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RELENTLESS sleep-transition central apneas
#21
RE: RELENTLESS sleep-transition central apneas
Try to relax and let it happen. There is really nothing you can do to affect this test. The purpose is to demonstrate efficacy, or that ASV results in an improvement. Clinical studies are always disruptive, so just do what you have to do to sleep.
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#22
RE: RELENTLESS sleep-transition central apneas
(06-17-2019, 05:24 PM)Sleeprider Wrote: Try to relax and let it happen. There is really nothing you can do to affect this test. The purpose is to demonstrate efficacy, or that ASV results in an improvement. Clinical studies are always disruptive, so just do what you have to do to sleep.

Thanks for the supportive words. Do you (or anyone else) know: what exactly needs to "happen" during the sleep test in order for the insurance to approve an ASV? I already have documented centrals and so the the sleep test is to titrate. If I only sleep for an hour but the machine fixes the centrals at onset, does that qualify as "improvement"? Do I have to sleep x amount of hours or anything like that?
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#23
RE: RELENTLESS sleep-transition central apneas
(06-19-2019, 02:52 PM)idlewire Wrote:
(06-17-2019, 05:24 PM)Sleeprider Wrote: Try to relax and let it happen. There is really nothing you can do to affect this test. The purpose is to demonstrate efficacy, or that ASV results in an improvement. Clinical studies are always disruptive, so just do what you have to do to sleep.

Thanks for the supportive words. Do you (or anyone else) know: what exactly needs to "happen" during the sleep test in order for the insurance to approve an ASV? I already have documented centrals and so the the sleep test is to titrate. If I only sleep for an hour but the machine fixes the centrals at onset, does that qualify as "improvement"? Do I have to sleep x amount of hours or anything like that?

What they need is proof that you require intervention for nocturnal breathing disorders of a kind, and then that they can be managed effectively somehow.  The lab does both; they first monitor you while you sleep and record movement, eye movement, breathing, brain waves, pulse, and vocalizing.  Then, if they establish that you have troubles, they may awaken you and have you put on a mask and see what happens during the rest of the night while they 'fiddle' with treatment to see what brings your AHI down.  

In my case, it was a whole night to monitor, then the specialist visit to tell me I had problems, assignment of a treatment protocol and a machine from a retailer sleep clinic/DME, and then another sleep lab overnight a month later to see if the treatment was 'correct'.  Once those two things were in place and placed before my insurer, they gave all of us the thumbs-up.
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#24
RE: RELENTLESS sleep-transition central apneas
Thanks for the response! I think I'm a little further along. I've had an at-home test and am currently using a Bi-Level machine, and my doctor has provided documentation of my centrals to my insurance company. I thought that I would be put on the ASV "right away" during the study (or that maybe they'd wait for a few centrals to pop up at most), but I wasn't sure if that was the case or what was "supposed" to happen after that!
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#25
RE: RELENTLESS sleep-transition central apneas
My understanding is that most cases require CPAP trial and failure, then the same or similar results on BPAP. After failing both then an ASV is considered. Each step may need a sleep study and titration as well. That’s what I’ve gone through to get mine.
Dave

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience regarding CPAP therapy and should not be considered medically professional direction or advice. Even a 1,000 mile trip requires a good first step. My recommended first steps include getting good walking shoes, 1 great cup of coffee, and a good GPS.

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#26
RE: RELENTLESS sleep-transition central apneas
I think my insurance has allowed an accelerated process. I did an at-home sleep study and went straight to Bi-Level. I remember seeing on some form that the doctor had indicated "CPAP intolerance" or something even though I never tried pure CPAP. Now the doctor has gotten approval for an ASV titration as far as I know. I don't think I need to "prove" I need ASV at this point, I think just show that it helps? I'm not entirely sure and the doctor is impossible to get hold of if you are not sitting in front of him.
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#27
RE: RELENTLESS sleep-transition central apneas
(06-19-2019, 03:20 PM)idlewire Wrote: Thanks for the response! I think I'm a little further along. I've had an at-home test and am currently using a Bi-Level machine, and my doctor has provided documentation of my centrals to my insurance company. I thought that I would be put on the ASV "right away" during the study (or that maybe they'd wait for a few centrals to pop up at most), but I wasn't sure if that was the case or what was "supposed" to happen after that!

Oops, a little careless reading on my part.  I failed to notice that you were interested in the ASV approval.  Sorry.

Dave is correct, therefore, that you have to be 'incrementally' deemed to have failed each successive type of less-costly treatment.  When all the other methods fail, and ASV is the last possibility, they will approve it, supposedly, and you'll be where you need to it if it's indicated.
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#28
RE: RELENTLESS sleep-transition central apneas
(06-14-2019, 10:51 PM)crowtor Wrote: You may not know this but even healthy people have O2%sat drop on falling asleep, that's part of physiology of falling asleep. With some of us apnea folks though, the brain learns to wake us up even when it shouldn't. This is your jolt problem, this is why sleep/relexation meds work for you when falling asleep.

