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New to Actually Posting - 2nd sleep study results (Need an ASV)
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vsheline Offline

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Post: #41
RE: New to Actually Posting - 2nd sleep study results (Need an ASV)
(02-22-2016 08:13 AM)richb Wrote:  Wow! Those events marked UA are most likely Central Apneas. It seems to me that your initial pressure is set too high. The result of high initial pressure is that periodic breathing is converted to Central Apnea. In other words what would be a rising and falling pattern with no machine or low pressure is converted to pauses where there is no breathing. My machine is set with a EPAP (exhalation pressure) of 6 and an IPAP (inhalation pressure) of 8. For me these pressures are low enough to not trigger many of the events marked UA in your graph. It seems that it is too late to treat the Centrals that may be caused by your machine in the first place, Your body may be convinced that you have no need to breathe and the very high pressures put out by the machine can't convince it otherwise. So, try going back to a starting point of much lower starting pressures and let your machine try to treat hypopneas instead of Centrals.

Rich


Rich - Sorry, but you've misinterpreted the waveforms. All the UAs in the recently posted data are very clearly obstructive. None are CAs.

metsfan302 - Whenever an ASV machine increases the pressure but the Flow stays flat at zero, this is clearly an OA.


Similarly, the zoomed-in Hypopnea you posted is clearly obstructive, too.

Lowering EPAP is only going to make the OAs and OHs more severe.

Something must be done to prevent all those obstructive events. Either sleep position needs to be improved or EPAP raised.

Are you no longer able to sleep on your side?

Or maybe you are rolling onto your back while asleep? If yes, got to prevent that somehow.

If you're unable to improve sleep position, I suggest raising EPAP to 12 or higher.

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 02-23-2016 06:14 AM by vsheline.)
02-23-2016 06:07 AM
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richb Online

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Post: #42
RE: New to Actually Posting - 2nd sleep study results (Need an ASV)
(02-23-2016 06:07 AM)vsheline Wrote:  
(02-22-2016 08:13 AM)richb Wrote:  Wow! Those events marked UA are most likely Central Apneas. It seems to me that your initial pressure is set too high. The result of high initial pressure is that periodic breathing is converted to Central Apnea. In other words what would be a rising and falling pattern with no machine or low pressure is converted to pauses where there is no breathing. My machine is set with a EPAP (exhalation pressure) of 6 and an IPAP (inhalation pressure) of 8. For me these pressures are low enough to not trigger many of the events marked UA in your graph. It seems that it is too late to treat the Centrals that may be caused by your machine in the first place, Your body may be convinced that you have no need to breathe and the very high pressures put out by the machine can't convince it otherwise. So, try going back to a starting point of much lower starting pressures and let your machine try to treat hypopneas instead of Centrals.

Rich



Rich - Sorry, but you've misinterpreted the waveforms. All the UAs in the recently posted data are very clearly obstructive. None are CAs.

metsfan302 - Whenever an ASV machine increases the pressure but the Flow stays flat at zero, this is clearly an OA.


Similarly, the zoomed-in Hypopnea you posted is clearly obstructive, too.

Lowering EPAP is only going to make the OAs and OHs more severe.

Something must be done to prevent all those obstructive events. Either sleep position needs to be improved or EPAP raised.

Are you no longer able to sleep on your side?

Or maybe you are rolling onto your back while asleep? If yes, got to prevent that somehow.

If you're unable to improve sleep position, I suggest raising EPAP to 12 or higher.

Several options have now been suggested that metsfan could try. It is very difficult to absolutely differentiate between CAs and OAs without the machine sending a resonant wave or having a probe inserted in the airway. So, I would try the several different options. Clearly half the night was quite free of Apneas so a positional change id implicated. Second, EPAP could be set at 12. Third go back to much lower settings and see if that reduces the Apneas. I still find the link between methadone and CAs compelling.

Rich
02-23-2016 06:50 AM
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metsfan302 Offline

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Post: #43
RE: New to Actually Posting - 2nd sleep study results (Need an ASV)
Thanks so much for all the inputs, it does mean alot!

I seem to be an odity, seems alot of fokes get an auto cpap dr sets it 4-20 and their ahi is under 5 no probs, not me lol.

I hope to be getting the call from the sleep center any min now, so looking forward to this ASV Tritration. Should I wear the same mask etc.

If you guys need me to post anything else please let me know, I'll try to see if I can figure out whats needed and post it.

Its weird too as my sleep dr said I have servere obstructive apnea too, but you guys seem to think its just centrals?

