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Need advice
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Hornnumb2 Offline

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Posts: 32
Joined: Nov 2014

Machine: Respironics series 60 Bipap auto sv
Mask Type: Nasal pillows
Mask Make & Model: Resmed P10
Humidifier: Respirionics 60 series
CPAP Pressure: none
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Baytown, TX

Post: #1
Need advice
I have had 2 sleep studies and need some advice what to do next, I am out of money and the sleep study said I need to go back to do a bipap study.

I tried to post links to the studies in my Dropbox but can't, any other way to do it or I need to get to 8 posts?


Thanks Michael
12-30-2015 04:29 PM
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AlanE Offline

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Posts: 1,496
Joined: Mar 2015

Machine: ResMed AirSense 10 Autoset
Mask Type: Nasal pillows
Mask Make & Model: P10 & Mirage Liberty backup
Humidifier: Built-in
CPAP Pressure: 10-14
CPAP Software: ResScan SleepyHead

Other Comments: ʕ•ᴥ•ʔ So Long, and Thanks for All the Fish

Sex: Male
Location: Southwest Florida

Post: #2
RE: Need advice
Welcome

You can idle chit-chat until 8 posts. It's not much. Where are you from? I see you joined last year. You had two sleep studies done? Was one a titration?

Feel free to answer each question on a separate post Too-funny



Using FlashAir W-03 SD card in machine. Access through wifi with FlashPAP or Sleep Master utilities.

I wanted to learn Binary so I enrolled in Binary 101. I seemed to have missed the first four courses. Big Grinnie
(This post was last modified: 12-30-2015 04:44 PM by AlanE.)
12-30-2015 04:43 PM
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justMongo Offline

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Posts: 3,853
Joined: Sep 2013

Machine: ResMed VPAP Auto (S9)
Mask Type: Full face mask
Mask Make & Model: ResMed Mirage Quattro
Humidifier: ResMed H5i
CPAP Pressure: 18 IPAPmax - 11 EPAPmin, PS=5
CPAP Software: Other Software

Other Comments: μολὼν λαβέ

Sex: Male
Location: Калифорния

Post: #3
RE: Need advice
You can do it as an attachment if you compress it to under 200kb
Paula's How to -- http://www.apneaboard.com/forums/Thread-How-to-Attachments

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
12-30-2015 04:49 PM
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cate1898 Offline

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Posts: 784
Joined: Aug 2015

Machine: PR System One 560BT Auto
Mask Type: Nasal pillows
Mask Make & Model: P10's/backup-DreamWear
Humidifier: PR attached
CPAP Pressure: 8.5 - 13. A-Flex 3
CPAP Software: SleepyHead

Other Comments: Began CPAP Therapy Sept. 11, 2015. Hx Hypertension, Post Graves Disease, chronic migraines.

Sex: Female
Location: Southern Ontario//SW Florida

Post: #4
RE: Need advice
Hornnumb2 in case you're not aware, Supplier #2 sells new open box machines and gently used machines if you have no insurance and need a less expensive machine. Good luck!

APNEABOARD - A great place to be if you're a hosehead!! Rolleyes

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EVERY ACCOMPLISHMENT BEGINS WITH THE DECISION TO TRY!
12-30-2015 04:52 PM
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Hornnumb2 Offline

Preferred Members

Posts: 32
Joined: Nov 2014

Machine: Respironics series 60 Bipap auto sv
Mask Type: Nasal pillows
Mask Make & Model: Resmed P10
Humidifier: Respirionics 60 series
CPAP Pressure: none
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Baytown, TX

Post: #5
RE: Need advice
From Baytown Tx
Yes second night was on a cpap machine.
(This post was last modified: 12-30-2015 04:53 PM by Hornnumb2.)
12-30-2015 04:52 PM
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Ghost1958 Offline

Advisory Members

Posts: 957
Joined: Aug 2014

Machine: PRS1 Series Sixty Auto Aflex
Mask Type: Nasal mask
Mask Make & Model: F&P Eson
Humidifier: PRS1 with Heated Hose
CPAP Pressure: 10.5 min 16 max
CPAP Software: SleepyHead EncoreBasic

Other Comments: Moderate to Severe SA Obstructive. Rapid O2 desat off the machine.

