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Zeoce's Therapy Thread
#1
Zeoce's Therapy Thread
Hi Everyone,

New to the site... like 

Quick backstory:
  • Had a overnight sleep study done (report attached), which indicated severe OSA/Hypopnea (much higher AHI on back, vs side sleeping)
  • Bought a lightly used Airsense 10 Autoset for treatment
  • Used machine last night for the 1st time with initially min/max range of 6-20 cmH20, adjusted to 8-20 cmH20
  • I'm a side-sleeper, healthy weight range etc, and have no other health issues that I'm aware of
Still learning how to interpret OSCAR etc, so wanted to request some insights from those more experienced for improvement. Last night I woke up at ~1:30am with a suffocation type experience, and quickly took off the mask. Changed the minimum cmH20 to 8, and slept through the rest of the night,

Questions & Insight Requests:
  • Insights on the sleep report & OSCAR daily graph screenshot, including recommended min/max pressure setting or any other changes
  • Any idea what happened at 1:30am? Want to avoid that happening again!
  • As the Airsense 10 bought was used, I deleted the stored data in the clinical menu - is the device still sending info the old provider? If so how do I stop it?
Any help is much appreciated.


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#2
RE: Zeoce's Therapy Thread
Below is some more OSCAR data:
  • Tried a new mask - Airfit N30i (nasal pillow style)
  • Woke multiple times, mouth breathing air like a dragon
  • Humidifier ran out of water at some point during the night
  • Adjusted min pressure up to 10 for this trial
  • Climate Control & Temp set to auto
Nasal pillow mask trial wasn't a complete loss - loved the top-of-head hose swivel point as I turn from side to side throughout the night. Will purchase a full-face style mask with a top swivel next.

Will lower humidity level / temp a bit for comfort.


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#3
RE: Zeoce's Therapy Thread
Below is some more OSCAR data:
  • Went back to my Vitera full-face mask
  • Was not breathing comfortably with min pressure set to 9, changed to 8 and slept better
  • Climate Control & Temp set to auto


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#4
RE: Zeoce's Therapy Thread
Below is some more OSCAR data:
  • Minimum pressure left to 8 through the night
  • Woke up at one point with an air leak needing mask readjustment
  • Feel better rested today than the previous night, I think the ~8 min pressure might be part of the reason
AHI rate seems decent(?), curious as to why there seem to be so many Clear Airways events night after night...


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#5
RE: Zeoce's Therapy Thread
Interesting that your diagnostic test recorded 100% central apnea and hypopnea and the diagnosis is "Severe Obstructive Sleep Apnea". The diagnosis is for convenience, and not based on facts. You have idiopathic central sleep apnea and your results with CPAP are consistent with the diagnostic results. Your event rate is significantly lower on CPAP and it's possible you may not need to progress to ASV, and that is why a CPAP trial is required to be completed and failed before any higher level therapy is considered. I'm fairly certain we can make some recommendations to reduce the number of apnea events, but that does not necessarily mean that CPAP is the best therapy for you. Optimizing CPAP therapy for an individual with a predominately central apnea diagnosis means that we can achieve an acceptable AHI, but you won't be considered a candidate for Adaptive Servo Ventilation, which is designed to treat your specific condition. The question we must ask is difficult. Is it better to optimize your therapy and lower AHI at the risk you may not continue on the path to the more ideal ASV therapy?

If you want to see a very low optimized AHI, I recommend setting minimum pressure to 7.0, Maximum pressure 7.0 and EPR 1. This will nearly eliminate the CA and hypopnea events, but I also suspect it will leave you tired, because it cannot treat CA which is the root issue. Give it a try, but also consider going back to the wide-open settings you started with and then working with your doctor to consider the REAL results of your diagnostic test and ordering a titration that moves from bilevel to ASV to identify the correct therapy. I expect you to ask questions about this conclusion, and I'm sure another member, Gideon will also concur with the above and help to arrive at a solution.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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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#6
RE: Zeoce's Therapy Thread
Thank you SO much for your time, and insight. Much appreciated - I’ve received nowhere near that level of analysis from my GP or sleep specialist!

I was beginning to wonder about the central sleep apnea diagnosis when there had been so many ongoing CA events. Was hoping there was a different explanation for them. 

I’ll try the min/max pressures of 7, w/ EPR at 1 and report back.  

