[split] A10 Autoset and CA events?

[old82]

My ResMed AirSense 10 Autoset CPAP machine allows me to see a detailed depiction of my nightly events using its SD card and the ResScan software program. This detailed report breaks down each apnea event into obstructive and Central apnea by color code showing the duration time in seconds of each one.

It shows that my apneas are predominately the central type by a wide margin. A typical night for example would show I had 50 to 80 centrals to 5 to 10 obstructives. My sleep doctor claims I cannot know this and I'm being misled because this CPAP machine does not have the capability of determining the difference between central and obstructive apneas even though I told her I'm using the products own ResScan software program to break this down.

She is board certified in sleep medicine...who am I to believe...her or ResScan? It's important because I'm using this information to justify a change in my therapy and possibly my machine.

[PaulaO2]

The ResMed machines can determine what is called a "clear airway event". They are so confident the machine is detecting a central event that I believe they are now calling them that in documentation and in the software. A clear airway event is where the machine determines you aren't breathing (based on air flow). It sends air pulses to you and based on the "echo" of it, can tell if there is a blockage or not. No blockage means their airway is "clear" so it is a central event. If it lasts longer than 10 seconds, it is logged. If it is blocked, then your Autoset reacts accordingly.

For your sleep doc to not know this is not unusual. Most of them focus mostly on diagnosis. Treatment means "here is a machine" and that's it. If they did care more, they would be asking for more than "how many hours a night are you using it?"

How long have you been using your machine? If it is not very long, then you are experiencing "CPAP induced central events". These typically reduce in number the longer you use it. The common treatment is to lower the pressure for a while then increase it again. If you had a titration sleep study, this was probably noted during it.

During mine, it was determined a treatment pressure of 10 eliminated nearly all of my OA but my CI (central index) was some high number. 7 and it was 36. My initial pressure was set to 8 for 3 months then increased to 10. I have no idea what my data was since I had a brick of a machine and this was back with the S7s models.

[archangle]

My ResMed AirSense 10 Autoset CPAP machine allows me to see a detailed depiction of my nightly events using its SD card and the ResScan software program. This detailed report breaks down each apnea event into obstructive and Central apnea by color code showing the duration time in seconds of each one.

It shows that my apneas are predominately the central type by a wide margin. A typical night for example would show I had 50 to 80 centrals to 5 to 10 obstructives. My sleep doctor claims I cannot know this and I'm being misled because this CPAP machine does not have the capability of determining the difference between central and obstructive apneas even though I told her I'm using the products own ResScan software program to break this down.

She is board certified in sleep medicine...who am I to believe...her or ResScan? It's important because I'm using this information to justify a change in my therapy and possibly my machine.

$leep doctor$ love in-lab $leep te$t$ and have a financial incentive to do things with $leep te$t$ instead of using the data generated of the actual therapy generated for free every night in the patient's home.

She may be drinking the koolaid and believing her own prejudice, though. The medical mafia is pretty good at convincing themselves of their own infallibility and mi$conception$.

An in-lab sleep test does have some advantages. You don't count apneas of any kind unless you're asleep. An in lab sleep test has an EEG, so it knows if you're awake or "aroused" (partly awake). The CPAP machine can't tell that and will count "waking" apneas. An in-lab test uses a chest effort belt to tell if your body is trying to breathe. The CPAP machine has to try and tell if your airway is open by sending pulses of air through a 6 foot hose and detect changes in airflow. This is somewhat difficult, but I think the machine can do it. Another problem is that you can have a closed airway when you have a central. In this case, your machine will report a central as an obstructive.

However, there is a great deal of value in real, in home, free measurement of your own treatment data. There is a lot of the data that IS pretty indisputable. If you look at the data, you can get a pretty good indication of what's real, whats "wrong," and what's questionable. Simply ignoring the data is inexcusable.

The data recorded by the CPAP machines is pretty good, pretty objective, and is very useful. There are limitations to the data recorded in an in-lab sleep test, too.

If you're competent, you evaluate all the evidence including CPAP machine data, and use it to the best benefit of the patient.

