Losing hope feeling worse on CPAP than without. Any advice?

[AFAFAF]

Your charts still prove that you're not treated, as we knew it would not be able to due to the CA. CSR flags are in this case translated to variable breathing and should not concern you.

The leaks aren't helping, be certain not to overtighten straps. If your response to leaks is tighten till it hurts, then you need a different size cushion or a different mask altogether. Mask choice is the hardest part of Apnea therapy.

As for what I meant about BPAP without a backup rate, this is a regular BPAP like VAuto.

If the doc tries to say you don't need ASV to treat the CA, you should have a copy of the ResMed Titration about ASV and a ResMed page describing what the different machines prescribed treatments are. And you should explain your ongoing sleep apnea symptoms and complaints. It's a great idea to write down what these symptoms and complaints are so you can discuss them with the doc later. This means all the negatives about your therapy, CA flags, unrest, fatigue, and so on. And if the doc still doesn't get it, then get another doctor that does understand how to treat Central Apnea.

I'll see if I can find my ResMed Titration info and post it later today.

Can you let me know how my graphs prove I'm not treated? Would love to explain it to a doc or something. Is it just the consistent CA events? They don't seem like I have too many so why would ASV be a good idea here? I'm just worried they won't believe me because it seemed to have lessened with CPAP treatment. All I can say to them is I really feel worse on the machine and am losing hope.

What is wrong with BPAP?

If they suggest BPAP, what do I say against it? That I have complex apnea rather than non-compliant OSA?

The ResmedTitration (https://document.resmed.com/en-us/docume...er_eng.pdf) says ASV treats patients with central/mixed/complex apneas. So I show them this table specifically right?

Ok I'll make a document with my results and symptoms and show it to them.

In it will say:

Proof:

24 Obstructive Apneas now gone

45 Central Apneas persisting/more (45/770 minutes, is 45/13 ~= 3.5 AHI)

252 hypopnea (likely more central than not) (not sure if I need this one)

Consistent Central Apneas

Feeling worse on machine than off. 

Titration table:



Graphs:...

Thanks for the replies.

[quiescence at last]

As seen in the below shot, flow limitations are resistances to flow, which are sometimes in the inhale (lime) or in exhale (peach) where airway is only partially blocked causing you (consciously or unconsciously) respiratory effort.  You can spot this in your flow as non-rounded tips or troughs.  Inhale issues usually degenerate toward a snore, an obstructive apnea, or an arousal.  Exhale issues do not generally degenerate into any countable event and either resolve, arouse you, cause you to do some mouth breathing to release left over exhale, or when you do wake you'll possibly notice it as stuffiness, or mouth very dry. 



QAL

p.s. showing us a little 8 minute chunk of your flow during periods the machine shows higher flow limitations will help recognize either type.  Or you could be blessed with both, like me.

[SarcasticDave94]

The chart shows the Central Apnea, that they are not treated, and it shows an AHI over 5.0 frequently. There are still plenty of CA that show, we know your CPAP can't treat CA.

Also note that CA are consistently inconsistent and this means they will be up and down. A lower level CA one night doesn't indicate they're treated.

Your evidence should include your unrest, etc. Your recital of symptoms and complaints do not necessarily need to be linked specifically to a cause that you point out. Make the doctor work some as well to prove or not why you're not sleeping well. Just state that you can't sleep well with this PAP, you see lots of CA flagged events and you're concerned about them, your research indicates ASV treats CA, and that your PAP cannot treat CA.

Just a plain BPAP, again the ones without backup rate, will certainly make CA increase. I have seen this for myself, and we've seen it with others on the Apnea Board. Focus on ASV as the right answer, the other machines are wrong.

PS forum etiquette suggests limiting quotes, just reply without quoting please. Someone will address your questions. There's sight impaired members that may be trying to follow along and reading lots of quotes can be a hindrance. Thanks for your understanding.

