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A lot of CA's - Printable Version

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A lot of CA's - itchy365 - 09-01-2020

I seem to have a handful of CA clusters on my BiPap Dreamstation. My latest screenshot is attached.  Any suggestions on adjustments that might be made?  Thanks for any assistance.

RE: A lot of CA's - Sleeprider - 09-01-2020

You are using a Dreamstation Auto BiPAP in a fixed pressure configuration of IPAP 15.0 EPAP 10.0. You are experiencing clusters of CA events. The solution is to reduce pressure support by reducing IPAP. I will suggest IPAP 14.0, EPAP 10.0 in your current BiPAP S mode, or if you want to look at Bauto mode, we can try a range of pressure, but again with less pressure support. We want to reduce pressure support by 1-cm any time we see clusters of CA like this. The protocol is to increase EPAP for obstructive events, increase IPAP for other obstructive events, and to reduce IPAP for central events.

[Image: attachment.php?aid=9715]

RE: A lot of CA's - Sleeprider - 09-01-2020

One additional thought; if you were dispensed a BiPAP because of central apnea events in your sleep study, then you are going to need a different therapy. Adaptive Servo Ventilation (ASV) is a specialty bilevel device used to treat complex and central apnea. I'm always a bit suspicious when a new member shows up with a BiPAP and central events that their doctor is simply following an insurance protocol that requires patients to fail at CPAP, and bilevel before getting the needed machine with a backup rate and pressure support to resolve central apnea.

RE: A lot of CA's - itchy365 - 09-01-2020

Thanks for the quick feedback.  You certainly could be correct.  I had a CPAP for a few months and just recently got the BiPAP.

I only had a home sleep test before getting the CPAP.  I do have a formal sleep study scheduled for next month.  My doc isn't familiar with all of the data from the machine.  I think he only gets summaries from the equipment proovider.

RE: A lot of CA's - Sleeprider - 09-01-2020

I think you will be better served by a clinical titration study, rather than a diagnostic sleep study without CPAP. At this point, you doctor surely knows you have excessive apnea with CPAP and BiPAP, and the next step is ASV. You should tell your doctor you are concerned about the central apnea you have been having on CPAP and BiPAP and ask your doctor about ASV Ask if he has a plan to move you towards that therapy option. He will be surprised to hear it from you and may come clean as to what he suspects. The point of your conversation is to query your doctor's awareness and experience with complex and central apnea. Not all doctors have that experience or are comfortable with ASV therapy.

This link is the Resmed Sleep Lab Titration Guide and it describes the different kinds of machines and what they are intended to do. I want you to read about CPAP, bilevel (VPAP), and the advanced machines VPAP ST and ASV. This will give you a background to understand what is coming and more intellegently have a conversation with your doctor. https://www.resmed.com/us/dam/documents/products/titration/s9-vpap-tx/user-guide/1013904_Sleep_Lab_Titration_Guide_amer_eng.pdf

Also, read our wiki about Justifying Advanced PAP Machines. http://www.apneaboard.com/wiki/index.php/Justifying_Advanced_PAP_Machines There is a bureaucracy involved with insurance companies to get advanced therapy, and you need to know about it to "win the game". You must know the rules of the game to win, and this is a start. Finally, I'd like to hear if you have very good insurance. It can be less expensive to self-treat by buying your own equipment and avoiding numerous tests and inflated prices from the usual medical equipment providers (DME).

RE: A lot of CA's - itchy365 - 09-01-2020

Thank you so much for your comments and suggestions!  I have some studying to do and then will engage with my doctor.

I think my insurance is pretty good as I haven't been out of pocket yet through the CPAP and now BiPAP.

RE: A lot of CA's - Sleeprider - 09-01-2020

It helps to know you have good insurance and can go through the process I suspect you will be submitted to. Have patience and understand that CPAP and your BiPAP are intended to treat obstructive sleep apnea. Some people have some success in reducing central or complex apnea with these machines but most need the ASV to really feel rested and get good results.

Your chart shows your events occur in clusters separated by quiet event-free periods. This complicates a clinical titration because the tech sees good results for an hour and concludes you respond well to a particular pressure, however that result is rarely repeatable. If we look at your sleep study and see central events, we can coach you to work more effectively with your doctor to avoid those kinds of testing errors.

RE: A lot of CA's - itchy365 - 09-01-2020

Ok, thanks for the support!

RE: A lot of CA's - SarcasticDave94 - 09-01-2020

Just saying I'm listening in. This sounds a lot like deja vu. Plan for a fight, but it's one you can win, assuming ASV is needed. So far it sounds like it's leading there. If in need of a Q&A on how to be prepped for this, feel free. I've been there and got the ASV, no T-shirts are offered though.

RE: A lot of CA's - itchy365 - 09-01-2020

I’m prepping for a fight. Will be back with updates and questions. Thanks so much.

If I can’t get a t-shirt, how about a hat?