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[Treatment] No Success Yet
#1
I was having 80 events/hour during my first sleep test, and I was started on a CPAP machine, which had little effect other than to reduce my events to around 20/hour. Then after a titration test I was switched to a BIPAP which also didn't help.

Now I'm scheduled for yet another test, which will probably result in yet another machine. I appear to have complex apnea - what other treatments should I expect after all of this?
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#2
Well, first going from 80/hr to 20/hr is a major step, not enough, but progress.

Second it depends on what your events are if you are having primarily Central events they will probably put you one an ASV machine which is designed specifically to treat Central events.
I am not a Medical professional and I don't play one on the internet.
Started CPAP Therapy April 5, 2016
I'd Rather Be Sleeping
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#3
Agreed
[Image: 1F4m9Ift.jpg]
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#4
(04-06-2016, 11:00 AM)TheSleeperWakes Wrote: I was having 80 events/hour during my first sleep test, and I was started on a CPAP machine, which had little effect other than to reduce my events to around 20/hour. Then after a titration test I was switched to a BIPAP which also didn't help.

Now I'm scheduled for yet another test, which will probably result in yet another machine. I appear to have complex apnea - what other treatments should I expect after all of this?

What FrankNichols said.

It's a process. I think they probably should have spotted the central apneas during the sleep study, but maybe not. Or maybe they did. The ASV machine for complex sleep apnea is more expensive than the ones you've already used, so your insurance might not pay for it until it has been conclusively shown that you don't respond to CPAP or BPAP.

And as FrankNichols said, a reduction from 80 to 20 events an hour is nothing to sniff at. It means that most or all of your obstructive events have been handled, and that definitely gives your body some degree of relief. Your next test will almost certainly be a "titration study," during which they'll put you on ASV and fiddle with the settings all night to find out what gets your central apneas under control.

I've been down a similar road lately, after nine years on plain CPAP. I'll never know when it turned to complex apnea -- maybe it was there from the start. Now I'm on ASV and although my AHI isn't as low as what some people here are getting, I'm working on it. I only wish I'd started sooner.
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#5
I don't know how long of a process this has been for you, but the steps you have/are taking are pretty typical for insurance coverage.
I was on the same path, Try the base machine and if you fail that (don't get better), then try the BiLevel, and then on to the ASV (expensive)

ASV is the only machine that can treat centrals and/or prevent your treatment from causing even more centrals. Everything but the machine and a few settings will be the same. The experience will be different as the ASV actually attempts to trigger you into breathing when you are experiencing a central (higher pressure for that breath). I have hear that it is quite comfortable and easy to breathe, also that when you first put it on you may need to give it some test breaths to get it sync up with how you want to breath (rate and depth). Sometimes it takes a couple "no not like that, like this you silly machine" and then it does fine. We all breathe differently and differently at different times of the day and night, it can't know this in advance.

Good luck. You have found a good place to be for information and it sounds like you like to be informed. You are better and getting better still, this does work, just not usually right out of the box unless you are the elusive "default" person.
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#6
(04-06-2016, 11:00 AM)TheSleeperWakes Wrote: I was having 80 events/hour during my first sleep test, and I was started on a CPAP machine, which had little effect other than to reduce my events to around 20/hour. Then after a titration test I was switched to a BIPAP which also didn't help.

Now I'm scheduled for yet another test, which will probably result in yet another machine. I appear to have complex apnea - what other treatments should I expect after all of this?

Have you tried different sleeping positions?
I have found that my AHI changes with my sleeping position. You may find you can reduce the AHI by changing you sleeping position.
Thinking-about

See the text below on clinical studies related to sleeping positions and Apnea
Thinking-about

American College of CHEST: Physicians Prevalence of Positional Sleep Apnea in Patients Undergoing Polysomnography.

Positional sleep apnea was defined as a total apnea-hypopnea index (AHI) >4 with a > 50% reduction in the AHI between the supine and nonsupine postures, and an AHI that normalizes (AHI < 5) in the nonsupine posture.

The 2009 AASM guidelines relating to treatment of positional therapy state: “Positional therapy, consisting of a method that keeps the patient in a non-supine po­sition, is an effective secondary therapy or can be a supplement to primary therapies for OSA.

Because not all patients normalize AHI when non-supine, cor­rection of OSA by position should be documented with PSG before initiating this form of treatment as a primary therapy.

To establish the efficacy of a positioning device in the home, providers should consider use of an objec­tive position monitors Treatment specific outcome indicators to monitor with therapy include: self-reported com­pliance, objective position monitoring, side effects, and symp­tom resolution .”



Discuss this with your with your doctor
2004-Bon Jovi
it'll take more than a doctor to prescribe a remedy

Observations and recommendations communicated here are the perceptions of the writer and should not be misconstrued as medical advice.
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#7
Hi TheSleeperWakes,
WELCOME! to the forum.!
Good luck to you at your titration.
Hang in there for more responses to your post and much success to you as you continue your CPAP therapy.
trish6hundred
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