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New Guy! High AHI
#11
RE: New Guy! High AHI
    Sorry, last night was my first night ever with an SD card.  Here's 0100- 0110
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#12
RE: New Guy! High AHI
   
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#13
RE: New Guy! High AHI
OK no changes tonight. Let's make sure that is not a one- off night, you want to know if this is somewhat consistent.
Tomorrow, unless your doctor says otherwise,

Set max pressure to 8 and
Set EPR to 0

and as I said before, both of these should help reduce your Central apnea.
I don't know but this may or may not be related to either the drugs that you are taking or a heart condition, which you know you have. To us it's a signal that you should be checked out.
See from 01:02:30 on that is pretty classic looking CSR pattern. You can check the rest of the CSR portions for that pattern, and your cardiac and sleep doctors should be made aware that you have a breathing pattern that "looks like classic CSR starting at 01:02:30 on with the waxing and waning breath flow with Central Apneas inbetween".

Let us know what they say.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
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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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#14
RE: New Guy! High AHI
Thank you, and sleep well!
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#15
RE: New Guy! High AHI
            More evidence of CSR, it seems...
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#16
RE: New Guy! High AHI
Believe it or not, those are not classical CSR. But sufficient t
And extensive enough to approach your doctor for a discussion

Tonight make the changes I suggested. That will give a good indication of if you need an ASV machine to manage your Centrals.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#17
RE: New Guy! High AHI
Thanks. I’ll give it a try.
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#18
RE: New Guy! High AHI
Aug 15, 2019 Data  (Lowest AHI I've seen so far.  Still some centrals)
EPR: Off
Min: 4
Max: 8

           
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#19
RE: New Guy! High AHI
(08-14-2019, 09:28 PM)bonjour Wrote: That has some sets that are typical CSR and some that are not.  Same thing but 1:00 am to 1:10 am please, that is a denser bunch of CAs.  It is not a steady stream of classic CSR which typically means you have a heart condition with CHF being common.  Classic CSR is nearly sinusoidal in waveform and is very distinct.  

Is this typical of what you have been seeing as far as Centrals and Obstructive events with some variation of course.  And could you show the full view of the previous night?
If it is similar I'm going to ask you to set your EPR=0 then show tonights chart,  looking to see a significant drop in Central Apnea.

thanks
Good afternoon,

Well, buy now I've been through 4 total sleep studies:  1 at home that wasn't very useful, a diagnostic one in a lab, a CPAP titration, and a BiPap titration. 
Bottom line:  My doc thinks that my CAs will be controlled with a BiPap machine.  My DME delivered a ResMed Aircurve 10 Vauto yesterday, set to 10 / 6. Results:  High AHI (17.6) and what appears to be more CA's than ever.  Calls to the DME and doctor's office have not yielded any suggestions about that to change.

So..Reaching out to the folks who know something about this stuff:  you all! 

Attached is last night's graph.  Suggestions?

Thanks!

Dave


Attached Files Thumbnail(s)
   
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#20
RE: New Guy! High AHI
(11-20-2019, 05:32 PM)dahornor Wrote:
(08-14-2019, 09:28 PM)bonjour Wrote: That has some sets that are typical CSR and some that are not.  Same thing but 1:00 am to 1:10 am please, that is a denser bunch of CAs.  It is not a steady stream of classic CSR which typically means you have a heart condition with CHF being common.  Classic CSR is nearly sinusoidal in waveform and is very distinct.  

Is this typical of what you have been seeing as far as Centrals and Obstructive events with some variation of course.  And could you show the full view of the previous night?
If it is similar I'm going to ask you to set your EPR=0 then show tonights chart,  looking to see a significant drop in Central Apnea.

thanks
Good afternoon,

Well, buy now I've been through 4 total sleep studies:  1 at home that wasn't very useful, a diagnostic one in a lab, a CPAP titration, and a BiPap titration. 
Bottom line:  My doc thinks that my CAs will be controlled with a BiPap machine.  My DME delivered a ResMed Aircurve 10 Vauto yesterday, set to 10 / 6. Results:  High AHI (17.6) and what appears to be more CA's than ever.  Calls to the DME and doctor's office have not yielded any suggestions about that to change.

So..Reaching out to the folks who know something about this stuff:  you all! 

Attached is last night's graph.  Suggestions?

Thanks!

Dave

What you need is the Resmed Aircurve 10 ASV. The Vauto cannot and will not treat central apnea.  The truth is your doctor is either following the process required by insurance that you try CPAP and fail, try Bilevel and fail and perhaps even try the awful ST bielvel and fail before finally reaching hte machine you need.  This is so common, we have written a wiki Justifying Advanced PAP Machines.

The alternative is that  your doctor is actually clueless and thinks the Vauto will treat central apnea.  You need to understand there is nothing that will make that machine work properly, and you are actually better off with CPAP than bilevel because the IPAP/EPAP channels increase ventilation, lower CO2 (blood bicarbonate levels) and suppress respiratory drive.  The solution is the Adaptive Servo Ventilator which provides enough pressure support when needed, as needed to cause you to take a breath, even when you don't spontaneously take one, and gets out of the way when you do.  The ASV provides enough exhalation pressure (EPAP) to keep your airway patent against obstructive apnea, and enough pressure support (difference between IPAP and EPAP) to cause air to flow into your lungs during a central apnea or to increase ventilation during hypopnea.  It does this by learning your normal minute vent (air volume per minute = tidal volume x respiration rate) and your normal rate of respiration in breaths per minute.  The Vauto is a very good bilevel machine intended to treat obstructive apnea, upper airway resistance, flow limitation and hypopenea, but is has no mechanism to resolve central apnea.

So you now know the deep dark secret that it is insurance that drives your medical care and not your doctor.  The good news is you just need to complain often enough and loud enough to your doctor, and he probably know how to treat this.  If not, find one that does.  I encourage all patients with your problem to directly confront their doctor and ask what experience and knowledge they have in the treatment of central apnea, and why he has not prescribed ASV. You need to force the issue and self-advocate for the right therapy.  Last question...does your insurance cover most of the cost of testing and equipment or have you personally been saddled with a large part of these costs.  The reason for this question is that it affects the strategy moving forward.
Sleeprider
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.
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