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UARS: AirCurve 10 VAUTO $500 vs Dreamstation APAP $400
#21
RE: UARS: AirCurve 10 VAUTO $500 vs Dreamstation APAP $400
Based on your response, you have Treatment-Emergent Central Apnea. Without the VAuto you do not have that. Based on what I am seeing and the verbal report on your recent Sleep Study, you do NOT have Obstructive Sleep Apnea. Boy, I never thought I'd say that here. If you can't identify any disturbances that are interfering with your sleep there is no sense in continuing with the VAuto. That said it is a good way to record a lot of what is happening during your sleep, apnea or not.

Don't chase what doesn't exist. Your first task is to identify when you wake, when your sleep is disturbed. If you can't do that there is nothing you can do to alleviate nothing.

View the entire night to identify areas of interest, this means looking at 2-3 minute segments looking for disturbances. Then attempting to understand what happened.
Try recording yourself overnight to see if you are having any unusual movements.
Oximeter to see if you are having any unexplained desats (This should show on your recent sleep test)
Understand what sleep state you are in, see if the stage shifts correlate with your disturbances.

Do let us know what you find.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#22
RE: UARS: AirCurve 10 VAUTO $500 vs Dreamstation APAP $400
The tricky part is I don't have OSA, it's all about UARS for me. I
'm on ADHD drug Vyvanse the last two weeks and it's not helping so far. My only hope is that UARS is the culprit.
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#23
RE: UARS: AirCurve 10 VAUTO $500 vs Dreamstation APAP $400
(10-30-2019, 10:05 AM)hombrecpap Wrote: The tricky part is I don't have OSA, it's all about UARS for me. I
'm on ADHD drug Vyvanse the last two weeks and it's not helping so far. My only hope is that UARS is the culprit.

Per bonjour's point, the thing to look for with UARS is evidence of RERAs.

Quick way to do that is look for areas where the FL graph is more active, and zoom on those, per his instructions.

Normal way to resolve those RERAs is with PS; in my case, over 5.

I had CAs crop up for a bit, but over time they've resolved, so that last couple of weeks, I have had a number of days with 0 AHI.

Nice thing about VAuto is you control PS at a pretty fine-grained level; in increments of 0.2.
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#24
RE: UARS: AirCurve 10 VAUTO $500 vs Dreamstation APAP $400
Fred, I’m confused. He had Centrals in his sleep study too. While pressure support (at 4) may have made it worse, it seems like there was already a problem.

Does it make sense to try to treat the UARS at some minimal level of pressure support, or even try the CO2 rebreathing gadget that some here have experimented with so he can tolerate more PS for UARS?
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#25
RE: UARS: AirCurve 10 VAUTO $500 vs Dreamstation APAP $400
I really like this response by Bonjour. I agree with it, however it leaves you without resolution for the high RDI of 13 events per hour (21 supine), which will leave you feeling like sleep is poor and generally fatigued. Positive Air Pressure is one solution for UARS, but we really don't understand from the test if you actually have upper airway restriction, just that there are respiratory related arousals that are worse when you sleep on your back. Your best sleep was sleeping on your left and right side during he latter half of the study.

There are a lot of approaches to sleep disordered breathing, one being positive air pressure therapy. I think we can work with what you have to try and optimize your sleep comfort, but keep an open mind towards trying other approaches. As Fred notes, poor sleep can arise from insomnia, physical movement, and even sleep hygiene. If there is an upper airway restriction that causes arousal, you have the best machine to treat that, and early treatment emergent centrals often self-resolve. We just don't want to make it worse by using overly aggressive pressure or pressure support.
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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#26
RE: UARS: AirCurve 10 VAUTO $500 vs Dreamstation APAP $400
(10-23-2019, 02:20 PM)hombrecpap Wrote: ENT called me (I haven't seen my report yet) after seeing the report and told me I have no surgical options (no sleep apnea, no insurance coverage), and that we should cancel my sleep endoscopy (which I regret now not getting it though).