Upload your own SD card data if you're comfortable with that.

[old82]

The ResMed machines can determine what is called a "clear airway event". They are so confident the machine is detecting a central event that I believe they are now calling them that in documentation and in the software. A clear airway event is where the machine determines you aren't breathing (based on air flow). It sends air pulses to you and based on the "echo" of it, can tell if there is a blockage or not. No blockage means their airway is "clear" so it is a central event. If it lasts longer than 10 seconds, it is logged. If it is blocked, then your Autoset reacts accordingly.

For your sleep doc to not know this is not unusual. Most of them focus mostly on diagnosis. Treatment means "here is a machine" and that's it. If they did care more, they would be asking for more than "how many hours a night are you using it?"

How long have you been using your machine? If it is not very long, then you are experiencing "CPAP induced central events". These typically reduce in number the longer you use it. The common treatment is to lower the pressure for a while then increase it again. If you had a titration sleep study, this was probably noted during it.

During mine, it was determined a treatment pressure of 10 eliminated nearly all of my OA but my CI (central index) was some high number. 7 and it was 36. My initial pressure was set to 8 for 3 months then increased to 10. I have no idea what my data was since I had a brick of a machine and this was back with the S7s models.

Thank you very much for the "CA" explaination. I just wish my sleep doc had thought to explain her position along those lines. So ...bottom line...she is really correct that the machine can't really differentiate between central and obstructive but they "brag" that it does based on information my doc claims is insufficient without a sleep lab study.

I've been on the machine for 6 months and I get the same results all the time...more centrals than obstructive.

Thanks for the great response.

[old82]

My ResMed AirSense 10 Autoset CPAP machine allows me to see a detailed depiction of my nightly events using its SD card and the ResScan software program. This detailed report breaks down each apnea event into obstructive and Central apnea by color code showing the duration time in seconds of each one.

It shows that my apneas are predominately the central type by a wide margin. A typical night for example would show I had 50 to 80 centrals to 5 to 10 obstructives. My sleep doctor claims I cannot know this and I'm being misled because this CPAP machine does not have the capability of determining the difference between central and obstructive apneas even though I told her I'm using the products own ResScan software program to break this down.

She is board certified in sleep medicine...who am I to believe...her or ResScan? It's important because I'm using this information to justify a change in my therapy and possibly my machine.

$leep doctor$ love in-lab $leep te$t$ and have a financial incentive to do things with $leep te$t$ instead of using the data generated of the actual therapy generated for free every night in the patient's home.

She may be drinking the koolaid and believing her own prejudice, though. The medical mafia is pretty good at convincing themselves of their own infallibility and mi$conception$.

An in-lab sleep test does have some advantages. You don't count apneas of any kind unless you're asleep. An in lab sleep test has an EEG, so it knows if you're awake or "aroused" (partly awake). The CPAP machine can't tell that and will count "waking" apneas. An in-lab test uses a chest effort belt to tell if your body is trying to breathe. The CPAP machine has to try and tell if your airway is open by sending pulses of air through a 6 foot hose and detect changes in airflow. This is somewhat difficult, but I think the machine can do it. Another problem is that you can have a closed airway when you have a central. In this case, your machine will report a central as an obstructive.

However, there is a great deal of value in real, in home, free measurement of your own treatment data. There is a lot of the data that IS pretty indisputable. If you look at the data, you can get a pretty good indication of what's real, whats "wrong," and what's questionable. Simply ignoring the data is inexcusable.

The data recorded by the CPAP machines is pretty good, pretty objective, and is very useful. There are limitations to the data recorded in an in-lab sleep test, too.

If you're competent, you evaluate all the evidence including CPAP machine data, and use it to the best benefit of the patient.

Upload your own SD card data if you're comfortable with that.

-------------------------------------------
Archangle
first off I would be glad to upload my SD card info but in spite of your excellent instructions I can't, for the same reason I can't figure how to get the Sleepyhead software to work...lack of computer expertise.

