Trying CPAP one last time... AHI looks really bad

[gsilver]

The lab didn't send me the sleep study, so I'll try to get a copy of it when I go to the office again. I do know that some central apneas were present, but they were low in comparison to the obstructives... I know, not the most descriptive of statements.

I'll try adjusting the IPAP to 5 and see how it goes.

As for how I'm feeling today, it's not great, and I couldn't get by without napping, but not horrible like yesterday. Though after a night like Thursday, I probably won't feel 100% for a while.

[gsilver]

Here's the chart from last night with the 5/4 settings. Subjectively, I'd say that I feel worse than yesterday. It took a long time to get up (I was drifting in and out of sleep since about 5, fully awake by 6, but not actually up until 8:30) and already feel like going back to bed :|

No OAs were observed, but still lots of centrals.

[sheepless]

your doc suggested trying bilevel. is there some rationale for using this particular machine vs asv?

[Gideon]

OK, Let's try EPAP = 5 IPAP = 6
Keeping the PS of 1.
I'm looking for your most comfortable settings.

[jaswilliams]

your doc suggested trying bilevel.  is there some rationale for using this particular machine vs asv?

ASV is often a journey.

CPAP Treatment Unsuccessful
BiLevel Treatment Unsuccessful
ASV Successful


To comply with Insurance or other paying guidelines each step must be followed it is not easy to shortcut the process. It takes time often with many visits to the Dr and many overnight sleep studies the reason being sometimes BiLevel works so no need to move to an ASV.

[Sleeprider]

You are going to end up with ASV. It's miraculous how effective ASV is in treating people with your classic central apnea. It's not a matter of if, but when. You should start informing your doctor of these results sooner than later, and emphasize how your results are much worse with higher pressure and pressure support, as compared to low constant pressure. This is a typical presentation. The sooner you and your doctor are on the same page to get you on ASV, the better. This is why you failed CPAP the first time, and will again unless you get the therapy that is appropriate and works.

[gsilver]

You are going to end up with ASV.  It's miraculous how effective ASV is in treating people with your classic central apnea.  It's not a matter of if, but when.  You should start informing your doctor of these results sooner than later, and emphasize how your results are much worse with higher pressure and pressure support, as compared to low constant pressure.  This is a typical presentation.  The sooner you and your doctor are on the same page to get you on  ASV, the better.  This is why you failed CPAP the first time, and will again unless you get the therapy that is appropriate and works.

Yeah. I'm definitely talking to my doctor on Tuesday. I kind of started this treatment at a bad time in terms of doctor availability (long holiday weekend, with the doctor taking off a few days in the week before)
I have an appointment set for the 6th, but I should at least be able to get some feedback from him prior to that.

[Gideon]

Show the doctor the charts from this thread.
He already felt you failed at CPAP
These charts, especially the first one, demonstrate you failing at BiLevel wo Backup.
The latest charts again (you went there because of the horrendous results at BiLevel) and again demonstrate failing at CPAP pressures and settings, but they are barely sleepable if I'm understanding you correctly.  

I believe that he will feel the need to prove that the CA events are not Treatment-Emergent so ask him.
When do you think we can trial an ASV machine? What needs to be done to demonstrate the need to trial?
Do you think my CA events are Treatment-Emergent?  If so when can we state that they are not because they are persistent?

Review in detail all mentions or Central/Clear/Mixed/Complex/Treatment-Emergent events (all these include Central events) in your diagnostic study.

Below is the criteria to qualify for ASV per MediCare
For Central Sleep Apnea
For Central Sleep Apnea the Medicare requirements for issuing an ASV machine.

• Document a central apnea-central hypopnea index (CAHI) is greater than or equal to 5 per hour also apnea-hypopnea index (AHI) greater than 5'
  
• Document The sum total of central apneas plus central hypopneas is greater than 50% of the total apneas and hypopneas
  
• Document the presence of at least one of the following symptoms: These symptoms are specifically noted by Medicare. These are key symptoms that we look for by asking "How do you feel?". Do not limit your answers to the following and do not fabricate the answers.
  

1. Sleepiness, "How do you feel?"
   
2. Awakening short of breath, "How do you feel?"
   
3. Difficulty initiating or maintaining sleep, "How do you feel?"
   
4. Frequent awakenings, or "How do you feel?"
   
5. Nonrestorative sleep, "How do you feel?" Nonrestorative sleep is defined as the subjective feeling that sleep has been insufficiently refreshing
   
6. Snoring, Can be documented on Sleepyhead
   
7. Witnessed apneas Most of us have this one with our significant others
   

The green indicates what you have described in this thread.  It is VERY important to relay this info to your Doctor.

[gsilver]

I can pretty easily check every box on that list except for snoring... I don't see any measured in sleepyhead, and my energy level is impacted enough that I really can't get out much after work, so I don't exactly get feedback on it from anyone.

2. I frequently wake up gasping when I need to take naps during the day at work. Less so at night
3. I fall asleep very quickly at night (usually <10 minutes) but I very often wake up and can't get back to sleep
4. Ditto
7. Plenty of data from sleep studies on this one.

[gsilver]

I was awake for a large portion of last night, probably because I ended up having to spend much of yesterday lying down, and only ended up using the cpap for about half the night. There probably isn't much of a point of posting that chart since I was awake for so much of it, but I still didn't see any snoring or anything besides central apneas.