And yes, I can ultimately setup the titration study later if need be, and purchase an ASV machine if that’s what’s best for my health.
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#7
RE: Zeoce's Therapy Thread
This seems to be standard practice in the sleep medicine industry that everyone is diagnosed with obstructive sleep apnea even with predominately central events. "Why" would make a good question for your doctor at a follow-up. Most members we see with a similar diagnostic study, improve with CPAP therapy, but many report they do not feel that sleep is restorative due to occasionally unstable respiration. Some move to ASV n their own, or work through the trial and fail procedure that is common with insurance. The wiki on "Justifying Advanced PAP Machines" describes the struggle. http://www.apneaboard.com/wiki/index.php...P_Machines If you stay on the forum or look around the past posts under "central apnea" or "ASV" and similar searches, you will find the problem is actually fairly common, and is not often associated with any severe health issues, thus "idiopathic" or without cause. We usually see some periodic breathing as the apneic threshold is reached with CO2 dropping resulting in hypoventilation, and increases in CO2 resulting in hyperventilation. The most simple explanation is an individual sensitivity to changes in CO2 which affect the respiratory drive rather than a neurological or pathological origin for CSA.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#8
RE: Zeoce's Therapy Thread
Yes, I'll will ask about the obstructive diagnosis the next time I speak with the doctor.

In regards to ASV therapy vs my current machine:
  • I don't currently have health insurance (so zero gov't/work coverage)
  • Bought the existing CPAP for $500 and can likely resell for same
  • There is a lightly used ResMed VPAP Aircurve 10 on sale locally for $3,500
If an ASV machine would provide significant improvement, I can afford to purchase one out of pocket.

If I were to  buy on my own ASV machine and post the OSCAR results here for guidance would I still need order a titration study (that cost will be covered by gov't)?
Would be nice to not have to go in again for another study if the benefits are negligible.

Attached is last nights  OSCAR data with the suggested min/max of 7 and EPR of 1. I think those setting had me sleep the easiest of all my previous adjustments and pressure range since getting the machine a week ago. Still don't feel very rested though, and woke up briefly 3 or 4 times (probably just due to still getting used to sleeping with a mask and hose). My apple watch w/ associated 'autosleep' app shows a great sleep according to their metrics, and the best numbers since getting the CPAP.


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#9
RE: Zeoce's Therapy Thread
Zeoce
may I ask what full face mask you are using? I'm using the F20 and have a much higher leak rate than you do... it wakes me up numerous times at night.
Resmed Airsense 11/Resmed F30 face mask,cervical collar, MyAir software, OSCAR for data analysis
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#10
RE: Zeoce's Therapy Thread
I had expected lower AHI with the fixed pressure and reduced pressure support (EPR), so we're going to call that a learning experience that your particular central issue is not going to just go away with lower pressure differential between inhale and exhale. Flow limitation is higher, so there is some obstructive aspect to your sleep breathing and you apparently benefit from the EPR or pressure support. I think it is worth continuing to try these settings until we can establish a trend, especially since you found this more comfortable and effective.

With regard to your doctor you should make sure he/she knows you are not seeking to satisfy insurance dispensing requirements and are prepared to pay out of pocket for the right machine. It will make getting a prescription easier. I think between your diagnostic results and early CPAP data there is adequate justification to trial ASV at your own risk. A titration study is actually pointless with ASV because it is fully automatic and either works or it doesn't. They are always required if insurance is paying because they require you to fail CPAP and Bilevel and to demonstrate efficacy with the respiratory assist device being prescribed, but when paying on your own, your doctor has a lot more discretion. If you have co-pays or deductibles for a test, the titration test can actually cost more than the machine...worthless! Keep in mind the titration test simply consists of setting EPAP at a pressure that prevents obstructive events and letting the machine apply the adaptive pressure support to maintain rate and volume. I'll post the titration protocol below. I'm confident your AHI will approach zero with ASV, but there is a learning curve and adaptation challenge as the machine will push pressure support to maintain your minute vent and respiration rates.

You can buy a new Resmed ASV from Supplier #2 for $2599 or gently used and warranted for $1699. This is a rock-solid supplier with great customer service and reliability, so save some money, and this is a better choice.

There is a Resmed Aircurve ASV on the Nashville Craigslist listing #7559180446 Belleview TN for $1000 used one year. Be sure to use save payment methods and verify the seller actually has the machine by asking for a photo of the use-hours (Clinical Menu/About/). I use SearchTempest.com for these searches.

You may also want to check the DotMed website under Respiratory/Bilevel listing for ASV and only buy from known, rated domestic sellers.

[Image: attachment.php?aid=4210]
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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