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APAP results - desertscorpion - 07-11-2019

Diagnosed 1 year ago with moderate sleep apnea (AHI 16 with mostly central events)
Doctor prescribed Resmed Airsense 10 with pressure setting of 5-20 using Dreamware nasal mask
events went down to 8-9 with 80% being central apneas
Had 2 overnight studies done and they adjusted machine settings...at one week in January , they placed constant pressure of 5 and AHI went to around 5 but because still was having daytime fatigue, they put machine back to 5-20.
Attached are last 2 days results with year summary.
Any advice would be greatly appreciated.


RE: APAP results - alshayed - 07-11-2019

Hey there! I'm sure you will get more experienced advice than I have shortly but I don't think even by medical standards you are being successfully treated since they want AHI below 5. Almost a year is a long time to go like this, and my feeling is you need to be on an ASV machine instead of CPAP/APAP. Let's see what the others have to say but hang in there, you're going to get help to go through this.


RE: APAP results - desertscorpion - 07-11-2019

Thanks for speedy reply.

They said I wouldnt qualify for ASV because my apnea wasnt severe enough for it...said I need to "flunk out" of APAP treatment before being able to qualify for an ASV unit....guess they think my apnea is good enough even though still tired during day. Sad


RE: APAP results - Melman - 07-11-2019

Welcome to the forum. I think the previous post is correct. The machine you have will not treat your condition adequately. It appears you are using EPR. Turning off EPR may reduce the number of centrals but probably not to the point at which you will be adequately treated. A lower fixed pressure may also be best. The trial at 5 demonstrated that.


RE: APAP results - desertscorpion - 07-11-2019

Seeing they wont qualify me for an ASV machine (and my insurance wont pay for it unless I meet my $6000 deductible), will try to improve things with a constant lower pressure of 5 (like in January) and lower EPR down to see what difference that makes.
Thanks for advice


RE: APAP results - alshayed - 07-11-2019

Before you make more changes wait for one of the more experienced people to respond. I think you've already flunked out and your doctors just aren't being realistic and following the actual guidelines. You may be able to make CPAP work "good enough" for the doctors but still feel horrible, and you want to get onto the correct treatment for your condition. I mean you've already been at this for almost a year, I don't know what else they would want. You are probably going to have to become the squeaky wheel and keep complaining to them about how bad you feel until they do the right thing. Just tell them the truth without sugar coating it.

Also check out this Wiki page - http://www.apneaboard.com/wiki/index.php?title=Justifying_Advanced_PAP_Machines


RE: APAP results - alshayed - 07-11-2019

Just saw your update about being concerned about the cost. Supplier # 2 might be able to help you make it happen more affordably, but if your deductible is that high it's definitely a concern.


RE: APAP results - sheepless - 07-11-2019

desertscorpion, I was in a position similar to yours a while back. originally diagnosed 32 years ago with moderate central apnea with no treatment available. in late 2016, a home sleep test returned severe central and obstructive apnea in near equal numbers but diagnosed obstructive anyway and prescribed a resmed autoset. 1.5 years later overall ahi was between 5 and 6. my doc seemed very pleased but I continued to feel awful. I bought a used $1000 usd asv out of pocket, figuring if it didn't work better than apap I could easily resell it. as it turned out, the results are a striking improvement over apap with overall ahi under 0.3. like you, even if insurance permitted, and there was a question about that, I would have paid out of pocket because of a high deductible. I don't know for sure I wouldn't have qualified for asv but I knew it was going to be an uphill battle. in the end I didn't go back to the sleep doc because it cost me $350 for 10 to 15 minutes with him and he wouldn't look at anything other than summaries and averages. folks here helped me get started on asv and I continue to self-titrate as my layman's understanding of the data and how the machine works grows. lots of trial and error but eventually got there. the machine was out of pocket but my action saved me the time and cost of additional doctor appointments, sleep studies and titrations since they would have been against my high deductible as well. when it comes time to replace the asv, I might have to find a doc willing to prescribe the asv based on the existing data and without further sleep studies.


RE: APAP results - desertscorpion - 07-11-2019

sheepless, thanks for sharing your struggles...sounds like the same situation I am in...doc seems to think apnea results OK even though I dont feel any different before or after starting treatment...they have tried various settings with some improvement (constant pressure of 5 seems to have worked best for AHI but still tired).
They did have me have a brain MRI done and heart stress test,etc to be sure there wasnt any heart failure or brain abnormalities  and those tests were normal so I think I should possibly purchase a Aircurve10 and with the knowledge I am receiving here and the help of the people like yourself here in this forum, perhaps I can titrate the settings that will give me some improvement.
Thanks for your feedback


RE: APAP results - sheepless - 07-11-2019

you seem to have a pretty obvious ca issue so you may not need to look beyond that. keep it in the back of your mind however that there are a jillion reasons we could be tired. asv has helped me enormously but I'm still not up to par. in my case I believe periodic limb movements are causing a lot of arousals contributing to my severely fragmented sleep. IDK, but it's possible had I been properly treated for that, I would have felt better on apap. if/as/when I ever get some help for plm, I'll have to go back to the apap to test that. whatever; the point is simply to be on the lookout for non apnea / cpap related influences on sleep as well.