[CPAP] New to treatment: AHI Worsening

[SarcasticDave94]

You may want to look at ResMed titration protocol. However, if you know aspects are good settings now, such as Min EPAP, etc. you can use those to plug into an ASV.

I think the better Mode will be ASVAuto for most. This gives an EPAP and PS range you can set, with IPAP auto ranged according to the EPAP and PS ranges.

As for purchase, there's suppliers in the list above. Sistemma Supplier #33 and Secondwind Supplier #2 tend to have decent pricing for used and new. I'm only mentioning these 2 as they're on my own shop list, not as a dislike for the others.

PS assuming self-fund if applicable, formal paid-for titration not necessary. Myself and others on AB can help with this. You set the pressures and use it. Look at OSCAR, view the data for trouble spots while noting how well you slept. The ResMed ASV has 4 pressure settings, the rest are comfort.

[Sleeprider]

I completely agree with Dave on this. Many individuals have idiopathic central apnea, or treatment emergent central events. We already discussed my thoughts on using a BiPAP ST and it is NEVER the next step. Take a look at this Resmed Sleep Lab Titration Guide https://www.resmed.com/us/dam/documents/...er_eng.pdf This is an excellent guide to the conditions machines are intended to treat and provides protocols for titration of the various machines. Pay particular attention to what conditions The VPAP ST and ASV are intended to treat. You will quickly see the ST is intended for the treatment of COPD, Neuromuscular Disease, and Obesity Hypoventilation Syndrome and other respiratory conditions with severe pulmonary restriction or obstruction. The ASV is intended for patients with central and complex apnea and periodic breathing such as Cheyne Stokes Respiration. Your doctor lacks a basic acquaintance with advanced positive pressure non-invasive ventilation, and the kinds of tests suggested were done to simply intimidate you. We see this far too often.

Sometimes your primary doctor is more knowledgeable than the specialist, and I would not hesitate to ask for his/her opinion. Be aware that the sleep specialist may have other specialties such as cardiac, pulmonary, neurological and otolaryngology, all of which may bias their approach to treatment. I am yet to see a sleep specialist / urologist combination, but you never know. Seriously, we will support your efforts, but it is unfortunate to hear your current doctor is not more open minded.

[Universeonwheels]

Thank you guys. I really appreciate all the help.

I called up a bunch of sleep medicine clinics and found one which claims to use ASV in complex patients. I have an appointment with them on Monday. Hoping it goes well.

[SarcasticDave94]

Hope it goes well. Keep us updated.

[Sleeprider]

Great way to handle the situation. Do some internet research on complex sleep apnea, and you won't find many doctors claim a neurological connection. You are much better off separating from that malpractice.

[SarcasticDave94]

Just wanted to put this out before I forget. Note down all settings on the current machine, and whether they are giving good therapy or not. Therapy settings can be plugged in or adjusted as necessary. Comfort things should just carry over.

[sheepless]

"you won't find many doctors claim a neurological connection"

since my first dx of central apnea in 1987 and complex apnea more recently, central apnea has consistently been described to me as idiopathic because for me it's not related to a known underlying condition like heart failure or to opiods, and as neurological because of the lack of respiratory effort or to breathe spontaneously. if current thinking about this has changed, I'm not aware of it. otoh, I've also never heard of an effective neurological treatment or solution, even if some kind of neurological problem can be found and demonstrated to be related to central apnea, neither of which I've heard of either (not that my knowledge or lack of knowledge is in any way definitive).

[Universeonwheels]

It being believed to be neurologic-induced doesn't necessarily imply the doctors believe treatung the neurological issue will treat the apnea. It could mean: "Hey, let's treat that neurological issue."

[Sleeprider]

It being believed to be neurologic-induced doesn't necessarily imply the doctors believe treatung the neurological issue will treat the apnea. It could mean: "Hey, let's treat that neurological issue."

That's fine, but this is not needed as a prerequisite to getting ASV titration, which is the appropriate response to solve the problem at hand. I would never argue that a neurological workup may be appropriate as a good precaution, however that can go hand-in-hand with the appropriate therapy for central apnea, and needs to consider your financial ability to undertake a battery of expensive tests along with an assessment of risk for not performing them. Your sleep specialists job was to take care of the central sleep apnea problem, and in that role, he may recommend other health evaluations, including cardiac or neurological workups.  My understanding is that ASV was rejected out of hand and you should go get a CAT scan, or more accurately, your doctor does not recognize central and complex apnea as an easily treatable condition that is relatively common.  Without that perspective, that doctor is a waste of your time.

[Universeonwheels]

It being believed to be neurologic-induced doesn't necessarily imply the doctors believe treatung the neurological issue will treat the apnea. It could mean: "Hey, let's treat that neurological issue."

Oh absolutely. I was just adding my pedantics to the person's statement. It's  irrelevant to the thread.