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cpap and apap not effictive
#91
Here is a capture from last night at the settings my doctor wanted. While this is still on the dreamstation and not the resmed, I don't see how changing machines will make any significant difference given the amount going on here.

Even at this setting (apap 7-10 cflex 3) I have so much air it is keeping me awake. I was able to keep the machine on for a while last night, likely because I'm so completely exhausted.

https://1drv.ms/i/s!AgFs7hWqVGNflgiI_OrpxpfiwiHI


Question - given that my initial sleep study showed almost entirely central apneas, is cpap/apap even the right approach? I barely slept during the study, not sure how representative it was.
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#92
How willing are you to take this into your own hands and self-finance. Used machines could be easily had for under $500, a bit more the most current models. To get an idea of what is out there, try using the SearchTempest search engine and use the terms "Respironics BiPAP Auto". Or brand new the Dreamstation Bipap Auto is $1250 at Supplier #1.

With regard to your question, the most correct machine would seem to be ASV or auto SV Advanced. It is still baffling to me, the stubbornness of your sleep specialist being unwilling to test you for bilevel or ASV, especially in light of your symptoms and ineffective results with CPAP. If it were my decision, I would get my records and seek help elsewhere.
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#93
You pointed out recently "The good news is that since my last posts I've found that for the first part of the night/non REM I can clear my events with between 7 and 7.5 cm (with flex turned off). Anything above 8 or 8.5 and the aerophasia gets bad, so I don't know where, if ever, my REM sleep would get cleared up." Set your machine for straight 7.0 no flex and get a night of data. If the OAs are cleared up, we can begin to figure out how to clear up the Central events. You have to actually fail at clearing up the Centrals with your present machine before other options are available. You need a good baseline from which to make adjustments.

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

Download Sleepyhead
Organize your Sleepyhead Charts
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#94
I would try looking elsewhere but I am seeing the only 'sleep' doc in town. I'm not sure how to get help anywhere else without a lot of out off pocket costs. I may consider just paying for the machine though.
It seems pretty clear the issue on my current machine (in part) is flex. I may try flex off again, but for now I have to stick to what the doc suggested just to have the data to show him on the machine (since he wouldn't look at my sleepyhead data).

It's pretty frustrating since I've been at this since last April.
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#95
For some detail on my 2 studies:

First study (Feb 2016) showed:

zero OSA, 33 hypo and 81 Central with an AHI of 21.9

Second study (May 2016 titration) showed:

2 OSA and 5 Central

I can't explain the titration results, they are nothing even remotely representative of what I have gotten in any night of using cpap/apap for the last 8 months. Even the AHI, which was stated as .9, isn't anything I've ever seen. Best I've gotten for a night is well over 5 AHI, usual is 10-12 at best.

From what I have learned, wouldn't that initial study have clearly indicated ASV might be the best bet?
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#96
If you are on medicare you have to FAIL at using CPAP before you can get an ASV machine. So, get a baseline at straight 7 to see where you need to go. This very well might include going to a new Doctor.
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

Download Sleepyhead
Organize your Sleepyhead Charts
Post from Imgur


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#97
I'm not on medicare (I'm 44).

I don't really have a choice in changing settings for a while because unless I come back with exactly what the doc suggested he won't do anything differently. Hopefully I can get the Resmed machine quickly, then I have to stay on those settings for a week or two before I can go back to them (and ask for bipap/asv and/or at least a new study).


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#98
A predominately central AHI in a sleep study would certainly indicate ASV, however the doctors are in the habit of following Medicare and insurance guidelines for DME approval, which requires that you fail CPAP for efficacy, and then fail BPAP, and finally have an ASV titration and demonstration of medical necessity for this more expensive machine. The Medicare reimbursement guidelines for ASV HCPCS Code E0471, E0472

Quote:Central sleep apnea or complex sleep apnea:
Prior to initiating therapy, a complete facility-based, attended PSG must be performed documenting the following:
A. The diagnosis of CSA or CompSA; and
B. Significant improvement of sleep-associated hypoventilation with the use of an E0470 or E0471 device on the settings that will be prescribed for initial use at home, while breathing the patient’s prescribed FiO2.

If all above criteria are met, either an E0470 or E0471 device
(based upon the judgment of the treating physician) will be
covered for patients with documented CSA or CompSA.

You may find this checklist interesting http://www.cgsmedicare.com/jc/mr/pdf/mr_..._e0471.pdf

We could give your physician the benefit of the doubt that he is patiently waiting for you to fail CPAP before moving to the next step, or go for the nuclear option that he is incompetent to treat central sleep apnea. Dont-know

A fair question for his office: How many central and complex apnea patients have you successfully treated?
How many, patients do you personally treat that have been prescribed ASV?
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#99
(10-27-2016, 08:38 AM)Sleeprider Wrote: How willing are you to take this into your own hands and self-finance. Used machines could be easily had for under $500, a bit more the most current models. To get an idea of what is out there, try using the SearchTempest search engine and use the terms "Respironics BiPAP Auto". Or brand new the Dreamstation Bipap Auto is $1250 at Supplier #1.

With regard to your question, the most correct machine would seem to be ASV or auto SV Advanced. It is still baffling to me, the stubbornness of your sleep specialist being unwilling to test you for bilevel or ASV, especially in light of your symptoms and ineffective results with CPAP. If it were my decision, I would get my records and seek help elsewhere.
I agree with Sleeprider 100% here.

Questions about SleepyHead?
See my Guide to SleepyHead
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(10-27-2016, 09:58 AM)Sleeprider Wrote: A predominately central AHI in a sleep study would certainly indicate ASV, however the doctors are in the habit of following Medicare and insurance guidelines for DME approval, which requires that you fail CPAP for efficacy, and then fail BPAP, and finally have an ASV titration and demonstration of medical necessity for this more expensive machine. The Medicare reimbursement guidelines for ASV HCPCS Code E0471, E0472

Quote:Central sleep apnea or complex sleep apnea:
Prior to initiating therapy, a complete facility-based, attended PSG must be performed documenting the following:
A. The diagnosis of CSA or CompSA; and
B. Significant improvement of sleep-associated hypoventilation with the use of an E0470 or E0471 device on the settings that will be prescribed for initial use at home, while breathing the patient’s prescribed FiO2.

If all above criteria are met, either an E0470 or E0471 device
(based upon the judgment of the treating physician) will be
covered for patients with documented CSA or CompSA.

You may find this checklist interesting http://www.cgsmedicare.com/jc/mr/pdf/mr_..._e0471.pdf

We could give your physician the benefit of the doubt that he is patiently waiting for you to fail CPAP before moving to the next step, or go for the nuclear option that he is incompetent to treat central sleep apnea. Dont-know

A fair question for his office: How many central and complex apnea patients have you successfully treated?
How many, patients do you personally treat that have been prescribed ASV?
Again, Sleeprider is 100% on target.

We cannot help you figure out whether your sleep doc is paitently waiting for you to fail CPAP before moving to the next step or whether he just doesn't know enough about central and complex sleep apnea to know what's going on.

Asking How many central and complex apnea patients have you successfully treated? How many, patients do you personally treat that have been prescribed ASV? is a very good place to start figuring out whether this doc is the correct one to be treating your apnea.
Questions about SleepyHead?
See my Guide to SleepyHead
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