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Normal or NOT my report numbers I am at a lost
#11
RE: Normal or NOT my report numbers I am at a lost
I agree with Sleeprider. You have a ton of clear airway events. The cause is unknown. If it is caused by the machine it's due to the large pressure support being used. Your current pressure support is 8cm which is the difference in your two pressures. Normally we would recommend dropping the pressure support down to 3cm or lower to see if that stops the clear airways from happening. The problem with that is we don't know if there's a medical reason for your pressure support being so high due to a breathing problem. Hence the best advice is to contact your Doctor and let them know your suffering too many clear airway events.
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#12
RE: Normal or NOT my report numbers I am at a lost
(12-12-2017, 01:45 PM)Mogy Wrote: Hi Kiwi, Sleeprider,
Normal I would defer to Sleeprider's knowledge and good judgement but on this occasion I feel very strongly as well. I have followed Sleeprider's suggestion for pressure adjustments with good results. On this occasion I don't feel his recommendation is correct at this time. It is too early. ...

Yes, I also (normally) feel strongly on the conservative side. I'm glad that you've expressed your reasoning, as that is what makes Apnea Board such a valuable resource, and helps to provide checks and balances.

Thank you too for providing the data to justify your rationale.

Since Sleeprider has such a strong belief that Lise consult with physicians, I think there must be some reason for it. It isn't like he is recommending a change to her settings; he wants her to get medical assistance ASAP. It sounds like there is some reason that this should not wait.

I do not have enough knowledge to make any recommendation, or to understand why Sleeprider responded in the way that he did (what it is that makes this case so different from the others).
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#13
RE: Normal or NOT my report numbers I am at a lost
About 35% of complex apnea cases self-resolve with CPAP/BPAP. I don't think this is one of them, but I've been wrong before, the most recent example being CZOscar who started with an AHI of about 23 and now gets consistently less than 1 to about 4 AHI. http://www.apneaboard.com/forums/Thread-...017?page=3

My advise to Lise would be the same as what worked for CZOscar. Lower fixed pressure without pressure support/EPR will give her the best possible results. The reason she has the prescription she has, is she failed CPAP, and as the titration proceeded, they found a period of lower AHI at near the maximum pressure the bilevel would provide, with pressure support (8) that caused breaths to happen. But without backup rate this could not, and did not last. Bilevel at 25/17 is insane and the trend she posted is currently for increasing apena...She needs ASV. The lowest price is through Supplier #2 for a Resmed S9 VPAP Adapt, or Aircurve 10 ASV. The lowest Amazon price is $2100 USD (Medguru who ships internationally). If she wants her AHI to drop from 30 to less than 3, then that is the answer. There is a possibility that with time and lower fixed pressure, we can significantly reduce the event rate. It's really up to her if she wants to pursue that or see if her doctor will choose to treat her properly, rather then try to fit the square peg in the round hole.
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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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#14
RE: Normal or NOT my report numbers I am at a lost
(12-12-2017, 04:51 PM)Sleeprider Wrote: About 35% of complex apnea cases self-resolve with CPAP/BPAP.  I don't think this is one of them, but I've been wrong before, the most recent example being CZOscar who started with an AHI of about 23 and now gets consistently less than 1 to about 4 AHI.  http://www.apneaboard.com/forums/Thread-...017?page=3

My advise to Lise would be the same as what worked for CZOscar.  Lower fixed pressure without pressure support/EPR will give her the best possible results.  The reason she has the prescription she has, is she failed CPAP, and as the titration proceeded, they found a period of lower AHI at near the maximum pressure the bilevel would provide, with pressure support (8) that caused breaths to happen.  But without backup rate this could not, and did not last.  Bilevel at 25/17 is insane and the trend she posted is currently for increasing apena...She needs ASV.  The lowest price is through Supplier #2 for a Resmed S9 VPAP Adapt, or Aircurve 10 ASV.  The lowest Amazon price is $2100 USD (Medguru who ships internationally).  If she wants her AHI to drop from 30 to less than 3, then that is the answer.  There is a possibility that with time and lower fixed pressure, we can significantly reduce the event rate.  It's really up to her if she wants to pursue that or see if her doctor will choose to treat her properly, rather then try to fit the square peg in the round hole.
How do you recognize which complex apnea cases will self resolve and which do not?
How do you rationalize it when
 you are not correct and the OP goes out and purchases an expensive machine that they cannot afford and don't need? Not to mention the extra worry caused.
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#15
RE: Normal or NOT my report numbers I am at a lost
(12-12-2017, 06:16 PM)Mogy Wrote:
(12-12-2017, 04:51 PM)Sleeprider Wrote: About 35% of complex apnea cases self-resolve with CPAP/BPAP.  I don't think this is one of them, but I've been wrong before, the most recent example being CZOscar who started with an AHI of about 23 and now gets consistently less than 1 to about 4 AHI.  http://www.apneaboard.com/forums/Thread-...017?page=3

