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New to forum and to data analysis
#91
RE: New to forum and to data analysis
Seeing good results as she is getting used to the new Pillow mask. It does seem that there are fewer leaks but when it does leak , it wakes her up.
Very surprised at the reduction of the CA's this time. The past few days have had the usual of more CA's than anything.


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#92
RE: New to forum and to data analysis
not quite as good as the night before, but very good. Leak rate is low.


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#93
RE: New to forum and to data analysis
She says it seems like it leaks a lot, but apparently it is not leaking as much as it feels. She also was having trouble breathing to begin with as the Ramp pressure starts at 6 and we have it on auto. I raised the ramp start to 7.4 and left it on auto. Maybe later we can turn ramp off.
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#94
RE: New to forum and to data analysis
The increase in ramp pressure shortened the time for her to fall asleep (at least the machine was happy enough to go to full pressure). When she got up for the bathroom she had a problem getting the mask off and then back on again. We see that gap of time with the ramp low as she figured out the straps.
The leak rate is almost none at all. Pretty amazing. Planning on no changes, we will continue to monitor of course.


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#95
RE: New to forum and to data analysis
She is showing a return to higher CA's during her second session in the evening. After see wakes up the next session does go that well.
I have include the entire 2 sessions as well as just the last session by itself. I have been reading more posts on Central Apnea and the use of an ASV machine. She did get a Echo Cardiogram done. What were some of the key items to look for in the results? All we have heard is things look ok. I did pull this from the Echo report - Considering 2D visualization and technical calculations the left ventricular ejection fraction estimate is 60-65%.
Her sleep study got delayed until first part of January. Anything that we should push for during the study? What makes it a study focused on ASV needs?
In a few of the threads I have read there have been folks with insomnia and that an ASV actually helped with that. My wife has insomnia also and takes some pretty strong sleep meds. If she does not take them , she does not sleep. Possibly when she wakes in the middle of the night she can't go back to sleep because of the insomnia as the meds may have lost most of there strength. This may be related to why we see those CA's come back at that time.
I"m more trying to provide more info to the experts to see if there is something we should be looking at or having the doctors look at.


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#96
RE: New to forum and to data analysis
With fixed pressure, she is getting lots of flow limits, RERA and hypopnea, but adding pressure support or EPR results in CA events. The ultimate solution to resolving that paradox is ASV which can provide bilevel pressure support for both problems. Getting a doctor to agree with you means finding one that actually thinks out of the box and is motivated to solve these problems, because this is not a traditional application for ASV.

If we look at the likely outcome of titration, she can achieve satisfactory efficacy with CPAP. If a test were ever to progress to bilevel to actually try to improve tidal volume, RERA and hypopnea, then it is likely that titration would reveal the CA and things could move forward towards ASV. The requisite awareness must be that it rarely works that way and sleep clinics simply operate on the premise of stopping OA events, and even H events are only scored on the basis of SpO2 desaturations in excess of 4% below baseline. For the purposes of her upcoming sleep test, it is important that the doctor begins the test as bilevel moving to ASV as needed, rather than a CPAP test. In other words, he must conclude ahead of the test that CPAP has not produced adequate results for comfort and efficacy and he has decided to move her to bilevel to resolve the FL, H, RERA and related obstruction, then deal with CA as it arises.

The events rates we see in these charts suggest primarily upper airway restriction or obstruction and the CA events are just under the radar. Many doctors will accept the results as-is and it is up to the patient to express her intolerance of continuing therapy with these uncomfortable events and consequences. Since you are doing the speaking on her behalf, that might be up to you. How does she feel?
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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#97
RE: New to forum and to data analysis
I will talk to her more about when she feels good with the sleep and when not. Last night is interesting data for her 1st session. She indicated that she slept good until she had to go to the bathroom. I know she was awake at 7:00 I will ask more about how she felt.


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#98
RE: New to forum and to data analysis
A suggestion is to keep some sort of note taking, a notebook or similar to note symptoms and complaints regarding poor sleep, things the current therapy is failing at, etc. Present this to doc every time the doc sees the patient; reason to mention every time is that there should be paper trail of symptoms that are chronic, on-going over more than 3 months. This is likely a good idea to do whichever direction it goes, from CPAP to BPAP, or higher. This action helped me in getting ASV to 1) be looked at as an option, and 2) for the medical team to pay attention to my CA events not addressed.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#99
RE: New to forum and to data analysis
Thanks for the suggestions. I have some scattered notes, I will work on getting them together in one place with a screen shot here and there to show why some changes were made as well.
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RE: New to forum and to data analysis
Makes sense to document therapy changes. Compile them in a method that works for you, so you can convey to doc with conviction that you demand attention to x y z.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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