Cannot get answers!!

[zonk]

With the greatest respect for some of the advice in this thread I think you need to take a bit more time and get to the bottom of the problem before deciding that a particular machine is "the best".

Lambsydoats is in US and the doctor script say "CPAP (E0601)" 9 - did pt fail CPAP? no

CPAP has to be tried and failed before another type of machine prescribed and maybe another sleep study in sleep lab if required

[DeepBreathing]

Thanks for the clarification, Zonk. However that doesn't change my basic advice:

1. Central apneas are not trivial and cannot just be ignored. If they are caused by CPAP pressure and resolve themselves, that's fine. But the OP indicated she had them in a home sleep study without CPAP. That is a concern.

2. If the CA are not just pressure-induced, they will need an ASV machine to treat them.

3. If an ASV is required, it is better to plan a strategy so you don't get stuck with a base CPAP or APAP with no way to upgrade except out of pocket.

[PhyllisBalboa]

1. Central apneas are not trivial and cannot just be ignored. If they are caused by CPAP pressure and resolve themselves, that's fine. But the OP indicated she had them in a home sleep study without CPAP. That is a concern.

2. If the CA are not just pressure-induced, they will need an ASV machine to treat them.

3. If an ASV is required, it is better to plan a strategy so you don't get stuck with a base CPAP or APAP with no way to upgrade except out of pocket.

I agree with this. My husband's initial sleep study showed equal numbers of central events, yet he was prescribed the S9 autoset. Now, 7 months later, we are really struggling with this machine of his. Any adjustment in pressure downward relieves the centrals but leaves the obstructives. Upwards pressure adjustments fixes the obstructives but leaves centrals galore. And this is 7 months later!

Now that we've changed countries recently (US to Canada), getting the machine replaced is very difficult, not even accounting for insurance issues. It's better to get the right machine from the start.

In my case, my sleep study showed the same thing, mixed with lots of centrals. I was initially prescribed an S9 autoset as well, but a good tech told me to argue about that, which I did. So I was given a second study and then given a revised RX for an ASV machine.

The upshot is that I am doing much better than my husband, with my consistently low AHI's (under .2), while he is still struggling (barely under 5).

I know the common thinking here is that centrals are usually pressure induced and will calm down after a couple of months, but in our case that wasn't true. And it could be there are quite a few more examples that we're just not hearing from.

[retired_guy]

1. Central apneas are not trivial and cannot just be ignored. If they are caused by CPAP pressure and resolve themselves, that's fine. But the OP indicated she had them in a home sleep study without CPAP. That is a concern.

2. If the CA are not just pressure-induced, they will need an ASV machine to treat them.

3. If an ASV is required, it is better to plan a strategy so you don't get stuck with a base CPAP or APAP with no way to upgrade except out of pocket.

I agree with this. My husband's initial sleep study showed equal numbers of central events, yet he was prescribed the S9 autoset. Now, 7 months later, we are really struggling with this machine of his. Any adjustment in pressure downward relieves the centrals but leaves the obstructives. Upwards pressure adjustments fixes the obstructives but leaves centrals galore. And this is 7 months later!

Now that we've changed countries recently (US to Canada), getting the machine replaced is very difficult, not even accounting for insurance issues. It's better to get the right machine from the start.

In my case, my sleep study showed the same thing, mixed with lots of centrals. I was initially prescribed an S9 autoset as well, but a good tech told me to argue about that, which I did. So I was given a second study and then given a revised RX for an ASV machine.

The upshot is that I am doing much better than my husband, with my consistently low AHI's (under .2), while he is still struggling (barely under 5).

I know the common thinking here is that centrals are usually pressure induced and will calm down after a couple of months, but in our case that wasn't true. And it could be there are quite a few more examples that we're just not hearing from.

In the case of this OP's doctor, the CA's were not significant. While I don't always put a lot of faith in what sleep tests and sleep docs say, the only thing the OP can do, in accordance with her prescription, is to begin with the prescribed machine. I have every confidence she will receive great benefit from the therapy as prescribed. I also have every confidence that if she does not, then the issues can be dealt with at that time.

