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Questions for Pulmonologist
#1
Questions for Pulmonologist
I will be seeing my Pulmonologist in about a week for my medicare compliance and I thought I would check in with the experts.

A REVIEW And BACKGROUND
I'm paying for Medicare so I might as well get a machine through them.
I was previously using a Dreamstation
I have tried using a Resmed Airsense Auto and Airsense auto for her for about a month in 2017 and I got some very strange and disturbing results
Because of these results 2 years later a bought a used Resmed Vauto with good results.
I tried hard to get an Aircurve auto issued but I was unable too. I took the Airsense auto and if I got the same scary results it would be evidence for the Vauto.
I never got the same results .

Airsense Auto in 2017

high flow limits
high respiratory rate
low tidal volume
1 to 1  I/E ratio
[Image: JA1Gy7y.png]
[Image: GiBTPnU.png]


Aircurve Auto

Can't get much better
[Image: HiHT9u4.png]

Recent Airsense

Higher respiratory rate
lower tidal volume
I/E ratio lower
higher flow limits
[Image: 7sg6LVI.png]

As you can see the Aircurve was doing a great job compared to the Airsense auto. I never get the wild results I was getting in 2017. I wish I new why.
On the recent Airsense auto my results are in the acceptable treated range but I am concern about the inhale to exhale ratio and what that means. Sometimes it is close to a 1 to 1 ratio Withe the Aircurve it is nearly a 1 to 2 ratio

Ant comments would be greatly appreciated. Thanks, car54
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#2
RE: Questions for Pulmonologist
Quote:I never get the wild results I was getting in 2017

EPR is different. Your flow limits appear to be better with a higher EPR.
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#3
RE: Questions for Pulmonologist
(02-21-2020, 03:50 PM)harrywr2 Wrote:
Quote:I never get the wild results I was getting in 2017

EPR is different. Your flow limits appear to be better with a higher EPR.

Yes, this; your more recent results had the highest EPR, and the earlier were lower.

Your FL was obviously much lower still on the VAuto. 

What about sleep quality and daytime symptoms?

If not significantly different than the VAuto, then no problem.

But if yes, mention that and ask if there's anyway to get a VAuto?
Caveats: I'm just a patient, with no medical training.
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#4
RE: Questions for Pulmonologist
I seem to be more tired as the day goes on.  Sometimes when I sit I feel like dozing off. This may be partially due to a shoulder problem that limits what position I can sleep in.

car54
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#5
RE: Questions for Pulmonologist
I/E times are almost always wrong in OSCAR, I really don't like doing analysis on them. Lower PS and EPAP could both be playing roll and you also don't have timing controls at play so numerous factors possibly influencing those numbers.

If you want to get the same bad results from 2017 use the same bad settings. Aka 10 cm of pressure and no EPR.

I'd be curious if your autoset results get better by raising EPAP to 8 cm, where you had it on Vauto (would be min pressure of 11). Vauto definitely was dialed in a bit better by the looks of it and I imagine both the lower EPAP and slightly lower PS are the reasons for more flow limitations on the autoset. Timing controls may also have been having some effect.
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#6
RE: Questions for Pulmonologist
Medicare can and will approve bilevel without backup (HCPCS E0470) if the patient does not "tolerate" CPAP. You actually have evidence of an improvement of efficacy with bilevel and while it is not entirely based on AHI, most doctors can put together the puzzle of flow limitation and pressure support. Medicare will cover this, and the doctor only needs to be able to communicate your intolerance for CPAP therapy based on your qualitative feedback, as evidenced by the quantitative data that clearly shows the importance of pressure support for you. It really comes down to the doctor being willing to appeal the inevitable denial and stick with you as an advocate. Some doctors just don't have that, and you don't want them. Be sure you're working with your medical advocate!
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#7
RE: Questions for Pulmonologist
(02-21-2020, 05:21 PM)Geer1 Wrote: I/E times are almost always wrong in OSCAR

I disagree with your above statement.  Without question, there are times when factors do throw them out of wack. When this happens the cause does need to be investigated but it is nowhere near "Almost always"
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#8
RE: Questions for Pulmonologist
(02-21-2020, 08:22 PM)bonjour Wrote: I disagree with your above statement.  Without question, there are times when factors do throw them out of wack. When this happens the cause does need to be investigated but it is nowhere near "Almost always"

Well it is almost always for me(median values wrong 100% of the time and individual breath times wrong 95+% of the time). All it takes is a single cardiogenic oscillation per breath to screw up these numbers (at least on my machine/version of OSCAR). 

Here is an example of a breath with a single oscillation that barely touches 0 flow rate (I believe a fairly common waveform in most individuals). As you can see the reported inspiration rate is incorrect and overstated. Actual inspiration time is 1.583, reported inspiration time is 1.84. 

   

Why are car54's numbers different? It could be that the machines report the values differently, his inspiration time might be longer due to different EPAP/PS, he might have had fewer cardiogenic oscillations that night or maybe they are affected by EPAP/PS. Too many possibilities to comment on without seeing detailed data. First step would be to confirm what the numbers should be as I am willing to bet they are wrong.
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#9
RE: Questions for Pulmonologist
I think I see a flaw in your logic based on the graph you posted.  You are highlighting an inhale on a graph that is 1 minute in length.  The value for the Insp Time graph is based off of an average of the 1-minute time frame.
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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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#10
RE: Questions for Pulmonologist
I see, for a sample size of one, now that is really compelling, especially on a thread where your single results don't matter, (it's not your thread).
Stop disrupting threads.
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