He told me I had two self funded options for UARS: 
- oral appliance (I have invisalign, retainers going on, can't probably try that)
-  slumberBump to force me to sleep on my side (which I tried last week, pain in the rib lasting all day after using it). It seems from the study I barely slept on my back though.

He wasn't even going to bring up CPAP as an option because it's not covered by insurance...

Another Idea. 

American Academy of Sleep Medicine (AASM) recommended protocol is to do the test again if inconclusive, and me read is that sometimes the Doc may believe one night is not conclusive.  Also, I believe your Doc can keep pushing the Insurance, Medicare, etc to help if the patient continues to fail the ESS test, struggle, complain, etc.  

So if you want Insurance in the game then you might set up your own Home Sleep Study - Sleep Analysis and Improvement Lab 

With a Pulse-ox you can wear all night that records and presents the nights data your VAuto and a ~$25-50 Internet enabled IR camera off Amazon can get really close to a Home Sleep Test, night after night.  

If you really need the therapy then 1-3 three nights results of results from your home lab printed out and carried back the Doc and your back in with Ins..  or you really need to find a new doc. 

Much of this is what some people do anyway in order to improve the effectiveness of their therapy.

First, start up gen 1 of your "I will nail this and sleep well" Home Sleep Lab: 
  • OSCAR provides an overview of the night and events that surface.
  • The Pulse-ox shows SpO2 saturation/disaturation for the night and also shows the severity or not of events in OSCAR.  
  • Seek out times of specific events in Oscar on the IR camera and note/score back, left side, right side, half side & back.  

Second, just like at a sleep lab document your compliance with the ResMed Clinical Titration process. 

1. Using the VAuto first execute the low starting settings of ResMed's CPAP titiration protocol for at least one night just to set a solid hard to refute baseline of your need for Therapy.   "At the initial CPAP settings my AHI was still xxx.x". Since you already own the BiPAP no need to execute the CPAP protocol until you fail and prove you need a BiPAP. Your just looking to gather hard proof of whatever level of apnea you have.
   

2. Using the VAuto methodically execute the ResMed BiPAP Titration process as written starting again from the lowest settings without deviating from the protocol (you want to show what ever higher AHI's exist at the starting settings). Make one change per night for at least five days running.  After five days you have all the documentation you need.
   

3. Using your IR camera, for just 1-3 nights score your sleeping position at the most significant events in OSCAR and biggest Desats on the Pulse-Ox.  You do not need to recreate full documentation of all sleeping positions and % of each through the night.  Grab a few funny screen shots from the camera images along the way to share with loved ones for a laugh.  Occasional use of an IR camera is a effective use of $25 to help understand and improve your sleep but don't wait to get one to start steps 1 and 2, that detail alone is all you need for a really powerful conversation with your Doc. Details from the camera are only extra icing on that cake. The value of the camera is really better slumber for you if you do not achieve your sleep goals quickly.

If you results show you have a serious Apnea challenge then:
  • Make a copy of your sleep study with the centrals and other top issues highlighted.
  • Print the Pulse-Ox, OSCAR Daily Pages, and your sleep position notes
  • Carry these papers to the Doc with your specific request (~~maybe update your diagnosis, get insurance onboard, write me apnea prescriptions so can even buy masks, etc).
  • I would expect your Doc is a dedicated guy/gal and will just sign up to help you and take on the topic.   If not then your best off with a Doc who will. 

If you don't surface a big enough apnea challenge to chase Insurance help but a real issue that would be helped by the VAuto then carry this same output to your doc and (an idea / opinion only) ..  ask him/her ~"please write me apnea prescriptions so can legally buy CPAP masks and replacement or backup BiPAP machine from legitimate vendors. "      

WillSleep

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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#27
RE: UARS: AirCurve 10 VAUTO $500 vs Dreamstation APAP $400
(10-30-2019, 10:05 AM)hombrecpap Wrote: The tricky part is I don't have OSA, it's all about UARS for me. I
'm on ADHD drug Vyvanse the last two weeks and it's not helping so far. My only hope is that UARS is the culprit.
Btw, Vyvanse is converted in the body to a form of amphetamine. As far as I know, most ADHD drugs are some form of low-dose stimulant (which seems odd I realize). I’m not sure how that helps ADHD, but apparently it does.