[PhyllisBalboa]

[quote='retired_guy' pid='89028' dateline='1414692367'
In the case of this OP's doctor, the CA's were not significant. While I don't always put a lot of faith in what sleep tests and sleep docs say, the only thing the OP can do, in accordance with her prescription, is to begin with the prescribed machine. I have every confidence she will receive great benefit from the therapy as prescribed. I also have every confidence that if she does not, then the issues can be dealt with at that time.
[/quote]

Yeah, I went back and looked at the RX, 18 obstructives and 11 centrals. My husband's were almost that, not really equal come to think of it, a few more obstructives than centrals. Diagnosed as moderate, just barely. Doctor said the centrals were from pressure and would go away, so just ignore them. Unless he meant they'll go away in the 8th month, but we're not holding our breath. And I would have been in the same boat. Thank goodness for that tech.

[PaulaO2]

The 9cm pressure is not to be compared to severity (or lack of) at all. It just means that's your treatment pressure for YOU.

It depends on how many central events you had during the home test and when they happened. Did they happen when you were asleep or when you were awake? A central event is when breathing stops but the airway is open. A good yawn. A bad dream. Yes, 10 seconds is a long time but it does happen.

The point is to not worry. Concern? Sure. It is your body. Educate yourself. Understand what is going on. Worry and fret? Not at this point. Get the machine and understand the data. If they do not go down on their own, become your best advocate. By being educated and empowered, you can take the data to your doctor and ask for clarifications. You will KNOW the doctor is full of crap or that it may take more time, etc.

[Whitewabit]

When will you get your machine and what is it ??

[Lambsydoats]

Thank you all for continuing this discussion on my behalf. I'm learning....

I got the call today from the local DME to whom my doctor sent my prescription. I hadn't read these posts yet, so I didn't know to ask her about which machine she planned to start me out on. I did, however, have the presence of mind to make my appointment later in the week (as badly as I want to get started on therapy) to give myself more time to research and understand more about all of this before being presented with THEIR solution.

I did find out that my insurance company codes all CPAP machines the same--with the exception of features (e.g., heated humidifier). In other words, just because the doc checked the top box doesn't mean that an auto-CPAP can't be dispensed (as far as my insurance company is concerned).

I e-mailed Supplier #9 on the list because I had read good reviews about them, and received a nice, intelligent and helpful e-mail in response. Today I wrote again to ask if they would call my insurer for pre-authorization. We'll see where we get with that.

I cannot WAIT to get my machine and start getting some restful sleep, which I am confident I will do from the first night, as I had no problem sleeping with a CPAP during the titration.

Oh--as for not being able to get in to see anyone, the assistant called me early yesterday, and I missed her call. I called her back within 1/2 hour, but got her voice mail. I tried again a couple of hours later when I still hadn't heard from her, and was told she had just taken a patient back to a room. I left another message. She never called back. So no...I still have not gotten in to see anyone. While I understand that CAs should or should not be of concern, I want to know why they THINK I'm having them, particularly on my second of three studies. To answer someone's question, my numbers on that second test (no pressure) were the same as with pressure: 18 OSAs and 11 CSAs.

The number of desaturations are interestingly listed as follows:

At or under 90%: 23 minutes
At or under 85%: 0 minutes
At or under 80%: 0 minutes
At or under 89%: 10 minutes
At or under 88%: 3 minutes

Isn't that an odd way to list them, not in descending order by saturation level nor descending order by number of minutes??

Lamb

[3porpoise]

Attached is the Rx.

Is the # of sleep apneas the number per hour, or the total number for the time I was asleep

Hi again everybody,
Maybe I'm missing something but AHI is 18. So doesn't that mean all obstructives +centrals+ hypopneas Divided by tst gives AHI? Cause # of obs is 18 #of centrals is 11 and if that was per hour then ahi would be at least 29?
It's early morn and I just woke up so please forgive me if the answer is obvious to every body else.
3

[DeepBreathing]

Hi 3porpoise. Yes, the AHI is the average number of events (obstructive, central and hypopnea) per hour. What's not clear from the Rx the time over which those events occurred.