My advise to Lise would be the same as what worked for CZOscar.  Lower fixed pressure without pressure support/EPR will give her the best possible results.  The reason she has the prescription she has, is she failed CPAP, and as the titration proceeded, they found a period of lower AHI at near the maximum pressure the bilevel would provide, with pressure support (8) that caused breaths to happen.  But without backup rate this could not, and did not last.  Bilevel at 25/17 is insane and the trend she posted is currently for increasing apena...She needs ASV.  The lowest price is through [/url][url=http://www.apneaboard.com/forums/Thread-CPAP-Supplier-List?pid=31#pid31]Supplier #2 for a Resmed S9 VPAP Adapt, or Aircurve 10 ASV.  The lowest Amazon price is $2100 USD (Medguru who ships internationally).  If she wants her AHI to drop from 30 to less than 3, then that is the answer.  There is a possibility that with time and lower fixed pressure, we can significantly reduce the event rate.  It's really up to her if she wants to pursue that or see if her doctor will choose to treat her properly, rather then try to fit the square peg in the round hole.
How do you recognize which complex apnea cases will self resolve and which do not?
How do you rationalize it when
 you are not correct and the OP goes out and purchases an expensive machine that they cannot afford and don't need? Not to mention the extra worry caused.
Indeed , by all means Lise can and of course will carry on with her current settings and machine. 

Sleep rider has seen and interpreted a helluva lot of data from many of us. As he has humbly noted, he can be wrong but I for one am ready to wager he is not wrong.
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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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#16
RE: Normal or NOT my report numbers I am at a lost
I'll just add that even the relatively few individuals that resolve apnea to clinically "acceptable" levels have inconsistent results that are easily upset by almost any variable. It is possible to optimize a complex apnea patient on CPAP, and we did that with Member SpyCar, yet he persisted and got the ASV which he described as "life-changing". I have worked with countless members that had complex and central apnea. Some resolve with CPAP or bilevel, most don't. There are at least a half-dozen currently in progress on the forum, and each one is an individual with their own unique response to pressure and pressure support or EPR. Most of the time, they can be brought below 8 events per hour,and sometimes, less than 5. Of all these individuals I have coached, I have not yet met one that regretted moving to ASV. By the time that investment decision is made or authorized by insurance, it is usually pretty clear if alternative non-ASV approaches will work or not. Also I have worked with a number of people that ended up on ST or ST-A machines, either because their health precluded moving to ASV, or their insurance or doctor would not go there. Again, even where ASV may be optimal, ST seems to work, but the comfort and satisfaction of the user is anecdotally lower.

I don't think I have to defend my record of helping people seek the best therapy for their needs on this forum. For the most part it is very straight-forward, but cases like this one simply don't fit the usual obstructive sleep disordered breathing mold. Even if CPAP eventually reduces the event rate of the complex apnea presented here to less than 5 events per hour, it is not the optimal therapy. It is a compromise that fits the economic and insurance model. I can already predict that if Lise changes her pressure to between 8 and 10 cm fixed in CPAP mode, the event rate will be reduced at least 70% or under 10 AHI consistently. That does not mean I think it is the best therapy. Not trying to be arrogant, but that is what works in most, if not all of these cases. The current case has 68% central, 20% obstructive and 12% hypopnea. Do you really think this will resolve at the current therapy?
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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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#17
RE: Normal or NOT my report numbers I am at a lost
Hi Lise, and welcome to Apnea Board. We each will do our best to help and teach you what's your own best actions are going to be. And all of us here support all others on the board in wishing the best success in treatment.

I'm chiming in not to take sides or anything like that, but to give my own self as an example. Earlier this year, I was on a BiPAP that I felt was working OK for a few days. I was aware that there should be a learning curve, yet after those first few days, I drastically felt worse each time I used the BiPAP. Within 2 weeks I knew BiPAP was wrong. My trend of continual worsening AHI was unbearable.

Yes, I will mention Sleeprider. He was I believe first to point to my PSG report of 124 Central to 24 obstructive. We tried setting adjustments, but that failed.

Because of how terrible treatment was making me feel, I requested a next day urgent appointment. That started my ASV path. I researched what I needed to do to help me be informed. For me, ASV was and still is the right call. Overall AHI avg is 0.7 this most recent 30 days. And I'm aware that ASV isn't for everyone, but it's certainly there for those that it's right for.

I'm aware this might be more difficult to get ASV to happen in Canada. OK then I would get the doc involved. He or she needs to know ASAP. Make informed decisions and actions with one exception. That exception is to do nothing, as doing nothing results in nothing getting better.

Again wishing you find success,

Dave B
Dave

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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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#18
RE: Normal or NOT my report numbers I am at a lost
(12-12-2017, 01:45 PM)Mogy Wrote: From studies published by NCBI, greater than 90 percent of complex apnea resolve by themselves.

(12-12-2017, 04:51 PM)Sleeprider Wrote: About 35% of complex apnea cases self-resolve with CPAP/BPAP.

It depends on what criteria you use for treatment-emergent CSA and what criteria you use for resolution. Per this reference, about two thirds of treatment-emergent CSA resolve or improve after 90 days of CPAP: https://www.uptodate.com/contents/treatm...bstract/27

Personally, I don't think we have enough information yet and would like to see the OP's diagnostic sleep study. With that said, there seems to be consensus amongst sleep medicine experts that BPAP without a backup rate is bad treatment for anyone with this apparent degree of CSA.

I would suggest that Lise address these data with her managing provider right away. If the data from the OP are confirmed, I would think that a reasonable immediate step (pending decision and availability re: ASV or BPAP-ST) may be to change from BPAP 25/17 to CPAP 17.
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