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need help setting BiLevel
#11
With APAP on bad nights I would get up 6 times (AHI 8-10) and on good nights I would only get up 2 times (AHI below 2 and even had a few 0's). After bad nights I would be tired all day, right from the start. Good days I would not get tired until around noon.

Before I got my APAP tuned I would wake up and rip my mask off gasping for breath, since then it's more like fatigue-I am just tired of it and need a break, I can do it, but it's just not comfortable for some reason- kind of like shoes that are a little too small.

Last night for one of the times I woke up I tried to lay there, relax and go back to sleep, it felt like I was not breathing-not low on O2, just not breathing. No joy with that, had to get up- maybe 10 seconds maybe less of trying.

When I am laying down before sleep, sometimes I concentrate on relaxing and breathing smoothly; sometimes I can feel the volume decreasing and I need to force myself to take breaths a few times and then it goes away. Other times when I am thinking of other things, I will lay there and think "oh I have stopped breathing", it's quite comfortable, no panic at all and I just start myself breathing again.

[Image: iLqErM0.png]

This is last night. Total hours includes an afternoon nap of just under 2 hours (not on the plot). That last 6 hour stretch was the longest yet and I went into it thinking about just ignoring everything and just sleeping-I guess it worked. So far today I just feel normal, not tired or well rested. We will see later in the day how it goes.

Thanks for your attention and interest.
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#12
[Image: GRi3ufU.png]

From 8-24-2015 with APAP, when my breathing goes south this is what it looks like
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#13
PoolQ, have you had a discussion with your doctor regarding ASV? I'd be interested in his/her rationale for not prescribing that kind of therapy for what appears to be mild/moderate complex apnea.
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#14
(09-09-2015, 09:10 AM)Sleeprider Wrote: PoolQ, have you had a discussion with your doctor regarding ASV? I'd be interested in his/her rationale for not prescribing that kind of therapy for what appears to be mild/moderate complex apnea.

It sure looks like that is the path I am on. Once the APAP was tuned (2 months total) I was almost always under 5AHI, mostly under 2, and sometimes 0.0. My centrals would spike to around 10 a night with 1 or 2 OA's, but I was having trouble sleeping even though I would keep the mask on for 8+ hours a night. I cannot sleep at all without it. Compliance looked good. I would, as above, have bad nights.

For BiPAP I am at one week and we both thought this might settle things down.

This is exactly why I am posting now, I am going to contact him about what is going on and wanted to make sure I am not boxing shadows.

Last night was my first bad night with BiPAP, out of bed 5 times
CA 62
Hypo 3
OA 11
UF1 17 20% 8s
UF2 23 50% 8s

So my data card will be walked into the office today and I will shoot off a message to him, he does respond quickly.

Being just 3 months into this process, it was important for me to get conformation from someone more experienced then myself.

THANK YOU to all who responded.
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#15
When do you know it's time to have the ASV conversation with your doc? Over the course of the last 10 days I have had an average of 46.5 CA events a night with a high of 64 (2 nights ago) to a low of 26 (a week ago). Is that considered high or maybe average? My AHI's have been averaging about 9.5 over the last week, but it was down to 6.16 last night. I haven't had an AHI below 5 since 21 Aug and am averaging just under 8 for the last month and just under 14 over the last 6 months (I have only been on therapy 4 1/2 months). Thanks
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#16
(09-11-2015, 01:46 PM)wxmcpo Wrote: When do you know it's time to have the ASV conversation with your doc? Over the course of the last 10 days I have had an average of 46.5 CA events a night with a high of 64 (2 nights ago) to a low of 26 (a week ago). Is that considered high or maybe average? My AHI's have been averaging about 9.5 over the last week, but it was down to 6.16 last night. I haven't had an AHI below 5 since 21 Aug and am averaging just under 8 for the last month and just under 14 over the last 6 months (I have only been on therapy 4 1/2 months). Thanks

I think anytime your therapy drops significantly below expected efficacy for an extended period, that suggest "something" has changed. No CPAP, APAP or Bilevel is designed for the treatment of CA events, and when this is the cause of high AHI and unsatisfactory quality of sleep, then you can have that conversation. I would expect the doctor to investigate why things have changed, and whether there are other solutions than adaptive ventilation. So whenever you're out of ideas of your own, and concerned about it, is a good enough time, assuming you have the motivation, time and financial resources, to chase the problem.
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#17
+1
My impression of my Doctors reaction to ASV and Centrals is: (YMMV and I may be incorrect, this is just my thinking as of now)
1. He does not seem to trust the cause of my centrals, they can be CPAP caused and he is not sure yet what is causing them
2. The Resmed alert that came out at the beginning of the year has really shaken the medical side of CPAP. They are more than a little concerned that another shoe will drop.
3. ventilation (ASV) is a whole different beast and if/when they take a patient there they want to be really sure that they have exhausted all other options
4. if you have had any heart issues on your record I think they tend to take caution up by at least 2x regarding ASV

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#18
So okay I met with my sleep Doc. He does not want to see sleepyhead plots-"I don't know what those are". He thinks my centrals are caused by arousals, I had over 250 of them in my last sleep study, and he basically thinks it's all in my head. I now have his permission to "play" with all my settings, he has fallen back on I am better than before and my AHI is mostly below 5 so I am good, right. I fixed the not enough air feeling by increasing T2 to 3 seconds.

I can look over my past data and 100% predict if I had a good or bad night, less than 25% of the sleep with my strange breathing patterns and it was good, I have had nights with 85+% strange breathing patterns and those were very bad nights indeed.

Pulmonologist visit is the next step
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#19
Well. Getting referred to a pulmonologist by my sleep doctor. He thinks I am have sleep apnea AND beginning COPD. I am now sleeping 30-60 minutes at a time all night, the good news is that I am getting really good at falling asleep quickly.
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#20
Well, in some respects, I'm sorry to hear you may have early COPD, but on the other hand, a course of action and diagnosis, even tentative, is a step forward. Good luck PoolQ. Do you have risk factors for COPD like smoking or occupational exposure to lung irritants?
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