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New to CPAP (~2 months), still struggling
#11
RE: New to CPAP (~2 months), still struggling
Those look ideopathic meaning non-CO2 based central apneas, Back those out to 10 minutes ant that should show better. Also include a zero line for the flow rate, all on top is inhale, under is exhale.
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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#12
RE: New to CPAP (~2 months), still struggling
10-min view with 0 dotted line added to flow rate.

From a health perspective, what does it mean to have CA at 29 years of age? As I understand, most that suffer from it are 65+. Do I need to make changes to my lifestyle? What else can help in improving the occurence? Is CPAP my only option?


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#13
RE: New to CPAP (~2 months), still struggling
it means very little. more people have a few central apneas than have none. Our concern is oxygen desats, and only a few have significant desats with a CPAP, and mostly sleep disruption.
Without question CPAP is the Gold Standard treatment fo Sleep Apnea.
Life style changes, just the usual ones, eat well, loose weight, sleep well, and play hard.
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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#14
RE: New to CPAP (~2 months), still struggling
Since I have my appointment with my sleep doc tomororw, I just need a bit of clarification on what machine I should be pushing for exactly.

You mentioned ResMed AutoSet and ASV, but looking at the descriptions below they appear to treat different apneas.
AutoSet doesn't treat central, only OSA. ASV treats mixed.

Quote: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
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#15
RE: New to CPAP (~2 months), still struggling
With the PR machine you still have central apneas, even after enough time for treatment-emergent central apneas to go away.  The ONLY way to eliminate these is with an ASV.  The issue with them is that the centrals are under 5 CAI, a level the medical community will say does not justify an ASV, just live with it or words to that effect.

You have significant obstructive events including hypopneas and RERAs (which contribute to RDI, just add RERAs to AHI for RDI) and flow limits which the medical community ignores.  Thus your PR machine is failing.  The equivalent ResMed Machine will do a significantly better job at it BUT, to your advantage, the AutoSet is considered by the medical community to deliver identically to the Auto DS you have therefore it makes no sense to get the AutoSet.  BiLevel is the next step up and is intended for intolerant CPAP cases which is what you are.  With this you want a ResMed VAuto, even if you let them set it up in manual / S / Spontaneous mode.

In otherwords, the system will fight you getting an ASV, even though the ultimate cost with testing, yacht purchase, machine purchase is far more costly than just getting the ASV in the first place.

The poor service of the PR is the justification for getting a BiLevel (VAuto) than just changing brands for the equivalent machine.  It is the easier sell.
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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#16
RE: New to CPAP (~2 months), still struggling
I'm looking at my graphs from Monday night and Tuesday night, looks like my CA numbers have dropped down from the ~2 range. Was 1.23 Mon night, and 0.78 Tues night. This was after changing max pressure to 13 (didn't do 14 as I felt it was interfering with the mask fit). Although I'm not sure if that's the direct cause for the drop in numbers. But I like the signs of improvement, hope it continues to drop.

In any case, I'll fight for a ASV. VAuto will be my second choice.


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#17
RE: New to CPAP (~2 months), still struggling
Goose, I was diagnosed with central apnea at 32 in 1987 but there was no treatment available at that time. my memories combined with the stories my family tells about my noisy thrashing sleep suggest it's been lifelong. 30 years hence (older and fatter) a new sleep study returned nearly equal numbers of central and obstructive apnea and yet my neurologist sleep doc diagnosed me with obstructive apnea and prescribed an apap that won't treat central apnea. it seems to be the rule rather than the exception. it'll be up to you to push push push to get an asv if that's what you need. most doctors and insurances will balk and make it difficult but perseverance usually pays off. if not, you can buy a used asv to prove your case. ca is inconsistent from night to night so you have to document a pattern or history.
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#18
RE: New to CPAP (~2 months), still struggling
Appreciate the advise, sheepless Thanks


Just got done with my appointment. Doctor was pretty adamant about doing another sleep study (not at home) to understand what exactly my brain activity is like before trying out another machine. I talked a bit about the data from OSCAR, which he took in but didn't seem to change his impression on what he feels is the best thing to do. So another sleep study will be scheduled, pending approval from insurance of course. I suppose I don't mind following this course, since there will be more data available, and especially related to my brain function during sleep. At-home sleep studies only records breathing, and not brain activity. 

Until then, I'll continue with the current treatment. I don't think it needs any more fine tuning, since there's only so much to be played with.

I'll be sure to post updates as soon as I have something!
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#19
RE: New to CPAP (~2 months), still struggling
No updates regarding a sleep study yet. I'm going to reach out to my doctor's office next week for one.

The past couple of weeks, I've been having some serious gas which I think is also contributing to this back pain I've developed. The pain is not persistent throughout the day. I only feel it from waking up after a few hours of sleep. Sitting up straight and standing helps relieve some of it. The pain usually subsides after 30 mins once I get my day started. And of course, farting throughout the night and morning helps.

Not sure why the aerophagia is happening all of a sudden, or why I'm suddenly swallowing in more air than normal. Guess I'm breathing through my mouth a fair bit now.

Any suggestions? Should I lower the pressure? My AHI levels have been 1-4 since changing the pressure min. 9 max 13.
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#20
RE: New to CPAP (~2 months), still struggling
I had my sleep study on Sep 20th, and didn't realize that the results were out a week later until I checked today.

Anyway, overall I had lousy sleep. Not sure if it had to do with the fact that I was in a different environment or that that I was recorder. I had a hard time falling asleep, before falling asleep I would a numbing/tingling sensation across my body, feel like I haven't taken a breath in a while so I would wake up. I also felt like I didn't get any sleep at all, even though the technician told me that I was. Looking at the results from the sleep study, it looks like all of this have been attributed "spontaneous arousals".

I got a call from the supplier, and they informed me that my sleep doc wants me to run my machine as PAP at a continuous pressure of 9. No more A-CPAP, range of 9-13. I'm also getting ht Eson 2 Fisher & Paykel mask shipped, it's what I used at the sleep study. I guess they like the fit better.

Not sure what my next steps would be other than discussing the results with my doc. But I would appreciate if anyone can have a look at the results and shed some light to it

.pdf   sleep_study.pdf (Size: 974.61 KB / Downloads: 4)
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