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sleep study attached, looking for advice
#1
sleep study attached, looking for advice
Hi, i was dianosed with moderate OSA back in November and unfortunately, not knowing any better accepted the brick that my DME gave me, and i have tried to get an autoset machine with no luck.  So basically, the only data i have is the nightly AHI numbers, and zero useful data.  The prescribed pressure was 9cm and i have no issues with using the machine.  After 6 months of use, i still feel tired throughout the day, and wake up 2-3 times per night, and have a 6 month average AHI of 5.7.   During the titration study, they took the pressure all the way to 19cm, where i still had obstructives and hypopneas present, as well as a ton of central events that began at 11cm.  The doctor says that 9cm was what i needed, but i fail to see how it is enough if i was still having obstructives at 19cm. I was diagnosed with a chiari malformation about 3 years ago, which i have read can lead to central or complex sleep apnea.  

Being that i have a brick, i have no idea what type, duration, or severity of the events i'm still having.  I'd love nothing more than to be able to look at the data through sleepyhead and figure out what adjustments to make.

I have a follow up with my doctor this wednesday morning, where i plan to ask to be prescribed an autoset machine, and hopefully he will agree to that, if not, i might just end up purchasing one out of pocket if i have to.  

I've attached a copy of my titration report and sleep study, because i'd love to hear other users thoughts on it and see if they have any advice on how to approach my doctor the right way about this.  Would a different type of machine work better possibly?  I'm concerned if all he does is make a pressure change to something higher, how will we even know if it is any better or if centrals are emerging?

thanks,
jason

initial diagnostic night
   

titration night
   
   
   
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#2
RE: sleep study attached, looking for advice
Take the brick back to the DME and go find yourself a DME that will issue a Resmed AirSense 10 Auto Set.
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#3
RE: sleep study attached, looking for advice
(04-30-2018, 12:41 PM)Walla Walla Wrote: Take the brick back to the DME and go find yourself a DME that will issue a Resmed AirSense 10 Auto Set.

I've tried arguing with them already, they tried to tell me that my machine has all the latest and greatest reporting features.  I honestly think they believe that too.  They seem pretty clueless.
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#4
RE: sleep study attached, looking for advice
I agree you are flying blind without the data. With 6-months of use under your belt, the insurance has paid off and the DME is not going to exchange that machine. If your doctor changes the prescription, there is a good chance that based on lack of efficacy you will be able to get a different machine, but I think it would have to be a different class of machine like bilevel. Your AHI at 5.7 is borderline for arguing it is not working, although I would not trade you for that result. You might buy a recording oximeter to see if your oxygen saturation is being maintained. They can be obtained pretty inexpensively ($35-$100).

Keep an eye out on Craigslist for deals on a better machine. I quite often see Autosets and Philips Auto machines around $250 and less.
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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#5
RE: sleep study attached, looking for advice
(04-30-2018, 01:02 PM)Sleeprider Wrote: I agree you are flying blind without the data.  With 6-months of use under your belt, the insurance has paid off and the DME is not going to exchange that machine.  If your doctor changes the prescription, there is a good chance that based on lack of efficacy you will be able to get a different machine, but I think it would have to be a different class of machine like bilevel.  Your AHI at 5.7 is borderline for arguing it is not working, although I would not trade you for that result.  You might buy a recording oximeter to see if your oxygen saturation is being maintained.  They can be obtained pretty inexpensively ($35-$100).

Keep an eye out on Craigslist for deals on a better machine.  I quite often see Autosets and Philips Auto machines around $250 and less.

any advice on how to ask the doctor for a bi-level?  tell him i am having a hard time tolerating the pressure even with epr on 3 even though i'm not?
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#6
RE: sleep study attached, looking for advice
You raise a good question, what are your settings? Have you experimented with EPR? From your titration results it looks like lower pressures are better but no different EPAP/IPAP pressures were tried.
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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#7
RE: sleep study attached, looking for advice
Well my current settings are just 9cm, epr off, ramp off, humidity 6. I’ve tried epr on all 3 settings, none of which seemed to make a difference in how I slept and honestly found it more comfortable off although I’m sure at 19cm it might be a welcome relief. I remember the titration night I found it difficult to exhale against 19.

 I tried one night at 5cm, and found it uncomfortable like I was suffocating and the ahi for the night was about 7 I believe.  When I’ve tried the ramp feature, I’ve found the low starting pressures feel like there’s not enough air. 

I feel like I am just all over the place with this. One night I’ll have an ahi of 3 and feel like I slept well, and the next night I’ll have an 8 or even as high as 12 and be up 3 times in the middle of the night. Meanwhile my wife was just diagnosed as well 2 months ago and sleeps like a rock now with ahi’s below .5 almost every night.

Btw, I see your location is the home of respironics, are you from murrysville pa?
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#8
RE: sleep study attached, looking for advice
I am in Murrysville. I see you live in PA and if there is anything I can do to shed light on your situation, I will certainly try.

Central and complex apnea tend to be consistently inconsistent, but our best opportunity to advance to a proper diagnosis is to have some data to work from. If you're nearby maybe we can figure out a way.
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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#9
RE: sleep study attached, looking for advice
Wow, small world! I live in Greensburg and work right down the road in Export.
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#10
RE: sleep study attached, looking for advice
In our Pittsburgh Craigslist there is a distributor that sells the Airsense 10 Autoset for $495. As far as I know it's a legitimate deal, and they transact using Paypal for your protection. You have to call them to order, but it's a very good deal on a new machine with warranty. (888) 965-7655.

Just out of curiosity (and so I can avoid them), which DME dispensed the brick? Also, let me know if you ever want to meet at Rivertowne.
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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