Sex: Male
Location: KY

Post: #6
RE: Need advice
Your being milked for money. They know after the 2nd study what machine you need.
12-30-2015 05:04 PM
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SuperSleeper Offline

Administrators

Posts: 9,973
Joined: Feb 2012

Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
Mask Make & Model: ResMed Mirage Swift II
Humidifier: none
CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

Other Comments: Have diabetes Type II

Sex: Male
Location: Illinois, USA

Post: #7
RE: Need advice
(12-30-2015 04:29 PM)Hornnumb2 Wrote:  I tried to post links to the studies in my Dropbox but can't, any other way to do it or I need to get to 8 posts?

Hi Michael, in cases like this (for posting legitimate non-commercial links) you can post a "broken" link to your dropbox files, no problem).

So, instead of posting http://www.dropbox.com/linktomyfiles.htm

Instead, drop the http part and put a couple of extra spaces in the URL like this:

ww w.dropbox. com/linktomyfiles.htm

And tell folks to remove the spaces. This type of forum software work-around is okay, as long as the link itself would not violate the forum the rules. (and dropbox files where your sleep study is located are fine as links).

Once you get to 8 posts and a couple days of membership, you can post actual links - it's a spam-prevention thing in the forum software.

Coffee

SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.

12-30-2015 06:12 PM
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Hornnumb2 Offline

Preferred Members

Posts: 32
Joined: Nov 2014

Machine: Respironics series 60 Bipap auto sv
Mask Type: Nasal pillows
Mask Make & Model: Resmed P10
Humidifier: Respirionics 60 series
CPAP Pressure: none
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Baytown, TX

Post: #8
RE: Need advice
/www.dropbox.com/s/mdhnm8aodq6wkmt/Box%20Michael%20J%20CPAP%2012-17-15%20Final%20Report.pdf?dl=0

/www.dropbox.com/s/8rlxdip2hjdx2uz/Box%2C%20Michael%20PSG%2012-02-15%20Final%20Report.pdf?dl=0
Here are the first and second study. Thanks
(This post was last modified: 12-30-2015 08:52 PM by Hornnumb2.)
12-30-2015 08:52 PM
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Sleeprider Online
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Advisory Members

Posts: 3,376
Joined: Dec 2014

Machine: Resmed Aircurve 10 Vauto
Mask Type: Nasal pillows
Mask Make & Model: Resmed Airfit P10
Humidifier: Resmed Climateline
CPAP Pressure: Auto Bilevel 18/9, PS 3
CPAP Software: ResScan SleepyHead EncoreBasic

Other Comments:

Sex: Male
Location: Where they make Respironics

Post: #9
RE: Need advice
Please delete your links as they contain far too much personal information for a public forum. I will summarize the pertinent issues below:

The first study diagnosed severe central and mixed apnea. The second study attempted to titrate for CPAP but was unable to reduce events to a therapeutically effective level. The need for bilevel ASV should have been anticipated from the first diagnostic study:

First study:
Quote:RESPIRATORY EVENTS:
Respiratory event scoring identified 1 obstructive apnea, 203 central apneas, 148 mixed apneas, 17 respiratory effort related arousals, and 101 obstructive hypopneas for a critically elevated Apnea-Hypopnea Index (AHI) of 71 and a critically elevated Respiratory Disturbance Index (RDI) of 74.0. The lowest oxygen saturation was critically reduced at 67%.

From the second study:

Quote:RESPIRATORY EVENTS:
Respiratory event scoring identified 6 obstructive apneas, 36 central apneas, 13 mixed apneas, 7 respiratory effort related arousals (RERAs) and 32 obstructive hypopneas, for a significantly elevated apnea-hypopnea index (AHI) of 16.5 and a respiratory disturbance index (RDI) of 18. At the final CPAP pressure of 12 cm H2O, the AHI was 35.1 with a RDI of 35.1. The lowest oxygen saturation was reduced at 84 % and the mean oxygen saturation at maximum CPAP pressure was normalized at 92%. The residual sleep disordered breathing necessitates a repeat study with Bi-Level PAP.

