what appears to be your condition. I'm fairly certain, I could come up with appropriate settings based on what we see here. Bluntly, I think anything but a bilevel ASV is a waste of your time and money.
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#30
I do have insurance and certainly for expensive equipment I would use it. My deductible isnt met but it is only $2500 so that isn't a huge deal. It just didn't make sense at the time of looking for CPAP/apap machines since non traditional suppliers have them at low prices.

I will push him on asv and see what happens.
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