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Requesting help w/ CPAP adjustments
#11
RE: Requesting help w/ CPAP adjustments
(11-21-2019, 09:53 PM)flatlander Wrote: Here are my home sleep study results. Its terribly quality, I know. Im going to try and get a better copy from them. I wrote down what I could make out. 
Im going to try those setting out tonight. Thanks!

Currently I pay 30% out of pocket for the CPAP machine and supplies. But I can currently switch my insurance until December 9th to a different plan. I won't have my split sleep study until December 23th unfortunately. 

Here are my home sleep study results. Its terribly quality, I know. Im going to try and get a better copy from them. I wrote down what I could make out. 

Thanks for the help!
That says a lot, 88% of your apnea is central for 14.2 CAI 
This says that it is highly likely that EERS will NOT help you.

This makes it very important to specifically talk to your doctor about how to get you onto an ASV.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#12
RE: Requesting help w/ CPAP adjustments
You have in your hands, the diagnosis of primarily central apnea, with 2 mixed, 100 central 14 obstructive and 17 hypopnea evets. Oxygen saturation was below 90% about 5% of the time. Importantly, the signal quality was 100%, so we're actually looking at a report that has some q quality. Your CPAP data completely confirms these results with primarily central events.

If there was any suggestion of a conflict in the results between the home sleep study and the CPAP data, I'd be all in for a clincal PSG diagnostic study, but that is NOT the case. You are in fact dealing with primarily central apnea. The doctor should request a titration study where he can have central vs obstructive apnea evaluated and try to find the pressure in CPAP, BPAP or ASV that provides efficacy. This is the efficient approach to solving the problem. If it is obstructive apnea, that will be immediately evident in the titration test and it will titrate out with pressure. It won't. He can then move to BPAP and prove ou canot be treated with any combination of IPAP/EPAP. Finally if time allows, ASV will prove what works.

You do not need a diagnostic study. Talk to the doctor. Ask for the titration test because we already know what the real problem is.
Sleeprider
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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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#13
RE: Requesting help w/ CPAP adjustments
Hello Sleeprider,

So why in the world would they even waste my/their time with a CPAP machine when it won’t work? 
More importantly, why was I diagnosed with “moderate obstructive sleep apnea” with all these central events and so few obstructive events?
I am so confused. 

So I already have a titration test scheduled. I need to ensure they will have an ASV machine handy on that night. Is that correct? That seems to be the most important aspect of it all.  ASV is the only treatment for central  apnea?
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#14
RE: Requesting help w/ CPAP adjustments
Your doctor needs to specify an ASV titration as part or all of the study.

Why, they mentioned OSA and all the rest must be just an artifact and thus it is just ignored.  Your summary mentions centrals,  many do NOT which is why we specifically ask for full studies.  The common path is
Fail at CPAP
Fail at APAP
Fail at BiLevel wo backup (Vauto)
Fail at BiLevel w backup (ST)
Succeed at ASV

Why?  Insurance, the ASV is the most costly of all of these machines, and the insurance wants to spend as little as possible.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#15
RE: Requesting help w/ CPAP adjustments
(11-21-2019, 10:57 PM)flatlander Wrote: So why in the world would they even waste my/their time with a CPAP machine when it won’t work? 
More importantly, why was I diagnosed with “moderate obstructive sleep apnea” with all these central events and so few obstructive events?
I am so confused. 

The words "obstructive" and "sleep apnea" are used together so routinely that a mindset has developed that all apnea is obstructive. These guys don't even see central apnea when it's right in front of them. I had to explain the difference to an anaesthetist a couple of years ago when I had some surgery. It's very very common for central apnea to be diagnosed as obstructive. In my view it's close to malpractice, but everybody does it.

Quote:So I already have a titration test scheduled. I need to ensure they will have an ASV machine handy on that night. Is that correct? That seems to be the most important aspect of it all.  ASV is the only treatment for central  apnea?