The results of the second study indicate you have complex sleep apnea, probably caused by positive pressure. CPAP resolved obstructive apnea with a residual six events, but caused numerous central apnea events. The respiratory event related arousals (RERA) are something bilevel does a great job at resolving. It is unlikely that bilevel CPAP will succeed in resolving this, and the study would need to include bilevel ASV therapy (adaptive servo ventilation). If the study fails to have a progression including bilevel ASV it will be a further waste of your money.

You do not have obstructive sleep apnea, you have central or complex apnea. About 15% of apnea patients are unable to use CPAP due to complex or central. Conventional bilevel (BiPAP or VPAP) will not resolve your problem. Bilevel ASV however, can monitor your breathing on a breath by breath basis and provide a significant increase in pressure support to cause you to take a breath during a central apnea. I believe that if the studies follow the normal course, you will fail bilevel, and be rescheduled for another study to evaluate ASV. This machine provides a low exhale pressure to resolve your obstructive apnea, and a higher inhale pressure to resolve obstructive hypopnea and RERA. It also monitors your respiratory rate and volume and detects insufficient respiration and responds with additional pressure support to induce breathing and maintain volume.

To shortcut this situation, you need to tell your doctor, you are tapped out financially. 1. If the machine is not covered by insurance anyway, insurance approval becomes irrelevant. 2. If you have coverage the insurance company will want to see you fail bilevel and the effectiveness of ASV.

For situation 1. request a prescription for ASV, and locate the lowest online price, then work with your doctor to evaluate the machine data and make adjustments. ASV can work as a CPAP or bilevel, but it costs about twice as much as an auto bilevel machine. It is the only therapy that targets central apnea while resolving obstructive sleep apnea and RERA.

For situation 2. you are stuck with the additional study, but insist that it include a progression to ASV is needed so you don't need a fourth study. You will benefit from bilevel, but will probably need ASV. Be sure the study will evaluate for that.

This response may have raised more questions than it resolved, so please ask anything you need to know. Do not leave that much personal info in the internet. If you are uninsured, the study contains sufficient information for ANY doctor to prescribe auto bilevel ASV. You do not need to do another sleep study. Examples of these machines are Resmed Aircurve 10 ASV or Philips Respironics BiPAP autoSV Advanced.

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(This post was last modified: 12-30-2015 11:22 PM by Sleeprider.)
12-30-2015 10:53 PM
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DeepBreathing Offline
Wiki Editor
Moderators

Posts: 2,296
Joined: Sep 2013

Machine: Resmed S9 VPAP Adapt
Mask Type: Full face mask
Mask Make & Model: F&P Simplus
Humidifier: Resmed H5i
CPAP Pressure: EPAP: 9 - 15 PS: 3 - 10
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Male
Location: Perth, Western Australia

Post: #10
RE: Need advice
The links are gone now, but from Sleeprider's summary it's obvious you have central / complex sleep apnea. I assume your first test was without a machine, and you scored 44.8% central apneas and a further 32.7% mixed apneas. If this test was taken without a machine (as I assume) then the centrals are not pressure-induced, but idiopathic.

Putting it very simply, these central apneas occur when the brain fails to send the "breathe now" message to the lungs. They are quite different from obstructive apneas which occur when your airway collapses and physically obstructs the flow of air.

As Sleeprider rightly said, it's almost for certain that you're going to need an ASV type machine to treat your central apnea. I'm not familiar enough with the rules in the US, but you need to enquire of your doctor, insurance company and Medicare (if eligible) to ensure you have access to an ASV at the lowest possible cost. Be careful with the terminology - not all bilevel machines are ASV. In addition to those Sleeprider mentioned, you could look for the recently superseded Resmed S9 VPAP Adapt, which is an excellent machine. If you end up having to pay out of pocket, you could check supplier No 2 (see the "suppliers list" link at the top of the page). They have "gently used" machines for substantially less than the retail price.

DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
12-31-2015 05:08 AM
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