Zeoce's Therapy Thread - Printable Version +- Apnea Board Forum - CPAP | Sleep Apnea (https://www.apneaboard.com/forums) +-- Forum: Public Area (https://www.apneaboard.com/forums/Forum-Public-Area) +--- Forum: Main Apnea Board Forum (https://www.apneaboard.com/forums/Forum-Main-Apnea-Board-Forum) +--- Thread: Zeoce's Therapy Thread (/Thread-Zeoce-s-Therapy-Thread) |
Zeoce's Therapy Thread - Zeoce - 11-16-2022 Hi Everyone, New to the site... Quick backstory:
Questions & Insight Requests:
RE: Zeoce's Therapy Thread - Zeoce - 11-18-2022 Below is some more OSCAR data:
Will lower humidity level / temp a bit for comfort. RE: Zeoce's Therapy Thread - Zeoce - 11-19-2022 Below is some more OSCAR data:
RE: Zeoce's Therapy Thread - Zeoce - 11-20-2022 Below is some more OSCAR data:
RE: Zeoce's Therapy Thread - Sleeprider - 11-20-2022 Interesting that your diagnostic test recorded 100% central apnea and hypopnea and the diagnosis is "Severe Obstructive Sleep Apnea". The diagnosis is for convenience, and not based on facts. You have idiopathic central sleep apnea and your results with CPAP are consistent with the diagnostic results. Your event rate is significantly lower on CPAP and it's possible you may not need to progress to ASV, and that is why a CPAP trial is required to be completed and failed before any higher level therapy is considered. I'm fairly certain we can make some recommendations to reduce the number of apnea events, but that does not necessarily mean that CPAP is the best therapy for you. Optimizing CPAP therapy for an individual with a predominately central apnea diagnosis means that we can achieve an acceptable AHI, but you won't be considered a candidate for Adaptive Servo Ventilation, which is designed to treat your specific condition. The question we must ask is difficult. Is it better to optimize your therapy and lower AHI at the risk you may not continue on the path to the more ideal ASV therapy? If you want to see a very low optimized AHI, I recommend setting minimum pressure to 7.0, Maximum pressure 7.0 and EPR 1. This will nearly eliminate the CA and hypopnea events, but I also suspect it will leave you tired, because it cannot treat CA which is the root issue. Give it a try, but also consider going back to the wide-open settings you started with and then working with your doctor to consider the REAL results of your diagnostic test and ordering a titration that moves from bilevel to ASV to identify the correct therapy. I expect you to ask questions about this conclusion, and I'm sure another member, Gideon will also concur with the above and help to arrive at a solution. RE: Zeoce's Therapy Thread - Zeoce - 11-21-2022 Thank you SO much for your time, and insight. Much appreciated - I’ve received nowhere near that level of analysis from my GP or sleep specialist! I was beginning to wonder about the central sleep apnea diagnosis when there had been so many ongoing CA events. Was hoping there was a different explanation for them. I’ll try the min/max pressures of 7, w/ EPR at 1 and report back. And yes, I can ultimately setup the titration study later if need be, and purchase an ASV machine if that’s what’s best for my health. RE: Zeoce's Therapy Thread - Sleeprider - 11-21-2022 This seems to be standard practice in the sleep medicine industry that everyone is diagnosed with obstructive sleep apnea even with predominately central events. "Why" would make a good question for your doctor at a follow-up. Most members we see with a similar diagnostic study, improve with CPAP therapy, but many report they do not feel that sleep is restorative due to occasionally unstable respiration. Some move to ASV n their own, or work through the trial and fail procedure that is common with insurance. The wiki on "Justifying Advanced PAP Machines" describes the struggle. http://www.apneaboard.com/wiki/index.php/Justifying_Advanced_PAP_Machines If you stay on the forum or look around the past posts under "central apnea" or "ASV" and similar searches, you will find the problem is actually fairly common, and is not often associated with any severe health issues, thus "idiopathic" or without cause. We usually see some periodic breathing as the apneic threshold is reached with CO2 dropping resulting in hypoventilation, and increases in CO2 resulting in hyperventilation. The most simple explanation is an individual sensitivity to changes in CO2 which affect the respiratory drive rather than a neurological or pathological origin for CSA. RE: Zeoce's Therapy Thread - Zeoce - 11-21-2022 Yes, I'll will ask about the obstructive diagnosis the next time I speak with the doctor. In regards to ASV therapy vs my current machine:
If I were to buy on my own ASV machine and post the OSCAR results here for guidance would I still need order a titration study (that cost will be covered by gov't)? Would be nice to not have to go in again for another study if the benefits are negligible. Attached is last nights OSCAR data with the suggested min/max of 7 and EPR of 1. I think those setting had me sleep the easiest of all my previous adjustments and pressure range since getting the machine a week ago. Still don't feel very rested though, and woke up briefly 3 or 4 times (probably just due to still getting used to sleeping with a mask and hose). My apple watch w/ associated 'autosleep' app shows a great sleep according to their metrics, and the best numbers since getting the CPAP. RE: Zeoce's Therapy Thread - cberistain - 11-21-2022 Zeoce may I ask what full face mask you are using? I'm using the F20 and have a much higher leak rate than you do... it wakes me up numerous times at night. RE: Zeoce's Therapy Thread - Sleeprider - 11-21-2022 I had expected lower AHI with the fixed pressure and reduced pressure support (EPR), so we're going to call that a learning experience that your particular central issue is not going to just go away with lower pressure differential between inhale and exhale. Flow limitation is higher, so there is some obstructive aspect to your sleep breathing and you apparently benefit from the EPR or pressure support. I think it is worth continuing to try these settings until we can establish a trend, especially since you found this more comfortable and effective. With regard to your doctor you should make sure he/she knows you are not seeking to satisfy insurance dispensing requirements and are prepared to pay out of pocket for the right machine. It will make getting a prescription easier. I think between your diagnostic results and early CPAP data there is adequate justification to trial ASV at your own risk. A titration study is actually pointless with ASV because it is fully automatic and either works or it doesn't. They are always required if insurance is paying because they require you to fail CPAP and Bilevel and to demonstrate efficacy with the respiratory assist device being prescribed, but when paying on your own, your doctor has a lot more discretion. If you have co-pays or deductibles for a test, the titration test can actually cost more than the machine...worthless! Keep in mind the titration test simply consists of setting EPAP at a pressure that prevents obstructive events and letting the machine apply the adaptive pressure support to maintain rate and volume. I'll post the titration protocol below. I'm confident your AHI will approach zero with ASV, but there is a learning curve and adaptation challenge as the machine will push pressure support to maintain your minute vent and respiration rates. You can buy a new Resmed ASV from Supplier #2 for $2599 or gently used and warranted for $1699. This is a rock-solid supplier with great customer service and reliability, so save some money, and this is a better choice. There is a Resmed Aircurve ASV on the Nashville Craigslist listing #7559180446 Belleview TN for $1000 used one year. Be sure to use save payment methods and verify the seller actually has the machine by asking for a photo of the use-hours (Clinical Menu/About/). I use SearchTempest.com for these searches. You may also want to check the DotMed website under Respiratory/Bilevel listing for ASV and only buy from known, rated domestic sellers. |