Here is a screen from what it looked like before I got this machine - I feel the same almost, never rested etc but ahi is lower to the 20's / high teens.

[Image: J3YfKAal.png]

What is really strange to me is I mentioned something about increased central apnea events at the meth center I go too, the nurse asked the dr about it like could my central apneas and they really did no know anything. That seems strange as I am sure their are alot of fokes who are on methadone either for pain or like me methadone/addiction maintance were they too have apnea and prob just never know it.

Thanks Again!
Eric
02-23-2016 03:51 PM
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richb Online

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Post: #44
RE: New to Actually Posting - 2nd sleep study results (Need an ASV)
(02-23-2016 03:51 PM)metsfan302 Wrote:  Thanks so much for all the inputs, it does mean alot!

I seem to be an odity, seems alot of fokes get an auto cpap dr sets it 4-20 and their ahi is under 5 no probs, not me lol.

I hope to be getting the call from the sleep center any min now, so looking forward to this ASV Tritration. Should I wear the same mask etc.

If you guys need me to post anything else please let me know, I'll try to see if I can figure out whats needed and post it.

Its weird too as my sleep dr said I have servere obstructive apnea too, but you guys seem to think its just centrals?

Here is a screen from what it looked like before I got this machine - I feel the same almost, never rested etc but ahi is lower to the 20's / high teens.

[Image: J3YfKAal.png]

What is really strange to me is I mentioned something about increased central apnea events at the meth center I go too, the nurse asked the dr about it like could my central apneas and they really did no know anything. That seems strange as I am sure their are alot of fokes who are on methadone either for pain or like me methadone/addiction maintance were they too have apnea and prob just never know it.

Thanks Again!
Eric

Best of luck with the new titration. I have been through 5 sleep studies trying to get the right machine. It seems some sleep Docs. take the easy road, learning as little as they need, so that they can prescribe relatively standard therapy for OA. That was my first Doc. I wound up doing an enormous amount of research only to find that my Doc didn't treat Central Apnea and Periodic Breathing. You very well might have an Obstructive component to your apnea. This is called Complex Apnea. It is going to take some fine tuning to find a balanced treatment. Best of luck.
Keep us posted.

Rich
02-23-2016 04:17 PM
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metsfan302 Offline

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Post: #45
RE: New to Actually Posting - 2nd sleep study results (Need an ASV)
Thanks everyone. I do sleep on my side, my wife says I only sleep on my side......

Might Oxygen help me out? I always feel like I am not getting enough even when awake.....

Have not gotten the call yet for the sleep study, am sure insurance is trying to not pay for it.....

I'll make those adjustments as suggested and post in a few days.
02-25-2016 11:00 AM
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DeepBreathing Offline
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Post: #46
RE: New to Actually Posting - 2nd sleep study results (Need an ASV)
Metsfan, as you've guessed by now, your case isn't exactly typical. However to summarise a few points...

1. You do have severe central sleep apnea. This is normally only treatable with an ASV machine

2. You also have obstructive apnea. Hypopneas are obstructive in nature and are included in your AHI. The fact you had no obstructive apneas in the test doesn't mean you had no obstructive events - to repeat myself, you had a lot of obstructive hypopneas.

3. A properly setup VPAP Adapt will extinguish all central apneas, leaving only closed airway events to be reported. Read my earlier post which included a quotation from the Resmed clinical manual. The zoomed in flow chart you posted earlier clearly shows a continuous string of obstructive apneas, as Vaughn said.

4. You have other medical issues and medications which complicate the matter.

Your ASV titration should tease all this out. It should establish a baseline EPAP to control your obstructive events and a pressure support range to quench your central apneas. Hold out for a fully automatic machine which can vary both the EPAP and PS. While I personally prefer the Resmed machine, you might be better off with a Philips which has more adjustments. I can't say whether you need supplementary oxygen, but some of our members have found it makes a big difference. It might be that getting fit and healthy will be more beneficial (yeah, it's easy to say and I'm guilty of neglecting my home gym).

Good luck!

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02-25-2016 06:32 PM
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metsfan302 Offline

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Post: #47
RE: New to Actually Posting - 2nd sleep study results (Need an ASV)
(02-25-2016 06:32 PM)DeepBreathing Wrote:  Metsfan, as you've guessed by now, your case isn't exactly typical. However to summarise a few points...

