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Two days use-Wake up gasping for air
#31
RE: Two days use-Wake up gasping for air
Jteetie, you have CPAP onset central/complex apnea. This is not the norm, but also not so uncommon. We have many members here that have achieved near zero AHI using the ASV technology, some of which say, it gave them their life back. Adaptive Servo ventilation meets your needs on a breath by breath basis and is very unlike CPAP which uses a fixed pressure. ASV uses it's minimum exhale pressure (EPAP min) to maintain your airway free of the obstructive apnea you were diagnosed with. It also can increase the inhale pressure (IPAP) as needed, when needed to treat hypopnea and to cause you to take a breath when central apnea occurs. It stabilizes and maintains your respiratory rate and volume.

Your next step is to determine if your doctor has experience in treating complex and central sleep apnea. If his reaction is to ridicule that idea, you need to find a different doctor that will talk to you instead of quack. This is not an easy process. Insurance is going to require that you try bilevel (BiPAP) which you WILL fail, and finally demonstrate efficacy on bilevel with a backup rate (ASV and ST). You have a big learning curve ahead of you, and the most important point is you must remain focused on obtaining the Resmed Aircurve 10 ASV; not a BiPAP, not a ST (spontaneous/timed bilevel). You will get there, and the skill and knowledge of your doctor in dealing with complex apnea will be the biggest determinate of how long that takes. Your next sleep test should be a titration study that evaluates bilevel, then moves to ASV when bilevel fails. It can all be done in one night. Don't let them make you come back again and again to get the right treatment...you already know what needs to be done.
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#32
RE: Two days use-Wake up gasping for air
Thanks, sleeprider. This is really helpful. I have an appointment next Thursday with a new sleep center. I'm hoping for the best.
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#33
RE: Two days use-Wake up gasping for air
Sleeprider

What is it in the chart that tells you all that. I believe you, but I'd like to be able to go to my appointment and not just say, I was told I need an ASV, but why I think I need and ASV.  What charts best show that I need it and what about them show that need. Thanks.
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#34
RE: Two days use-Wake up gasping for air
(06-15-2018, 10:52 PM)jteetie Wrote: Sleeprider

What is it in the chart that tells you all that. I believe you, but I'd like to be able to go to my appointment and not just say, I was told I need an ASV, but why I think I need and ASV.  What charts best show that I need it and what about them show that need. Thanks.

The first clue is that you AHI is far worse with CPAP treatment than without it.  I have been able to observe hundreds of users and perhaps thousands of these charts, and the severity of your apnea is among the worst I have ever seen. Your events consist of both obstructive and central apnea, although the machines are not very accurate when things get this busy. Events are more prevalent at higher pressure than low pressure, and this is another indicator of centrals.  Even during periods where no events are flagged, we see very uneven respiration. 

When a new member comes on the forum and has a high number of events (20 to 35 per hour), I will often coach them to use some alternative (usually lower) pressure, and to turn off Flex or EPR and be patient.  In some cases with large number of obstructive events, I have had a lot of success suggesting a soft cervical collar to keep the airway patent from positional apnea.  In your case, the number are too high and mixed to make such suggestions.  It is unusual that a person is better off without therapy than with the CPAP, but that is you.  The event rate is so great and mixed that we cannot responsibly suggest making changes on the forum, and we would rather that you get professional help.

Finally, it is obvious you are using a machine at default settings.  That usually means that whoever prescribed it did not test you on CPAP pressure and has no clue how you would respond.  Most people can self-titrate on an auto CPAP, but this is complete and utter failure. A professional needs to observe this response in a clinical setting and be prepared to try CPAP, BiPAP and ASV to resolve it.  

Just a few finer points. Your tidal volume looks great but your respiratory rate is on the low side at 9.2 (probably because you don't breathe) and inspiratory time is twice your expiratory time.  We could zoom into the flow rate and figure out if that is real or not, and I'd be glad to take a look at a 2-minute closeup segment if you want.  Normally inspiratory time is shorter or equal to expiratory time and an inverse ration of 1:2 is extremely disturbed breathing.  Again, we don't know much about that without looking closer, but its another reflection of how disrupted your respiration is with CPAP. All of that said, what we have here is only two hours of therapy. Your doctor should schedule you for clinical evaluate with potentially all three variations of PAP; CPAP, BPAP and ASV.


[Image: attachment.php?aid=6702]
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#35
RE: Two days use-Wake up gasping for air
Thank you. I think I'm ready for my appointment now.
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#36
RE: Two days use-Wake up gasping for air
(06-16-2018, 06:09 PM)jteetie Wrote: Thank you. I think I'm ready for my appointment now.

Good luck
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#37
RE: Two days use-Wake up gasping for air
So, it's been about 3 months since my last post on here and a lot has happened.  I had an in office study and it turns out that my normal AHI is actually 55, not 17 as my in home study said.  So, when using the CPAP, my AHI going to 62 using the CPAP, wasn't as big as an increase, but still not good, obviously.  So, during that one night study, I had 3 parts, no machine, CPAP and BiPAP.  It was clear that the CPAP wasn't going to work for me.  Now, since they only had about 3 hours on the BiPAP, the decided to give him an auto BiPAP for 2 weeks and decide after that if I needed another full night test on the BiPAP and maybe the ASV.  However, I wasn't sure I needed another study.  When I sent to see the doctor, she looked at the 2 week average of my BiPAP use, which was not very good because my first week of use, my AHI was in the 40s and 30s.  However, in the 2nd week, the went into the 20s and teens, with 2 days at 9.07 and 8.29.  So, I scheduled another sleep study, but since then, my AHIs have been getting even better.  9/23-4.78, 9/24-6.9, 9/25-9.3, 9/26-3.29 and 9/27-4.27.  So, my question to the group is, should i do another sleep study?  Or should I just stick with the BiPAP and see how it goes for a while longer?  Should I be trying to get below 4 every night?  Is there anything else in my chart that make you think I may need an ASV?  The doctor did mention it in our last appointment.  

I've attached a screen shot of the data from 9/27.  I forget how to get the screen shot into the body of this post.  Thank you to everyone for your help and advice.  



.docx   Sept 27 2018.docx (Size: 155.83 KB / Downloads: 5)
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#38
RE: Two days use-Wake up gasping for air
Last night was my best night ever!  At least based on my AHI of 1.44.  So, I'm thinking that another sleep study isn't necessary.  Would you all agree?  Is there anything else in the data that jumps out at you?  I still need to go to bed earlier, but at least for the time I was asleep, my AHI was lower than it's ever been.  Thanks.  

[Image: attachment.php?aid=8552]


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#39
RE: Two days use-Wake up gasping for air
Here are my sleep study results from my study in July.  




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#40
RE: Two days use-Wake up gasping for air
In my opinion your results have improved, but you are still using what is essentially CPAP, and most of the night (based on the detail graph) you are not experiencing any pressure support on BPAP. This may be adaptation to the CPAP therapy. I was pretty convinced you had complex apnea previously, and I'm not sure that has gone away and could re-emerge unpredictably. Your sleep study shows 100% obstructive sleep apnea, and we don't know what the event spread is on CPAP/BPAP. Your CPAP titration study determined you needed bilevel...well from what I see, you're back to CPAP on a bilevel.

I think you eventually end up on ASV, but I'm impressed with how low you have gotten your event rate on conventional PAP treatment. I'm going to go back to my usual refrain on this; "the only consistent thing about complex apnea is the inconsistency of your results". I think this will apply to you in the long run.
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