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Trying CPAP one last time... AHI looks really bad
#21
RE: Trying CPAP one last time... AHI looks really bad
I would ask who in the office is the Central Apnea expert. Your apnea is all Central Apnea.

One of your questions is what do we have to do to trial or get an ASV BiLevel machine?
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#22
RE: Trying CPAP one last time... AHI looks really bad
Here's the graph from last night. Not a whole lot different from the previous one, but the peak AHI is a little lower. Still no snoring or obstructives.


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#23
RE: Trying CPAP one last time... AHI looks really bad
No doubts at all...as Bonjour and Sleeprider have already pointed out. You'll have to work with your doctor on moving into an ASV. I don't think I have ever seen a situation where it was more obvious. I'm not very knowledgeable about ASV but even I can see the big blinking indicators here!
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#24
RE: Trying CPAP one last time... AHI looks really bad
So, after talking to the doctor's office on Tuesday, they got me an appointment with the doctor's nurse on Wednesday, who didn't know what to do and got me an appointment with the doctor today. He said that he usually just works with patients with OSA, and is going to get me a referral to a different doctor.

I had another night were I was awake for most of the night, probably because I was so tired yesterday that I had to leave work early and immediately lie down for several hours, only getting up to eat dinner, then immediately lie down again until it was late enough to actually try to sleep.

To maintain compliance for insurance, I guess that I should keep using the device?

I got a copy of my latest sleep study, and it actually didn't show any OSA events. It showed mostly hypopneas, with some central events. It also noted quite a bit of snoring. I think that I have a scanner in a box somewhere, so I'll try to post what I can of the study. The print quality isn't great, though. But from those results, I guess that the bipap is working for the hypopneas and snoring? I've felt *much* worse since starting it, though.

Here's the graph from last night. I was awake for large portions of it (and during the hour long gap, I popped a Zaleplon and grabbed some water... No, I don't use those very often. I was given a prescription for them last year, got one bottle, and still have half of it left) so those long periods without apneas are less promising then they look... and my AHI reached 25 after initially falling asleep.


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#25
RE: Trying CPAP one last time... AHI looks really bad
Setting up for your new doctor.

If you can, go in with a laptop.  If not print Multiple screen shots, and several 2 min views of your centrals or zoom in on the laptop.
Make a copy of your SD Card and bring it with you, (he may want to look at it with his software.

Initial points
  1. I have one of the best machines available to treat OSA, but I have very little to no OSA, almost 100% Centrals
  2. My VAuto, unsurprisingly, doesn't do a thing for my Central Apneas.
  3. Here is what I feel every day (Make a list of your symptoms, be through)
  4. Here are my daily reports, I have my SD Card if you prefer to view it on your system.  First let me quickly go through them with you.  See, essentially noo OSA and nearly 100% Centrals, EVERY DAY.  would you like to drive?  (let him navigate)
  5. I understand that the ResMed AirCurve 10 ASV is likely a very good machine to treat Centrals with, after you have reviewed my data I'd appreciate it if you let me know if that is the right direction.
  6. What do we have to do to get there?

Here is what ResMed says
  • ASVAuto Provides an ASV algorithm plus expiratory positive airway pressure (EPAP) that automatically responds on the patient’s next breath to flow limitation, snore and obstructive sleep apneas. It Treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)

Qualifying criteria for ASV
  • Document a central apnea-central hypopnea index (CAHI) is greater than or equal to 5 per hour also apnea-hypopnea index (AHI) greater than 5'
  • Document The sum total of central apneas plus central hypopneas is greater than 50% of the total apneas and hypopneas
  • Document the presence of at least one of the following symptoms: These symptoms are specifically noted by Medicare. These are key symptoms that we look for by asking "How do you feel?". Do not limit your answers to the following and do not fabricate the answers.
  • Sleepiness, "How do you feel?"
  • Awakening short of breath, "How do you feel?"
  • Difficulty initiating or maintaining sleep, "How do you feel?"
  • Frequent awakenings, or "How do you feel?"
  • Nonrestorative sleep, "How do you feel?" Nonrestorative sleep is defined as the subjective feeling that sleep has been insufficiently refreshing
  • Snoring, Can be documented on Sleepyhead
  • Witnessed apneas Most of us have this one with our significant others
As you can see, by the numbers you are there
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#26
RE: Trying CPAP one last time... AHI looks really bad
Given that the appointment with the new doctor may be a while away (I was told to not expect the call to even schedule the visit until next Monday) should I try any adjustments to the settings now? (maybe try setting the IPAP and EPAP to the same value, to see if the change in pressure is contributing to the central apneas?) Or should I just hold here until I get new instructions from the doctor?

My current doctor didn't have any recommendations for the settings.
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#27
RE: Trying CPAP one last time... AHI looks really bad
After a quite terrible weekend with the same pattern as we've seen:
5/29: 57 centrals, 1 hypopnea, AHI 10.54
5/30: 55 centrals, 1 obstructive, AHI 9.97
5/31: 57 centrals, 1 hypopnea, AHI 12.21
6/1 (tried changing the mode to CPAP, pressure 5): 54 centrals, 1 hypopnea, 2 obstructives, AHI 10.49 (I felt significantly worse this day and set it back)
6/2: 50 centrals, 1 obstructive, AHI 10.77
When I woke up this morning, I switched from the bipap to the oral appliance, and then tried to go back to sleep.

I called the old doctor and asked if I could stop until the new doctor has recommendations, and they agreed.

So, back to the oral appliance (which I understand does nothing for my centrals, but the sleep study showed 114 obstructive hypopneas, and only 6 centrals (and 0 obstructive apneas, and 0 mixed apneas), desaturation down to 87%, and an AHI 23.6)
...And my previous sleep study (a SNAP at-home study) showed 33 obstructive apneas, 28 central apneas, and 151 hypopneas (with desaturation down to 87%) and an AHI of 11.1

//These numbers make no sense to me... The # of apneas/hypopneas was so much higher in the SNAP study, but the AHI is half?


Though I'm really confused as to why the types of apneas are so different between the sleep study (where I was untreated) and with the bipap.
At the very least, I know that I feel significantly worse on the bipap (even if I'm managing to sleep through most of it... my 3-5 AM wakeup times aren't great, but that's about the time I've been waking up even before the bipap) and I at least feel marginally better with the oral appliance.
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#28
RE: Trying CPAP one last time... AHI looks really bad
I’m sorry to hear about your problems CPAP has changed my life.  One thing I hope you’re considering is humidification.  The more humidification the happier you will be I have my mask set up so when I take it off in the morning it’s actually dripping.  I used to be a commercial diver -lots of problems with dry air.  Just make sure you keep things clean.
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#29
RE: Trying CPAP one last time... AHI looks really bad
If they give me an ASV machine, I'll be sure to try turning the humidity up. When I was using the machine, I just left it at 4.
I've always lived in dry climates.


Anyway, the first day off the bipap. I never thought that I'd appreciate the regular amount of tired and brain fog so much... it took a couple of really bad weeks to put it into perspective Too-funny
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#30
RE: Trying CPAP one last time... AHI looks really bad
Hi Gsilver,
Good luck in getting the machine you need.
,
trish6hundred
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