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New BiPAP ST user Vet with complex apnea
#41
RE: New BiPAP user
idk know why our sleep med system is so screwed up (insurance is my guess) but it looks to me like osa is diagnosed in the vast majority of cases, no matter what the sleep study returns, as long as the ahi is over 5. I had 204 obstructive and 192 central apnea events in my last sleep study and I was dx'ed obstructive and prescribed an apap that has no capability to treat central apnea. from my perspective the entire process is inefficient, inaccurate and a complete waste of time and money. it's possible to get proper treatment but we seem to have to fight for it. guidance from folks around here can help with that.
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#42
RE: New BiPAP user (PM exchange)
Here is a PM conversation I had with Sleeprider. It is posted with Sleepriders permission for others to chime in....
---------‐--------------------------------------------------------------------
Sleeprider here is the response I got from the VA

"I had Adam Winters review your readings and unfortunately, the lingering, unresolved events noted are obstructive in nature (meaning that they are not the central type). 
Your sleep apnea diagnosis is obstructive sleep apnea as that is the primary diagnosis. 
It is common for patients to have "both" type of apnea (obstructive and central). 
You would not be eligible for the BiPAP ASV at this point as your events continue to be primarily for obstructive. 
Adam's (and my normal reaction) to your elevated events would be to raise your pressure. 
It is currently 15/10 cmH20. He would like it increased to 16/12 cmH20. I can do this remotely but will await your response first."

Sleeprider responded helping me craft a response....

"Respond with the following:

You are mistaken that my diagnosis is obstructive sleep apnea. I have both central and obstructive sleep apnea that was classified as "moderate". My AHI has not improved with therapy from the diagnostic baseline. Please see the following interpretation from the 12/19/2019 study:

Results of home sleep study
I am writing to discuss the results of your Home Sleep Testing (HST) done at the Charles George VA Hospital. We have reviewed the results and the findings are consistent with central sleep apnea (CSA) and obstructive sleep apnea (OSA). CSA occurs when the brain does not send proper signals to the diaphragm to stimulate a breath. Because of the complexity of your apnea, I'm recommending a formal titration study to determine best treatment options. This requires an overnight stay in our sleep center to perform a formal evaluation. I feel this is the best approach based upon your symptoms and study findings. Our schedulers will be in contact with you regarding an appointment in our clinic for the titration study. I am hopeful that treatment of your apnea will improve your quality of life, help you feel better rested, and improve your daytime energy. We appreciate the opportunity to participate in your health care and look forward to continuing our relationship in sleep medicine.

Titiration study at VA findings.
SLEEP STUDY REPORT FINDINGS Date of Study: 01/27/2020 Location of Study: CHARLES GEORGE VA SLEEP DISORDERS CENTER Please see the scanned document in Vista Imaging for complete details PAP TITRATION STUDY IMPRESSION: - Sleep Apnea for PAP Titration. - Sinus rhythm with occasional PVCs. - PLMS; PLMI: 20 & PLMAI: 3. RECOMMENDATIONS: - BiPAP @ 15/10 cmH2O with BUR of 12 resulted in an AHI of 2 and a minimum oxyhemoglobin saturation of 90%

Your response ignores the significant findings of that diagnosis that I have complex sleep apnea. It is my understanding that the correct therapy device when central and complex apnea is present is the adaptive servo ventilator. Can we arrange for ASV titration to see if it is a better solution...Steve"

I then told Sleeprider that they had diagnosed me with OSA and Central on the home study but changed the diagnosis to OSA atthe titiration study.

He replied....

"Steve, I could not find it, but I though you posted a pages from your titration study that showed a lot of CSA. I deal with a lot of other people so it may not have been you, but I seem to recall your titration showed "treatment emergent central apnea"."

So I posted the titiration results ...

