(03-21-2013, 08:01 PM)racprops Wrote: From their notes:
Hyponeas and obstructive apneas were not significantly reduced with PAP during NREM and REM sleep.
CPAP was introducted and Titrated from 5 Cm to 19 CM and Bi-Level PAP at 19/15CM was sampled at the end of the night. Snoring was eliminated at 5 cm. CPAP was ineffective as a result of having developed complex sleep apnea (CPAP induced Central Apneas) and there was insufficient time for an adequate Bi-Level PAP titration.
Does that help?
Yes, that helps. Assuming that this sleep lab did everything correctly (which may
be an incorrect assumption), then you indeed need higher pressures to combat the OSA, but when those higher pressures are reached, centrals rise to unacceptable levels. It would be nice to find out exactly how many centrals occurred at that 19 cmH2O CPAP pressure level, if that could be obtained.
What really needs to be determined is at what level of pressure did the centrals start increasing while on CPAP? (I suspect at slightly over 15 cmH2O, given the above notes), and that's probably why he started you on Bi-level at 19 IPAP and 15 EPAP.
So, he was trying at least to go from least expensive option to most expensive as far as the machine is concerned. (CPAP, then Bi-level, and now wanting a new titration to re-test bi-level and perhaps ASV if Bi-level doesn't do the job).
I can see now why they wanted you to come in for a second titration night.
If you still want to do this on your own, the cheaper way would be to get a trial of a data-capable Bi-Level to test and see if it might work at the higher levels without inducing an unacceptable level of centrals (setting the lower exhalation pressure setting at or near 15, while incrementally increasing the upper pressure 1 cmH2O each night and noting the effect upon AHI and centrals). If that doesn't work, you may have no choice but to switch to an ASV. Or, you could just start off with an ASV that is auto-titrating and go that route.
Again, this is all not medical advice, as I'm not a doctor. My personal opinion now that I know a bit more about the facts is that going in for a 2nd titration night would be the safest route, as long as you can afford it. Going on your own with ASV right off the bat with no clear titration information in a sleep lab could be marginally successful, since it's going to be hard for someone brand new to all this stuff to self-titrate with good results using an ASV, not knowing all the ins and outs of ASV titration. Yes, it can all be learned, but at some point, with health care, it's safer to pay a professional who has done it many times before.
Hopefully other more knowledgeable folks will be here this evening to chime in on this.
In any case, I'll leave the thread for now and let ASV users respond to your original question of which ASV is best.