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+--- Thread: AHI score going way up, please advise. (/Thread-AHI-score-going-way-up-please-advise)
AHI score going way up, please advise. - Josephdfco - 11-26-2017
My AHI was initially greatly improved when I went from S mode to CPAP mode, but it has steadily gone back downhill. https://imgur.com/a/8bu4j
I've got an appointment at the VA's sleep medicine clinic tomorrow, and I'm trying to anticipate the excuses these people are going to make to leave me with this machine, like "you just have to give it time", or "switching you to a mask will fix this", or some other such nonsense. I'm utterly miserable, and I feel like I'm going to lose my mind if this doesn't get fixed. I wonder if I should go to S mode or VAuto mode for tonight, just so I can say "no, I already tried that"?
RE: AHI score going way up, please advise. - Sleeprider - 11-26-2017
Back to normal. Not much can be done in attempting to treat central apnea with a CPAP or BPAP without a backup. It's a bit like trying to fix a leak with duct tape...It might or might not actually work, but in the end, you have to make the right repair. You have demonstrated that both bilevel PAP without backup and CPAP fail to resolve your central apnea. When we first tried the fixed pressure, I mentioned this was a bridge to ASV, not a cure. I was amazed when your AHI actually dropped into single digits, but using CPAP to treat CA has unpredictable and inconsistent results. You're seem better off with fixed pressure than bilevel. You can try any mode you want, but since the device you have does not treat central apnea, results will not be predictable, and likely worse.
I have no experience with VA benefits and approvals of ASV in that system, however it appears to be very different from private medicine and insurance. I have seen where the VA has commissioned several medical studies that seem intended to avoid dispensing ASV, and veteran benefits may be contingent on a nexus to a disability related to the veteran's service.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3459202/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3242685/
https://www.va.gov/vetapp14/Files4/1426481.txt
I think in talking to them, I would emphasize your original diagnosis was for central apnea, and the bilevel resulted in a very high central event rate you could not tolerate. You attempted to use fixed CPAP and had some temporary improvement, but are not back to high levels of apnea. You need to show them this is affecting your function and disrupting life. Discuss details of how his is impacting you, and those around you. This is a critical part of the approval process, not just AHI numbers.
They should immediately recognize you need ASV, but if they don't pretty quickly show they are aware of the correct answer, you should not hesitate to directly ask when an ASV titration can be scheduled. If they suggest you keep using the machine and see what happens, insist on scheduling ASV titration as a contingency and remind them of your actual diagnosis of central apnea, and as they know, CPAP and BPAP without backup is not a recognized treatment. There are some viable alternatives, like the use of supplemental oxygen in addition to PAP therapy as shown in the NIH study linked above. This too would have to be evaluated in a sleep study, so scheduling that clinical evaluation remains the goal.
We can't know what will happen tomorrow. The goal is ASV, but the objective is to get scheduled for titration. Argue for what you need and want. If you can get a prescription for ASV, even if they don't provide a machine, get the script. Keep us posted.