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Treatment-Emergent Central Sleep Apnea
#11
RE: Treatment-Emergent Central Sleep Apnea
I dunno but it seems this song n dance is becoming more frequent here...practice makes perfect

FWIW I'll keep tabs on progression...no I'm not THE guru but I do have a T-shirt that says I learned AND created some ASV acquisition dance steps

Coffee
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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#12
RE: Treatment-Emergent Central Sleep Apnea
I cut the dance short by buying my own machine a used S9 Vpap Adapt at a great price, I just wanted to sleep ?
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#13
RE: Treatment-Emergent Central Sleep Apnea
I gotta try this EERS thing myself, im always over 5 AHI, I'm sure I'm hypocapnic atleast a bit, good thing you can turn dreamwear full face into a EERS setup just by taping the mask vents.
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#14
RE: Treatment-Emergent Central Sleep Apnea
Bonjour's post is a good outline of the path we normally follow with a new member that arrives with complex sleep apnea a.k.a. treatment emergent apnea. It's an unfortunate fact that a significant portion of the medical community has no clue that central apnea exists, or how to treat it. I'm very impressed with the path followed so far to implement a lower EPR and lower pressure on an Airsense 10 Autoset to reduce the incidence of CA. That is normally our first approach to improve results. This improvement was undone by the "professionals" thinking a bilevel machine would improve things. The VPAP simply added EPR back in at an even higher level. The setting of IPAP 12.0/EPAP 8.0 is equivalent to using your Autoset in fixed pressure mode at 12 with EPR 4. Clearly, it is the pressure support or EPR that greatly increases your apnea.

Central apnea in many cases is "consistently inconsistent", which explains why you can have a successful titration for a few hours but fail the long-term use of the bilevel. As you originally learned, you will either need fixed low pressure without pressure support or EPR, or the correct treatment is an advanced Adaptive Servo Ventilator, which is a form of bilevel positive pressure machine with a backup rate. We have many users on this forum that use this specialized PAP machine successfully. It works by maintaining a base-line pressure (EPAP) that keeps the airway open and prevents obstructive apnea. It uses a higher inhale pressure (IPAP) that can vary on a breath by breath basis to resolve any central apnea or hypopnea and keep your tidal volume constant. It's really simple in concept and application, but the price of a new machine is in the $2000 to $3000 range or more when purchased through insurance at your DME. Machines in the used marketplace are frequently less than $800 and can be found.

You need to move to ASV, and your biggest obstacle at this point is you also need a referral to a competent professional that understands central and complex apnea and the devices used to treat it. That should be your immediate priority unless you are going to self-treat. Find a doctor that does not quack. Your DME may actually be able to point you to doctors in your area with a history of prescribing ASV.
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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#15
RE: Treatment-Emergent Central Sleep Apnea
Okay, here is my initial sleep study that I did at home with a take-home device from Resmed. My doctor says there were no central apneas, but I see them noted on the graph. The diagnosis doesn't mention them. What gives?


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.pdf   Sleep Study Test Results _11162018 copy242.pdf (Size: 654.23 KB / Downloads: 44)
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#16
RE: Treatment-Emergent Central Sleep Apnea
Here is the sleep study I did just last month leading me to move from the AirSense 10 to the AirCurve 10 VAuto. This showed zero central apneas.

I have one more sleep study document that was conducted in January, but I don't have it in electronic form and I'm not sure how useful it is at this point other than to note that there were only three central apneas recorded on that study and it not a Bilevel study. I am working on posting some Oscar data from the past few days.

You people are godsends!


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.pdf   Sleep Study Test Results_08122019_redact.pdf (Size: 898.89 KB / Downloads: 22)
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#17
RE: Treatment-Emergent Central Sleep Apnea
The diagnosis doesn't mention them, therefore, they do not exist, and no I'm going to make a political statement about the CIC.  Typically they are not mentioned in the summary either.  This is why we always ask for full reports of sleep studies instead of just summaries.  Unfortunately, this is WAY TOO COMMON.

This means that 56% of your apneas pre-treatment are Central Apneas.  This also means that it is extremely unlikely that your apneas are treatment-emergent.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#18
RE: Treatment-Emergent Central Sleep Apnea
(09-06-2019, 04:49 PM)bonjour Wrote: The diagnosis doesn't mention them, therefore, they do not exist, and no I'm going to make a political statement about the CIC.  Typically they are not mentioned in the summary either.  This is why we always ask for full reports of sleep studies instead of just summaries.  Unfortunately, this is WAY TOO COMMON.

This means that 56% of your apneas pre-treatment are Central Apneas.  This also means that it is extremely unlikely that your apneas are treatment-emergent.

Okay, now I'm just mad. How and why would a medical doctor do this other than just a mistake, which I find hard to believe.
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#19
RE: Treatment-Emergent Central Sleep Apnea
Feel free to give him a second chance, but you had 5 Apnea and 14 hypopnea events per hour with the apnea split about evenly between central and obstructive. It is common to ignore the presence of CA events, and to be honest we see it more often than not. When therapy begins the machine data often shows the problem in a way not previously appreciated.

This is the time to point out things are not going as expected and perhaps those central events during the home study were meaningful. A home study is a screening test and if central sleep apnea is to be properly diagnosed to insurance and Medicare standards you will need PSG (polysomnograph).

Getting adequate diagnostic proof of your conditions will require a more accurate and professionally conducted sleep study. Or you could ask for a titration study to determine if there is a CPAP solution, or if BIPAP or advanced therapy like ASV is needed. Unfortunately you are stuck leading your doctor through this process because you are the more informed and interested person.
Sleeprider
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____________________________________________
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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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#20
RE: Treatment-Emergent Central Sleep Apnea
The Medical doctor read the summary, the sleep center makes the diagnosis, therefore the doctor did not make the mistake, the tech at the sleep center did, and the fact is that you definitely do have obstructive sleep apnea. The issue is that you also have Central Sleep Apnea. Keep a copy of the study and make a full paper copy for your doctor and highlight and circle the centrals in pink highlighter (stands out better than yellow).

Give your Dr. your copy of the study and ask if he knows of a doctor that specializes in Central Apnea. If he gives the wrong answer it is time to find a new doctor. Ask your DME what doctor writes prescriptions (plural) for ASV machines.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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