[AFAFAF]

As seen in the below shot, flow limitations are resistances to flow, which are sometimes in the inhale (lime) or in exhale (peach) where airway is only partially blocked causing you (consciously or unconsciously) respiratory effort.  You can spot this in your flow as non-rounded tips or troughs.  Inhale issues usually degenerate toward a snore, an obstructive apnea, or an arousal.  Exhale issues do not generally degenerate into any countable event and either resolve, arouse you, cause you to do some mouth breathing to release left over exhale, or when you do wake you'll possibly notice it as stuffiness, or mouth very dry. 



QAL

p.s. showing us a little 8 minute chunk of your flow during periods the machine shows higher flow limitations will help recognize either type.  Or you could be blessed with both, like me.

Is it possible to rephrase that in layman terms?  So what I got is that flow limitations is when airway is partially blocked and inhale/exhale results in different events. Here's a chunk of flow when it shows higher flow. Keen for some insights.

[AFAFAF]

Ok thanks for this. I'll be sure to mention my unrest and the continual appearances of CA. Someone in another forum said I don't have enough CA to justify a ASV. But with how poor I'm doing I rather try it than not.

What about a BPAP with a backup rate (not sure what either really means). Is this an alternative? Regardless I'll try get an ASV from the doc.

And OK I'll stop using the quotes.

[SarcasticDave94]

The ASV is a BPAP with backup rate, it also includes a special algorithm, the control program, one that is specifically designed to treat CA.

I'm sure I've forgotten, the event level from your sleep test showed how many CA, OA, and etc? The diagnostic test results are the more important if compared to a titration, if that has been done. Typically, if CA are equal to about half your untreated events, then ASV is a good choice. However if CA are uncontrolled while on PAP, that's another reason for ASV. Regardless, you have to fight like crazy to get the docs to agree and they need to get off their fat butt to fight for you instead of hindering your therapy.

I've had to learn myself how to deal with CA. I realize they may not be as serious as an Obstructive Apnea, but they still can ruin sleep, cause oxygen deprivation headaches showing upon waking, and generally cause the same problems as Obstructive events. Most doctors are trained by the insurance not to emphasize Central but Obstructive events. To add in even more of an issue, again that consistently inconsistent attribute of CA means it's harder to pinpoint.

[AFAFAF]

Ok gotcha. So this BiPap is suitable as it has the ASV algorithm?

[DME Link Removed] See: https://www.resmed.com/en-us/healthcare-...-10-vauto/

My results for central were double that of obstructive.
 
So:

24 Obstructive 
45 central 
252 hypopnea 

For I think 770 minutes.

Yes it seems quite inconsistent for me. But still feeling horrible so I'm hoping it's the cause so it can be fixed. I'll try make sure they take note of my over double central events than obstructive. Still weird they said its severe obstructive instead of complex. Do they think the hypopnea are obstructive maybe?

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[Sleeprider]

I did not see the original link, but if it is the Resmed Aircurve 10 Vauto, then no. That device does not have the backup rate or adaptive pressure support of ASV. The machines you are looking for are the Resmed Aircurve 10 ASV, or the older Resmed S9 Adapt. Frontier Medical has a listing on DotMed as follows:
RESMED Aircurve 10 ASV Bipap Bi-level PAP For Sale
2 units available with heated humidifiers and cases. 231 hrs and 1629

You can find the listing by navigating to DotMed and looking under the category Respiratory/Bilevel and filter for Resmed. The listing does not say what the asking price is. You need to contact the seller through that ad, and find out if this is a deal you can afford with shipping to AU. If it works fine, if not then know that the inventory on that marketplace constantly changes.

[Gideon]

The central's in the zoom your PM refered to are not typical CO2 driven Centrals and I would not expect them to respond to our avoidance techniques. That means that you need the ASV that many in this thread have described.

[AFAFAF]

Thanks for the replies guys. What does the large amount of hypopneas mean for me btw?

Also 

On another forum, they said I have too low pressure causing me more sleep disturbances and is why I feel terrible. Any thoughts on this?