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New to CPAP (~2 months), still struggling
#21
RE: New to CPAP (~2 months), still struggling
I would buy (and I did buy) a slightly used (mine had 1 month on it) ResMed VAUTO from Supplier #2 from the suppliers list on this site. Top ribbon. Great machine and a great company and it does come with a warranty. $799
Apnea (80-100%) 10 seconds, Hypopnea (50-80%) 10 seconds, Flow Limits (0-50%) not timed 
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#22
RE: New to CPAP (~2 months), still struggling
Your sleep study identified 11 CA and 8 H events in single pressure titration between 4 and 9 cm. I think your earlier results in this thread showed significant CA events and characteristic complex apnea. Your titration was with CPAP and while not a singel obstructive event was noted, your brilliant physician signed off on a diagnosis of obstructive sleep apnea and recommended a fixed pressure of 9.0.

I agree you will do better with fixed pressure, but it won't fix the problem. Turn off Flex, and use the prescribed pressure of 9.0. We will see what we see.
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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#23
RE: New to CPAP (~2 months), still struggling
(10-06-2020, 09:08 PM)staceyburke Wrote: I would buy (and I did buy) a slightly used (mine had 1 month on it) ResMed VAUTO from Supplier #2 from the suppliers list on this site. Top ribbon. Great machine and a great company and it does come with a warranty.  $799

What in the results show that using a VUATO would be beneficial to me?
I know bonjour had suggested I get the same in the past.

Also, what about these alpha-intrusions?
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#24
RE: New to CPAP (~2 months), still struggling
(10-06-2020, 09:59 PM)Sleeprider Wrote: Your sleep study identified 11 CA and 8 H events in single pressure titration between 4 and 9 cm.  I think your earlier results in this thread showed significant CA events and characteristic complex apnea.  Your titration was with CPAP and while not a singel obstructive event was noted, your brilliant physician signed off on a diagnosis of obstructive sleep apnea and recommended a fixed pressure of 9.0.  

I agree you will do better with fixed pressure, but it won't fix the problem. Turn off Flex, and use the prescribed pressure of 9.0.  We will see what we see.

Thanks for that. I'll turn off flex before bed tonight.
Is it worth seeing a different sleep doctor for a better diagnosis? I'm not feeling super confident in who I have now.

Edit - Flex was already off.
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#25
RE: New to CPAP (~2 months), still struggling
If the majority of your apnea events remain elevated and consist of centrals and hypopnea, there are relatively few options to improve that result using CPAP. We normally try using lower, constant pressure and this sometimes provides the needed airway stabilization against obstructive events and airway resistance, while avoiding excess ventilation that can induce hypocapnia and result in crossing the apneic threshold. Put more simply, increased ventilation in some individuals, flushes the CO2 from the pulmonary system and reduces respiratory drive. This is often seen as periodic breathing, along with CA and H events. When manipulation of CPAP settings does not resolve the problem satisfactorily, the appropriate response is to consider ASV (adaptive servo ventilation) therapy. ASV works by adjusting bilevel pressure support on a breath by breath basis to even out the breathing volume and rate.

If you are going to work with your existing or a new doctor, the path forward is to discuss that your tests and CPAP therapy both show central apnea as the predominate problem, not obstructive. You need to learn about ASV and why it is used, and be able to discuss your interest in resolving an unacceptably high AHI and unsatisfying sleep by using ASV. A good starting point is to read the Resmed Sleep Lab Titration Guide focusing on the flowcharts for CPAP and bilevel (VPAP) and the proper response to central apnea. https://www.resmed.com/us/dam/documents/...er_eng.pdf This source will also show you how ASV works. The other thing you need to understand is that all patients with sleep disordered breathing are diagnosed with obstructive sleep apnea, regardless of their actual clinical presentation with central or complex apnea. All are started on CPAP and must fail CPAP in order to move on to the next higher level of therapy. This approach has been institutionalized by insurance companies to supposedly minimize costs by diverting all patients to the least expensive (CPAP) therapy first. It works! Many complex apnea patients with a mix of obstructive, central or therapy onset central apnea, end up frustrated, untreated and quit. Only those that know the game will move on to complain and get a titration study that progresses from CPAP through bilevel and trials ASV. Even the multi-mode titration study can be tricky because central apnea is "consistently inconsistent" and it is common for apnea events not to occur at some point during the titration, long enough that the test concludes that a successful titration has occurred. That is what happened in your last titration, and it will invariably fail when used at home long-term. See our wiki on Justifying Advanced PAP http://www.apneaboard.com/wiki/index.php...P_Machines
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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