That said...I agree about the financial incentive comment. The billing to Medicare for my last sleep lab was over $4500 and that doesn't include the sleep doc fee I don't believe.

I have convinced the doc that my AirSense 10 isn't helping me and am told a change in machines and therapy is imminent and I'll know what that will be shortly and take it from there.

Thanks for your informative input.
Old82

[PaulaO2]

No, you misunderstood me. The machine CAN tell the difference between the two.

What it can't tell, as Arch pointed out, is if you are awake or not. But if the CA events are happening all during the night, then chances are you either have mixed apnea (both central and obstructive apnea) or you have complex apnea (obstructive apnea with central apnea being brought on by the machine and it isn't going away). They used to say the CPAP did not induce central apnea (but we users knew it did) but now it seems they even have a name for it. Either way, the machine you have isn't what you need.

Get your hands on your original sleep test while you argue with your doctor about the data you are presenting her. Don't let them tell you that you won't understand it. You will or at least we can help you. Just mention HIPPA and they'll twitch and get it printed right up for you. If they say it is fifty million pages long, tell them you want the doctor's summary. Look at them like they are idiots for even suggesting they give you the raw data.

This is your health, not theirs. If it comes down to it, switch doctors.

[old82]

t. But if the CA events are happening all during the night, then chances are you either have mixed apnea (both central and obstructive apnea) or you have complex apnea (obstructive apnea with central apnea being brought on by the machine and it isn't going away). They used to say the CPAP did not induce central apnea (but we users knew it did) but now it seems they even have a name for it. Either way, the machine you have isn't what you need.
s.

So I'm guessing I have complex apnea. Based on your experience what type of machine is best for that? And thanks for the HIPPA advice...she has already told me she doesn't have the time to teach me about the questions I have. Some day I may have to use the HIPPA advice.
OLD82

[retired_guy]

So I'm guessing I have complex apnea. Based on your experience what type of machine is best for that? And thanks for the HIPPA advice...she has already told me she doesn't have the time to teach me about the questions I have. Some day I may have to use the HIPPA advice.
OLD82

That's the problem; you're guessing. You don't want to do that. Call them up and ask them for a copy of your sleep study report right away.

If they decline, do not hesitate to demand it, on your way out the door to find a new doc. Once you have the report put the numbers out here so we can help you figure out what it all amounts to.

All I'm seeing right now is you've got a top of the line machine that has been dummied down to just a bit better than brick mode. Some will protest that fixed pressure of 7 isn't really dummied down, but without any documentation, or willingness of your doc to be forthcoming as to your actual needs/results, -------- it's dummied down.

Now. In the meantime you can be a little proactive in your treatment. Make sure you are not sleeping on your back. Maybe in the future you will be able to, but for now don't. Also make sure the head of your bed is elevated some. Not just your pillow, but the head of your bed. These things will help modify your apnea events until you get a better picture of what you need to do.

[old82]

[quote='old82' pid='109972' dateline='1429649414']



All I'm seeing right now is you've got a top of the line machine that has been dummied down to just a bit better than brick mode. Some will protest that fixed pressure of 7 isn't really dummied down, but without any documentation, or willingness of your doc to be forthcoming as to your actual needs/results, -------- it's dummied down.

Just to be clear...even tho my machine is a top of the line one with a Rx CPAP setting of pressure # 7...I have used its AUTOSET option with various pressure range settings as well as various pressure settings other than #7 in the CPAP mode searching for some relief with no satisfactory results. I'm convinced after 6 months I need a different type of machine.
OLD82

[PaulaO2]

How often are you making changes? Changes need time for the data to show trends.

If after this time you've made changes, watched the data in between (for about two weeks at least between each change) and the central events have not decreased, then it is time to go to another sleep doc, not take this on your own.

Demand a copy of your sleep report NOW. Find another sleep doc. Make a copy for yourself and take a copy to your new doc. Then you and this new doc can work together. For one, the machines to treat it are more expensive. You want to make sure you are getting the right one vs getting one on your own and it not be right and you have to spend yet more money.