Of course, amphetamine and sleep don’t really go together well. Maybe adjusting your dosage times would help.
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#28
RE: UARS: AirCurve 10 VAUTO $500 vs Dreamstation APAP $400
(10-30-2019, 12:57 PM)ragtopcircus Wrote:
(10-30-2019, 10:05 AM)hombrecpap Wrote: The tricky part is I don't have OSA, it's all about UARS for me. I
'm on ADHD drug Vyvanse the last two weeks and it's not helping so far. My only hope is that UARS is the culprit.
Btw, Vyvanse is converted in the body to a form of amphetamine. As far as I know, most ADHD drugs are some form of low-dose stimulant (which seems odd I realize). I’m not sure how that helps ADHD, but apparently it does.

Of course, amphetamine and sleep don’t really go together well. Maybe adjusting your dosage times would help.

Vyvanse doesn't give me a lot of side effects, but not being able to fall asleep was not one of them. I think me waking up at night is due to annoying feeling of a nasal pillows in my nostrils, and dry air (I keep forgetting to buy distilled water...)
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#29
RE: UARS: AirCurve 10 VAUTO $500 vs Dreamstation APAP $400
Distilled water is best, but tap is better than nothing. Occasional use of tap water is harmless. Continuous use may require a periodic soak in vinegar solution to remove mineral deposits.
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#30
RE: UARS: AirCurve 10 VAUTO $500 vs Dreamstation APAP $400
Thank you guys for your comments. 

Not sure if I mentioned, how all the testing started, I got enlarged tonsils out of no where Dec 2017 (no pain at all), they were not small in the first place; my now retired ENT prescribed me a home sleep study to decide if to remove them, and that home sleep study (july 2018) showed AHI 13-14 consistent over 3 nights (some centrals too, doesn't say how many, says "there were occasional central apneas" ATTACHED photos). 
(that study also showed oxygen desaturations)

Since then a recent in-lab sleep study (a YEAR later... I was procrastinating, one of my symptoms; after a year on exgoneous testosterone, TRT) showed very low AHI, I assumed home sleep studies might be so imprecise that they count respiratory arousals into AHI or something....

I also had an assumption until now that higher PS actually there to help with Centrals (help with CO2 buildup). And make breathing out more comfortable (which for me at least "7" pressure feels like bare minimum, and I had 12 during the night "auto" and it probably felt fine).

My main symptoms are: low energy for first 3-4 hours in the morning, self-control and concentration problems, distractability, short-term memory issues, procrastination (which are more life-long like, but got worse during the last 3 years, I got on TRT august 2018 primarily for low libido, after my home sleep study) . I have slim narrow neck, but I was anorexic until 2017. 6ft 150 lbs vs 175 lbs now.

It seems you guys are doubting my UARS diagnosis. I doubt it myself and my initial intention was to confirm UARS presence, since AirCurve 10 doesn't "estimate" RERAs, I have to rely on FL (but I assume all FLs are RERAs, they probably have to be manually reviewed each on charts).

@WillSleep I like your idea about the camera, recording myself makes more sense now when I have a timed history of respiratory events.
It seems like for UARS / RERAs monitoring it would be great if I would come up with some kind of a EEG solution. Zero ideas so far besides seeing earlier OpenEEG software package (and a discussion how expensive it was to deal with sensors and medical glue) and Dreem 2 onilne (for sleep phases, REM, it's not cheap, and not sure if it would work with my P10 mask). 

I'll get the oxymeter.

I'll start with CPAP fixed pressure titration (baseline analysis) starting "7". (6 seemed to be a bit too low for inhalation comfort). With PR 2 I guess to imitate EPR. (So 5 for EPAP)


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