The home study is the one that mentioned that I believe. Here is the titiration study

SLEEP STUDY REPORT FINDINGS Date of Study: 01/27/2020 Location of Study: CHARLES GEORGE VA SLEEP DISORDERS CENTER Please see the scanned document in Vista Imaging for complete details PAP TITRATION STUDY IMPRESSION: - Sleep Apnea for PAP Titration. - Sinus rhythm with occasional PVCs. - PLMS; PLMI: 20 & PLMAI: 3. RECOMMENDATIONS: - BiPAP @ 15/10 cmH2O with BUR of 12 resulted in an AHI of 2 and a minimum oxyhemoglobin saturation of 90%
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#43
RE: New BiPAP user
Thank you for bringing our conversation back to the forum. I try not to advise offline unless it is a matter of urgent privacy or sensitivity. We have a great community on Apnea Board and I appreciate everyone having input and the opportunity to disagree. I was especially happy to see MuzicCity post in this thread. He and Gurdbonk are the other two current cases of members that came here feeling therapy was failing, and all three of you were improperly issued BiPAP ST instead of the ASV you need. Unfortunately, I have seen this problem dozens, if not hundreds of times, where sleep specialists are prescribing a machine not intended to treat central or complex apnea, and their patients paying the price. I can't explain it, because these are supposed to be the medical doctors with the knowledge and experience to properly treat complex cases. They are clueless, and don't apparently care how much suffering they inflict. I can only draw attention to their malpractice and hope their professional organizations, and the device manufacturers will recognize the problem and re-train these hacks about what machines are used to treat central apnea.
Sleeprider
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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.
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#44
RE: New BiPAP user
So another Dr. Dopey Duck that cannot see Central Apnea and therefore they don't exist, but then issues an ST machine for the medical issues that do not exist in SHatfield. It's an epidemic!

ASV time soldier. Former PA Army Nat'l Guard w/ medical honorable discharge that was not from shrapnel on the PT boat riding with John Kerry.

Welcome to Apnea Board SHatfield. We represent the sanity of the insane medical issue called apnea. Best wishes to you on getting the ASV ASAP!
Dave

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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#45
RE: New BiPAP user
   

Day 2 with OSCAR
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#46
RE: New BiPAP user
   

flow rate zoom
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#47
RE: New BiPAP user
Obviously unsatisfactory results, and I 'm going to call the hypopnea central based on your zoom.  I'd also lke to see a zoom during the hypopnea cluster around 02:40.  The zoom appears to be a period of low inspiratory effort that is being "pushed" by the pressure support.  Since the machine is only increasing IPAP by approximately 3-cm (in spite of a PS setting of 5), the breath is insufficiently supported and appears flow limited. This sample does not have machine triggered breaths and you have a respiratory rate of about 14 BPM.  If you take the zoom out to 2-minutes (this is 1-minute), we can still see details and get more information.


Depending on what we see during the 02:40 zoom, I might suggest an increase in pressure support. An increase in EPAP pressure as suggested by your quack is not warranted because you do not have obstructive apnea.  The image below is the ST titration protocol. You can see that if obstructive apnea are present, the recommended response is to increase EPAP.  That is not applicable to you.  If oxygen saturation is too low or tidal volume insufficient, then IPAP is increased. This is the same as increasing pressure support (iPAP minute EPAP equals PS, or EPAP plus PS equals IPAP).  As I recall your doctor was proposing increasing EPAP by 2 cm and IPAP by 1 cm, which reduces PS.  Note teh right margin of the protocol as to what conditions are intended to be treated by ST. Also ask yourself why you have a ST machine if your apnea was simply obstructive. You would have been issued a CPAP like everyone else. They are LYING to you.

Something you might want to consider is getting an inexpensive wearable recording oximeter. These devices measure SpO2 oxygen saturation, and if you have low results, it would be further evidence you are on the wrong therapy. Have you increase Ti?

[Image: attachment.php?aid=8455]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
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Attaching Files
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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.
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#48
RE: New BiPAP user
I increased the Ti to 1.5.
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#49
RE: New BiPAP user
Did it help with the feeling of inhale being cut off?
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#50
RE: New BiPAP user
(03-10-2020, 08:44 AM)Sleeprider Wrote: Did it help with the feeling of inhale being cut off?

At first start up, it felt a little more difficult on my exhale. About the same on my inhale. 

I do notice (all the time, not just now) that when I start treatment the pressure is greater at first but settles down to a lesser amount of pressure through the night.  

I seemed to have slept a little better last night.  

I wrote back to the nurse and reiterated my concern about my high ahi numbers and feeling tired in the afternoons.  I also told her I'd been reading up on my machine and wondered, with a diagnosis of obstructive apnea, why I didn't have a regular cpap machine.
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