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New Guy! High AHI
#21
RE: New Guy! High AHI
This is NOT going to solve your issues, it is not going to reduce your central apnea beyond what you have accomplished with the AutoSet with no EPR.

The reduction of central apnea that you saw with EPR=0 was IMHO not sufficient.

My suggestions
Set PS=0 This will be the equivalent of setting EPR=0 and will reduce, but not eliminate your central apnea.  

The PS=4 is doing a great job with your obstructive side.  I would eventually like to raise the PS back to 4 but let's first get the central apnea under control.

The reduction in central apnea with EPR=3 indicated that we were on the right track.  It showed that at least a good share of the central apnea are related to having too low of a pCO2  level in your blood caused by the efficiency of your machine washing CO2 out of your blood.  Setting EPR/PS=0 gets you part way there.

I'd like you to think about using Enhanced Expiratory Rebreathing Space  (EERS).  This is a technique to increase the CO2 levels in the blood which would support this form of central apnea.  This will also allow the PS to be increased to better manage your obstructive apnea.  This is accomplished with a mask modification to facilitate a rebreathing of small amounts of your breath.  

Below are links to Wiki articles on both Treatment-Emergent Central Apnea and EERS, read them to learn more.

http://www.apneaboard.com/wiki/index.php...ace_(EERS)
http://www.apneaboard.com/wiki/index.php...tral_Apnea
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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#22
RE: New Guy! High AHI
Mr Bonjour,

Was this advice intended for me, or some other person?

Thanks,

Dave
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#23
RE: New Guy! High AHI
Dave for you.
I see that SR and I posted at the same time, 
ASV is the other option, which I put less immediate chance at since you just got the VAuto.

EERS is less mainstream and my thought would be to see if we could get the centrals down with EERS and then resolve obstructives with the VAuto and PS.  If this failed then the ASV.  I can virtually guarantee your doctor will not be familiar with EERS.
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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#24
RE: New Guy! High AHI
Foxfire is the member that first brought EERS to our attention
http://www.apneaboard.com/forums/Thread-...#pid265472
http://www.apneaboard.com/forums/Thread-...a-attached

His doctor has been instrumental in researching this approach to resolving central apnea, and like yourself, Foxfire experienced central apnea. He even used ASV which is considered the gold standard treatment for CA events. his doctor put him on EERS and I think the thread I linked has his express preference and success using that technique. I wish EERS was more widely understood and accepted, and it is unlikely your doctor has ever heard of it. If you want to try EERS, it's a fairly easy DIY to make up, and will likely result in an elimination of most CA events you experience, even with pressure support. This is a viable and useful alternative to ASV.
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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#25
RE: New Guy! High AHI
Thank you, SR and Fred! I'm going to set PS=0 for tonight and see how it goes.  EERS is intriguing.  To answer SR's question about insurance--after an initial high outlay for (almost useless) home study, I met my deductible and the other studies have typically most me about $100 in co-pay amounts.
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#26
RE: New Guy! High AHI
My sinuses were stuffy last night, to I was unable to tolerate at PS=0.  Perhaps if I had increased the ramp time to 20 or 30 minutes the humid air would have opened them.  I didn't have the energy to mess around with it. At any rate, I just slept  without the machine last night.

This morning my doctor's office called.  They say that the VAuto was the wrong machine and they are sending me an ST machine.  How do you think I'll need to set the ST machine for best results?  They are setting to 10/6 with something set at 9. I don't recall what the "something" is. 

Thanks!

Dave
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#27
RE: New Guy! High AHI
ohhh boyyyy, here we go.  Which of the following do you have?  COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) or other respiratory conditions?

You need an ASV!!!  Ask you doctor if you have any of the above conditions, include the pure OSA a CPAP/APAP/Vauto is designed to treat.  Follow by asking him how you are going to get the ASV, the ONLY machine designed to treat Central/Mixed Apnea.





This info is from the ResMed Sleep Lab Titration Guide

  • CPAP (continuous positive airway pressure) Fixed pressure delivered with optional expiratory pressure relief (EPR). It Treats OSA

  • AutoSet/APAP (automatic positive airway pressure) Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas. It treats OSA

  • AutoSet for Her/APAP Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas along with an increased sensitivity to each flow-limited breath, providing a more comfortable therapy for women. Increases sensitivity to each flow-limited breath, providing a more comfortable therapy for women (OK for men too). It Treats OSA

  • VAuto Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas; Pressure Support (PS) is fixed throughout the night and can be set by the clinician. It Treats OSA, non-compliant OSA

  • S (Spontaneous) Senses when the patient is inhaling and exhaling, and supplies appropriate pressures accordingly. Both treatment pressures are preset: inspiration (IPAP) and expiration (EPAP). It treats Non-compliant OSA and COPD

  • ST (Spontaneous/Timed) Augments any breaths initiated by the patient, but also supplies additional breaths if the breath rate falls below the clinician’s set “backup” respiratory rate. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions

  • T (Timed) Supplies a clinician-set respiratory rate and inspiratory/expiratory time, regardless of patient effort. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions

  • iVAPS (intelligent Volume-Assured Pressure Support) Maintains a preset target alveolar minute ventilation by monitoring delivered ventilation, adjusting the pressure support and automatically providing an intelligent backup breath. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions

  • ASV (adaptive servo-ventilation) Targets the patient’s minute ventilation, continually learning the patient’s breathing pattern and instantly responding to any changes. It treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)

  • ASVAuto Provides an ASV algorithm plus expiratory positive airway pressure (EPAP) that automatically responds on the patient’s next breath to flow limitation, snore and obstructive sleep apneas. It Treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)

  • PAC (Pressure Assist Control, also known as Pressure Control) The inspiration time is preset in the PAC mode; there is no spontaneous/flow cycling. Inspiration can be triggered by the patient when respiratory rate is above a preset value, or delivered at a set time at the backup rate. It Treats Neuromuscular disease (NMD), pediatric patients

Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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New to Apnea? Helpful tips to ensure success
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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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#28
RE: New Guy! High AHI
I.e. since I have none of the above, I must, therefore have Central/Mixed SA--and need an ASV machine. I have this sinking feeling the doctor will insist that I try the ST machine first. Which will make my CA's go up and put me at greater risk of AFib, strokes, etc.
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#29
RE: New Guy! High AHI
Plan your path to ASV with your doctor. The ST offers a timed backup, that is what I think your doctor sees.
Bring up that you have failed APAP, and failed BiLevel without backup (VAuto).
Ask if you can do a split study with ST and ASV. The concept is to get a formal trial with the ASV which you will pass. And ASV is DESIGNED to treat what actually ails you.

There is a decent chance that EERS will work for you, but I'm sure your doctor will not be familiar with it. This is what we hope to learn with the PS=0 test (which we can do with the ST)
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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#30
RE: New Guy! High AHI
Settings with the ST.
EPAP=IPAP=5 PS=0

Possibly with high PS something like PS=8 WITH a timed backup that is a bit slower than your normal breathing rate.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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