Here in germany you wont easily get a Rx for a -zepam drugs, instead you get mirtazapine for this type of problem. It's like using a battleship instead of a car to get to work.

Yes, I do take some comfort that these only happen at onset and that it seems like an aberration of what should be a normal process. I was so averse to taking medication (for pretty much anything) before this, but thank god I found something that helps, at least for the time being. Xanax is just a band-aid, but then again, ASV is just a band-aid, it's just a better band-aid (or so I hope).

Here's charts from 2 different nights. The first is me saying "Dammit, I'm going to sleep without taking anything no matter what", and what follows is an hour of hell never getting to sleep, way too much adrenalin, then just giving up. The second is "I've got something important tomorrow I better sleep I'm taking xanax". A handful of centrals (that I'm not even aware of or woken up by) and then nice sleep.

   

But it has had its drawbacks. My sleep architecture is different. I'm sleeping 45 minutes less every night on average, and spent 3 weeks waking up with brain fog, but my body adjusted. Still, I'll be happy to stop taking anything. In the meantime, I search for more "natural" alternatives -- magnesium, melatonin, passionflower tea, chamomile, lavender pills, l-theanine, etc etc. -- but nothing else has worked.
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#29
RE: RELENTLESS sleep-transition central apneas
Update: so I never did the sleep study, but... I did acquire an older ResMed S9 ASV for a ridiculously low price. It's the 36037 model which has ASVAuto and whose algorithm, I was told, would be similar if not identical to an Aircurve 10 ASV. Apparently I was wrong about my sleep study being "accelerated" - I talked to the sleep tech beforehand and he said I would have to suffer through Centrals for about 3 hours as he tried to treat them with a Bi-Level machine, before moving to an ASV. Yikes. The amount of adrenaline I would release in such a situation would've made further sleep impossible. I chose not to put myself through that... yet. I still intend on attempting it one day soon, but for now...

The ASV worked so well. My fears about being awakened by the pressure were unfounded. The first night or two, as I was drifting off, I did notice a pressure increase, but it did not interrupt my falling into sleep. I had at least 8 straight good days with it, no more jolts, no more need for Xanax!

However all is not roses. I did notice that whenever I would try to nap I would still jolt awake. And after those 8 nights, I now still have some nights when trying to go to bed for the night when I jolt. I would say it's been happening on about 20% of nights. I would like to get to the bottom of this so maybe someone here can help. Whereas before I was jolting awake after holding my breath for the better part of a minute, I no longer hold my breath in the face of the ASV's algorithm! But now I seem to be sometimes jolting awake when my breathing is too shallow over the course of many minutes. I'm guessing my CO2 levels are rising in a much more gradual way than when I was holding my breath, and I'm fearing there is nothing my machine can do about it. Example chart:

   

You can see in the sleep before arousal, my minute vent is getting as low as 4.5 (my expiration time seems awfully high at 5 seconds too and my RR is only 8). I have checked my other charts and on my entry into sleep, achieving steady-state without jolts, my minute vent is usually between 5.5 and 6 (and my RR is about 12). The machine is nowhere near hitting the Max PS, so there's no room for adjustment there. The problem, as I understand it, is that the machine really corrects for unstable breathing that occurs over a short period of time (changes to MV gauged against a 3-min moving average), which allows you to set the overall trend of your breathing. Since my breathing here is so regular for almost 7 minutes, the machine has no cause to raise pressure and intervene.

What on earth can I do? I would welcome any suggestions, or speculation as to cause (why would my respiration rate be so low, nothing is different about those days). Also, for anyone who knows, does the Philips ASV allow you to set a minimum ventilation rate? Because maybe if the machine could kick me up to an MV of at least 5.5, then I wouldn't awaken. Definitely no way to do this on the ResMed.
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#30
RE: RELENTLESS sleep-transition central apneas
I can't explain why the minute vent is allowed to fall from 9.0 to 5.0 over 7-minutes. The Resmed ASV is supposed to target the minute vent to maintain volume, and it uses the rolling 15 minute average. In this sequence, pressure support starts near 10 cm and drops to about 7 (hard to tell). I see EPAP starts at 9 and drops to 7.5, and IPAP drops from about 20 to about 15. so beginning PS is about 10 and ending PS is 7.5. I'm not sure that this is the expected behavior for the machine, and as a technical matter, Resmed might discuss it, but they won't deal with your health or symptoms. I'm not aware of any settings that could prevent this, and still allow for the adaptive algorithm when you don't need the pressure support. Congrats, you stumped the chump!
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Optimizing Therapy
Organize your OSCAR Charts
How To Attach Images And Files to your posts
How To Deal With Equipment Supplier
Mask Primer
Beginner's Guide to Sleepyhead

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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