1. You do have severe central sleep apnea. This is normally only treatable with an ASV machine

2. You also have obstructive apnea. Hypopneas are obstructive in nature and are included in your AHI. The fact you had no obstructive apneas in the test doesn't mean you had no obstructive events - to repeat myself, you had a lot of obstructive hypopneas.

3. A properly setup VPAP Adapt will extinguish all central apneas, leaving only closed airway events to be reported. Read my earlier post which included a quotation from the Resmed clinical manual. The zoomed in flow chart you posted earlier clearly shows a continuous string of obstructive apneas, as Vaughn said.

4. You have other medical issues and medications which complicate the matter.

Your ASV titration should tease all this out. It should establish a baseline EPAP to control your obstructive events and a pressure support range to quench your central apneas. Hold out for a fully automatic machine which can vary both the EPAP and PS. While I personally prefer the Resmed machine, you might be better off with a Philips which has more adjustments. I can't say whether you need supplementary oxygen, but some of our members have found it makes a big difference. It might be that getting fit and healthy will be more beneficial (yeah, it's easy to say and I'm guilty of neglecting my home gym).

Good luck!

Thanks for the summary Dancing

Well Its been almost 2 weeks since my follow up appt with my sleep dr. She was going to set up this third study the ASV one she orig wanted but insurance said I needed to show a failed bi-pap study before they would do an ASV one, seems they in the end would spend more money but hey its their business not mine.....

I thought I would of gotten a call from the sleep center by now, so I decided to quickly look online at my insurance companies website since my dr's office isnt open yet etc and I found something odd.

Well before I had this 2nd sleep study there was an approved Prior Auth for this 2nd study, I assume that is why the sleep center called me in and I had the study cause they knew they would get paid... Well right now there are no prior auths in for me and well I saw the "Paid Claims" section and well seems for my Feb 8th sleep study its showing -

Well decided to go online to just see on my insurance companies website - if indeed my sleep dr put in for a prior auth for this third sleep study (ASV) - As she tried before to get this last test an ASV test but insurance wanted to see a failed bi-pap one first (Seems they are going to spend more money in the long haul but whatever).

She got last months sleep study approved, it was prior authed etc, but now looking at it its showing



Date Place Claim
02/08/2016 Sleep Disorders Center 16A9774083 - Denied

So seems the sleep center never got paid.........

I can only assume that is why this new study is delayed, strange.

Wonder if that is why I am not getting a call for a new study Oh-jeez and would I have to pay for that one out of pocket.......

Ugg!
03-02-2016 06:55 AM
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metsfan302 Offline

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Post: #48
RE: New to Actually Posting - 2nd sleep study results (Need an ASV)
Also, I know everything else is Ugly with my sleep study, was wondering about the Oximetry Info should I be alarmed?

[Image: GFjIWhzl.jpg?1]

I cannot thank everyone enough for all the info

Thanks in Advance!
Eric
(This post was last modified: 03-02-2016 07:09 AM by metsfan302.)
03-02-2016 07:05 AM
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Sleeprider Online
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Post: #49
RE: New to Actually Posting - 2nd sleep study results (Need an ASV)
Asfar as the oximetry goes, the most significant feature is that you spent 9.1%, of the sleep time, or over 24 minutes below the desaturation threshold of 90%, and 11.4 minutes below 88%, with a minimum of 81% SpO2. That's a lot, and consistent with the very severe complex apnea indicated in the sleep study. Obviously, if you spend nearly 10% of your sleep hours in a state of hypoxia, it is going to have long-term consequences for your health, as well as some immediate effects like headache and fatigue.

I'm not too impressed with your insurance company. Have you called to complain, or asked your doctor to intervene on your behalf? This is a relatively urgent health issue that is not being addressed due to the insurance company policies for demonstrating less expensive therapy as ineffective. No competent person could look at your sleep study and reasonably believe CPAP or even bilevel would solve this problem.

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03-02-2016 10:06 AM
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PoolQ Offline

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Post: #50
RE: New to Actually Posting - 2nd sleep study results (Need an ASV)
I know all insurance varies with what they pay and how they interface with their customers, that said, I have had good luck calling them and asking for help. And if you have any heart condition or high blood pressure, throw it in the mix. I am concerned about not getting enough sleep, my pressure is going up, blah blah blah. I don't know what to do can you help me? so far it has worked wonders, they even got my DME to schedule an emergency after hours appointment to pick up my first CPAP the same day Smile YMMV worth a shot. Anything that may lead to liability for them will get them to take notice, actually retaining a customer does not seem to interest them at all.
03-02-2016 01:21 PM
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