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Need advice
#1
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



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#2
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

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

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#4
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!
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#5
From Baytown Tx
Yes second night was on a cpap machine.
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#6
Your being milked for money. They know after the 2nd study what machine you need.
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#7
(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.



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#8
/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
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#9
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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#10
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


Bed

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.
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