For pre-existing central apnea ASV is the gold standard treatment. It's really the only machine guaranteed to give you good results. If your central apnea was treatment-emergent we could suggest ways to manage it on your existing machine, but not so for pre-existing central apnea. You must discuss this with your doc and insist that an ASV is included in your titration study.
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#16
RE: Requesting help w/ CPAP adjustments
(11-21-2019, 10:57 PM)flatlander Wrote: Hello Sleeprider,

So why in the world would they even waste my/their time with a CPAP machine when it won’t work? 
More importantly, why was I diagnosed with “moderate obstructive sleep apnea” with all these central events and so few obstructive events?
I am so confused. 

So I already have a titration test scheduled. I need to ensure they will have an ASV machine handy on that night. Is that correct? That seems to be the most important aspect of it all.  ASV is the only treatment for central  apnea?

Insurance circus protocol requires you waste your time and your/their money to fail CPAP and probably BPAP too to prove to them you're needing an ASV. With this data evidence, they should, but probably won't, skip all the way to ASV titration. Demand they do ASV titration.

Most doctors can only see obstructive apnea and can only say "you need CPAP". It's partly to bow to insurance as well.

ASV titration will be done by a test machine that emulates CPAP BPAP ASV and others. It will function like an ASV you'd get.

Central Apnea can be treated by ASV, it's the latest and best CA treatment device. An ST-A machine can do it as well, but it is more for restrictive lung disease sufferers like COPD patients that also have apnea.
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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#17
RE: Requesting help w/ CPAP adjustments
Relatively few doctors are tuned into central apnea. It will help for you to very directly point out to your doctor that you are aware that your diagnostic home sleep study and your Resmed CPAP data both overwhelmingly show central apnea, not obstructive. Let him know that higher pressure results in higher AHI and events are central. If your doctor calls your apnea problem "obstructive" ask him about his experience in diagnosing and treating central and complex sleep apnea. There are doctors that don't even acknowledge anything but obstructive sleep apnea. You need to determine if this doctor is capable of working with you or if he is incapable of dealing with your condition. Don't waste your time working with someone that can't help you. You should be able to very quickly determine whether your doctor is listening and working to accurately diagnose you. If not, you must find a physician that is interested in more complex cases.
Sleeprider
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www.ApneaBoard.com

____________________________________________
Download OSCAR Software
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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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#18
RE: Requesting help w/ CPAP adjustments
    Hello Sleeprider, 

Im back after my overnight sleep study. I could not do ASV d/t insurance purposes and needing echocardiogram. Here are my results. I am confused bc the sleep tech said he could get my AHI to 3 using a pressure setting of 4. This confuses me bc after 5 weeks of home use and most nights zero leaks my AHI range is 5-15. Can you interpret anymore information from these results?

Also, why is he recommending a nasal mask if he was able to control my AHI so well w/ my current face mask? 

I have appt w/ sleep doctor but not until end of Jan. 

Thank you so much for the help. 

Flatlander
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#19
RE: Requesting help w/ CPAP adjustments
    Hello Dave, 

Im back after my overnight sleep study. I could not do ASV d/t insurance purposes and needing echocardiogram Sad . Here are my results. 

I am confused bc the sleep tech said he could get my AHI to 3 using a pressure setting of 4. This confuses me bc after 5 weeks of home use and most nights zero leaks my AHI range is 5-15. Can you interpret anymore information from these results? I have appt with sleep dr but not until late Jan. 

Also, why is he recommending a nasal mask if he was able to control my AHI so well w/ my current face mask? 

Thank you so much for the help. 

Flatlander

    Hey Bonjour,  

Any more insight after my overnight sleep study? I could not to ASV. 

I am confused bc the sleep tech said he could get my AHI to 3 using a pressure setting of 4. This confuses me bc after 5 weeks of home use and most nights zero leaks my AHI range is 5-15. Can you interpret anymore information from these results?

Also, why is he recommending a nasal mask if he was able to control my AHI so well w/ my current face mask? 

Thank you so much for the help. 

Flatlander
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#20
RE: Requesting help w/ CPAP adjustments
Can you post a daily chart from after the sleep test?  One from just before the sleep test?

The RT recommended a high amount (3) of "Flex"  but made no mention of using any during the study.

I suspect that the study was conducted without "Flex/EPR/PS".  Remember I suggested a pressure of 5 fixed with 0 EPR figuring that your CA events would drop significantly.  
That is what I expect happened during the sleep study.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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New to Apnea? Helpful tips to ensure success
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