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Stubborn Centrals
#41
RE: Stubborn Centrals
EPAP min is equivalent to PEEP in ventilation (Positive End Expiratory Pressure). This raises oxygen by recruiting more lung volume and increasing partial pressure for more efficient gas transfer. The alternative is to increase the FiO2 by using an oxygen bleed. (Please search the Wiki for CPAP Oxygen Bleed). I can detail more later but using a phone to reply.
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#42
RE: Stubborn Centrals
I think a little more epap will help.  In my titration they went up to a pressure of 8 partially because that resolved my desaturations.  I will try a min epap 7 then 8 if needed to see if the desaturations improve.  There is so much that goes into these settings.  Thank you all for this forum for helping people figure this out.  It seems like the professionals don't have the time or motivation to get people effectively treated.

Kevin
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#43
RE: Stubborn Centrals
Question regarding my titration study.  No hypopneas were recorded throughout the entire study.  They were a main component of my sleep study.  Is it possible that they did not monitor for hypopnea?
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#44
RE: Stubborn Centrals
I personally would chalk this to some inconsistent apnea or hypopnea event occurance. These studies are obviously a capture of one specific night. All apnea event counts are different every night.
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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#45
RE: Stubborn Centrals
I had an unbelievable night on the asv machine last night.  I decided to just follow the recommended asv auto settings of epap min 4, max 15 and ps min 3; however I did max ps 10 so I wouldn't get aerophagia.  The epap stayed very low with no apnea, just a few hypopneas!  I can probably raise max ps to help with more events if epap stays low.  It felt so much more comfortable than apap.  I am even wondering if the low epap pressure with resolve my plmd as it was "unmasked" with what was probably the wrong machine and too much epap.  I know it was only one night, but even at min epap 5, the overall epap has stayed very low.  I think this is very convincing proof that I was on the wrong machine and the ASV is the best therapy for me. I also decided to scrap looking at my spo2 readings as I think they were not accurate. With this machine I have been waking up earlier feeling refreshed like I never have my whole life.

   
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#46
RE: Stubborn Centrals
great to hear! for those for whom asv is appropriate, it's really effective at reducing events to less than 2/hr. I'll be curious to see if improved apnea therapy improves your plmd. fingers crossed!
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#47
RE: Stubborn Centrals
Regarding they hypopnea question, many clinics define hypopnea as an oxygen desaturation 4% or more with a reduction of respiratory volume. Individuals with a tendency for treatment emergent central apnea may experience reductions in respiratory volume that is not accompanied by sufficient O2 desaturation to score as an event. This is a common feature of people that balance their apneic threshold by varying respiratory volume. Those same non-events can mature into full blown CA with positive pressure therapy as hypocapnea is exacerbated by positive pressure therapy.

Regardless of what your diagostic study showed, we know that you had abundant CA events with PAP therapy, and that it is completely resolved with ASV. At some point, you should discuss this with your doctor and see if he intends to support the therapy proven to work best in the future, or if you should consider finding someone more open-minded. The proof is in your results, and could certainly be confirmed in a clinical titration, but that seems completely unnecessary to conclude that ASV is beneficial to you and medically necessary, and even to revise your diagnosis. That opens the door for insurance coverage.
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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#48
RE: Stubborn Centrals
I did have mostly central, mixed and hypopnea on my diagnostic study, so I don't know why I was diagnosed with obstructive.  I was going to ask for recommendations on how to approach my MD on this.  I think the summaries of usage for both machines will show a stark difference.  I could also print the charts for a couple of days.  I think he will be pretty agreable, but we will see.  I need to see him soon so that I can turn in the autoset and have everything updated.

Thank you,

Kevin
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#49
RE: Stubborn Centrals
I would rather bluntly make the case that your diagnostic test pointed to a high probability of central or complex sleep disordered breathing, and the ASV trial confirms that. It is clearly in your best interest to be accurately diagnosed for the record and for insurance purposes. Tell him you want your records to reflect this diagnosis based on the facts. Also ask that you prescriptivists of record specify ASV at the settings you have found effective. I don’t see the need for much debate on this. You did the research and self funded therapy that obviously works.
Sleeprider
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____________________________________________
Download OSCAR Software
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Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
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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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#50
RE: Stubborn Centrals
I just made the appointment.  They told me to bring the sd card.  I have one for each machine so I will bring both.  I will tell him I went rogue and I feel much better on the ASV and discuss the results I have gotten on both machines and the original sleep study.  I think I got the machine cheaper than what it would have cost me for another sleep study and my portion of the cost of a new machine through insurance anyway!

Thank you so much!

Kevin
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