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Sleep doctor says CPAP data on CA's not accurate
#11
RE: Sleep doctor says CPAP data on CA's not accurate
(10-18-2021, 07:56 AM)Sleeprider Wrote: This article explains respiratory drive and the relationship of CO2   In your case is also discusses the feedback loop that can occur as the respiratory drive waxes and wanes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193835/  If this is not in your wheelhouse, you need to know that respiratory drive, the urge to breathe, is strongly related to the amount of CO2 in your bloodstream. As CO2 rises, so does the urge to breathe, and similarly, as CO2 is purged from the bloodstream by higher ventilation rates, the urge to breathe is diminished or absent.  A feedback loop can develop where you experience a low respiration rate or apnea that triggers the urge to breathe deeper and faster, then as CO2 drops as a result, respiration becomes shallower and slower. This gives a wave-like appearance to the flow rate that we sometimes call periodic breathing or an apneic breathing pattern.  This is distinguished from obstructive sleep apnea by the lack of flow limitation and the oscillating flow rate that arises out of response to CO2.  In more severe forms this can be punctuated by a central apnea, or clusters of central apnea. There is s considerable difference in sensitivity to this fluctuating CO2 between individuals, with some of us able to tolerate high ventilation rates and pressure support without significant respiratory drive suppression, and others like you having therapy onset centrals with relatively low pressure and pressure support.  The fact your doctor does not understand this fundamental respiratory drive and attributes it to a false data signal shows he is unqualified to treat your central or complex apnea.  You will not change him or educate him. You need to find a doctor that understands this condition.

Sleeprider, thanks for all the info. The level of the article is way above my understanding but I get the gist of what you're saying. Depressing. Unfortunately (I guess) the doctor belongs to a hospital whose sleep department is considered to be one of the best (if not the best) in my end of the woods. Took me months to find the doctor and months longer to get to her. 
Maybe it's because the medical insurance here doesn't cover the more expensive machines so the dealers don't import them and the doctors don't prescribe them. A Resmed S10 costs around $2000 here so an ASV device would probably be 3 times that amount. Small market so higher prices than in the US.
I'll keep looking for a doctor with a more open mind.
I might even consult a doctor in another country. Come to think of it, my meeting with the doctor here was on video, so why not?
(As a matter of interest, is there somewhere on the forum a list of recommended doctors?)
Thanks again.
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#12
RE: Sleep doctor says CPAP data on CA's not accurate
Your doctor denies that the machine data is accurate. The kind of study that would demonstrate efficacy is a titration study using CPAP. Your AHI is not very high, and the frequency of central events changes through the night. It is very hard to obtain a doctor's order under those circumstances. If you want to source ASV, the best way is going to be to use a marketplace like DotMed. You can search for that site and look under Respiratory equipment/bilevel and filter for Resmed or ASV. These are surplus and used machines, often from distributors or hospitals. It is a very economical way of obtaining an ASV without a prescription. You would need to pay for international shipping, but that is often available. There are 2 Aircurve 10 ASV units available with heated humidifiers and cases. 231 hrs and 1629 hrs and you have to contact the seller to get a price quote. There is also the older RESMED S9 VPAP Adapt SV Bi-level PAP, which is also ASV. Inventory changes all the time, so if you want an ASV for a good price, you just have to keep looking and obtaining quotes for the equipment and shipping to Israel.
Sleeprider
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#13
RE: Sleep doctor says CPAP data on CA's not accurate
And when you get the ASV, several of us can help you with the pressure setup. Default ResMed ASV Auto Titration and paired with OSCAR, you're up and running in minutes. Yes there will be a few edits to your setup to adjust to your needs but it's not hard. I've used the 10 series ASV so I can add experienced comments, but that doesn't rule out others from helping. It's a lot of common sense adjusting like for most PAP machines, with a bit of ASV specifics.
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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