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[Treatment] Advice Please
#11
RE: Advice Please
Welcome,

1. "Patient HAS been diagnosed with OSA"  
This is incorrect and MUST be corrected:  The Primary diagnosis needs to be Central Sleep Apnea Primary central sleep apnea G47.37 or Primary central sleep apnea G47.31.  The secondary diagnosis can be Obstructive Sleep Apnea G47.33, and lucky you get a third whammy Periodic Limb Movement Disorder 

Your hypopneas were not evaluated to determine if they are also central so they are assumed to be obstructive.  In reality, most are likely to be central in nature.  Thus an argument could be made to drop the Obstructive Apnea diagnosis.

Recommendation #1 WILL NOT WORK for you.  Why? there is no timed backup and way too little pressure support

Recommendation #2 ASV or Adaptive Servo Ventilation WILL work for you.  The lab recommended returning to the lab for titration to prove the efficacy of an ASV. As others have noted above you have a couple of choices to make in how you choose to get this machine but rest assured this is the ONLY machine that will work for you.  I too recommend the Resmed over all others.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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#12
RE: Advice Please
Hi Ryan,
There is some conflicting info on the Sleep Report that you attached.
The report states that you have Obstructive Sleep Apnea.
It then says that the majority of your events are Centrals. The only way this makes sense is if is a Titration Report.

There are 2 types of Reports.
1.) The original report when you are not on a PAP machine. This is the important Report and would be the most useful to post.
2.) A Titration Report where you are on a PAP machine and they are trying to determine what settings are appropriate.
I believe that you have posted a Titration Report. 

I believe you may have Complex Sleep Apnea, or Treatment Emergent Sleep Apnea. Which means that the pressure of the PAP machine is confusing your sleep breathing centre, causing you to have Central Apneas.
(Your report doesn't specifically say that, but it is the only thing that makes sense.)
 The machine has resolved your Obstructive Sleep Apnea, but has given you Central Sleep Apnea.
This happens in about 10-15% of people with Obstructive Sleep Apnea.OSA.
In the majority of people with Complex Sleep Apnea it resolves itself within 3 months of CPAP usage. (I fall within this category. My Central Apnea resolved itself within 1 month of starting with my APAP.

My opinion is that you should download OSCAR and post some of your results from the usage of the machine you currently have. Sleeprider will be more than happy to help you optimize your settings.
It is very possible that your current machine will do the job. Give it a month.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3700705/
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#13
RE: Advice Please
FWIW it says in the area called Montage: Overnight Polysomnography ...
My take is the report attached from the OP post 1 is a PSG AKA a sleep study. Also since there's not any included table or chart with pressure and time with results, it's a PSG.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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#14
RE: Advice Please
[attachment=25871][attachment=25872][attachment=25873]

Is there a way to tag these reports to get some help with the data?
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#15
RE: Advice Please
(08-21-2020, 08:29 PM)SarcasticDave94 Wrote: FWIW it says in the area called Montage: Overnight Polysomnography ...
My take is the report attached from the OP post 1 is a PSG AKA a sleep study. Also since there's not any included table or chart with pressure and time with results, it's a PSG.
I guess we will continue to disagree on this point until possibly Ryan helps to clear it up. There are other things in this summary of a report that suggest it is a Titration Report.

Ryan.  Were they using a PAP machine for this report?
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#16
RE: Advice Please
(08-21-2020, 09:23 PM)Ryan needs to Sleep Wrote: Is there a way to tag these reports to get some help with the data?

There will be some advice over the next while on what this data is showing.
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#17
RE: Advice Please
As I see it, the 3 OSCAR data charts seem to indicate events could be lessened by more pressure except I also see areas of apnea clusters. If so then you may have some variant of positional apnea occuring at times.

I'd also say the Respironics has some trouble keeping tight rein on the events whereas a ResMed VAuto would improve the chart in an instant excepting for the suspected areas of positional apnea that a soft cervical collar would remedy if in fact they are as I suspect.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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#18
RE: Advice Please
Ryan it's simple, pack this machine up and drop it from  . . .   or deliver it to your doctor and tell him this (TLA) doesn't work,  That you need an ASV Yesterday!!!

OK, seriously now.

Min EPAP = 8 
Max IPAP = 8
PS min = 0
PS Max = 0
Flex Off (I think it is, make sure)

this removes all pressure variability, decreases the max pressure and raises the min pressure, and removes all flex and PS which hopefully lowers the CAI.  Post tomorrow  and we will see if we can lower the pressure more.

All we can do here is try and avoid centrals.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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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#19
RE: Advice Please
Sorry Ryan,

Better eye than me bonjour. I missed the CA. Yep, ResMed AirCurve 10 ASV. The BPAP is not ever going to help with the CA and in fact could increase them as it did me.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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#20
RE: Advice Please
Yes, I was on a pap all night.
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