Colorado Apnea Journey - Complex and Mostly CSA Questions

[CLCCW]

Good day! I am 21 days into my journey. Diagnosed with Complex apnea via home test and then titration test in the lab. Mostly CSA in lab. Prescribed a starting treatment with ResMed11 AirSense in APAP mode (see profile for settings). In the lab the notes said I was trialed on ASV for 3 hours and did well with my current mask, but "sample size was too low". (too little time?)

I have been compliant as heck, using nightly. Some nights short-changed due to early morning discomfort with the mask and frustration with the situation, but I am getting used to it. The last 3 nights I have slept through to 5-ish with a pee break somewhere around 2-4 usually.

I live at 5300 feet, have for 40 years. Echo shows no heart failure, EF normal. Mild mitral, tricuspid, and pulmonary valve reguritation. No afib. No High BP. Exercising. Nevertheless, CA's clump and persisting.  

Now that I am 2 weeks in: I see gradual decrease in the AHI index. Started in high teens low 20's. But never below a 6. Last night, uptick to 14. Check out the cluster of CA events! Sarcastic Dave notes the likelihood of me needing ASV and would likely have to fight for it, but thought I'd post last night's data to see what others see in my very purple-y CA clumps. I am totally learning to see the breathing pattern.

1. Weigh in: Am I unlikely to see progress on this APAP system? Should I lobby sooner than later for the fancy ASV?
2. CSR: I see this in some of my Oscar charts. What's the scoop with that?


   

   

   

[Deborah K.]

Yes, I think you should ask for the ASV now.  Any doctor, dentist, nurse practitioner, etc. can prescribe the machine for you.  You don't need to deal with a sleep specialist.  Explain that you need a ResMed AirCurve 10 ASV, ask them to prescribe that machine by name, and write that no other machine is to be substituted.  Otherwise, some DMEs provide whatever is cheapest, as they get paid the same for the best or the worst machines.

In the meantime, you will be more comfortable by changing your settings to 7 to 12.  You are not getting enough pressure with your present settings.

Best of luck with getting the machine you need!  

[SarcasticDave94]

I might be wrong, but I'm still thinking the therapy is as good as it gets with the AutoSet avoid CA plan. You'll need to make the call on when to address the need of ASV to treat Central Apnea.

The doctor has data for ASV, possibly they'll want more data to satisfy insurance if involved. So, I think it now comes down to when you want to call to push the process along to ASV and treatment.

[Carnal]

I'm new to CPAP & this forum also. Live near City Park in Denver. Sister is coming here from Phoenix this week for sons grad from School of Mines. I scour Phoenix & Denver Craigslistings daily. There is a $350 ASV machine WOW listed in Tuscon now with 450 hrs on it. I was thinking of asking her to get it, but realized I wanted the Vauto, not the ASV.   Who knows, maybe she could bring it here wed.

I'd list my tele, sellers tele & links to craigslist, but don't know whats allowed here

brian

search in phoenix craigslist for "resmed aircurve 10 asv bipap machine"
  

[CLCCW]

Good news. After my repeat pokes, my doc did review my data, and said that my CSA is not much improved from the original home sleep study (as we suspected). He is on the path to ASV with me. Has ordered a sleep titration ASV test. Yay!

[SarcasticDave94]

Congrats. Keep after them.

[lonigan]

ASV worked wonders for me, my breathing and AHI are very good these days. Other issues to work through but this was a big part of it.

good luck

[Sleeprider]

I'm sure your doctor will feel better with a clinical ASV titration, but experience on the forum has been that the Resmed Aircurve ASV is so well automated, that titrationi s really not needed. Generally, users will do great with default settings in ASVauto mode at EPAP min 4.0, EPAP max 15.0, PS min 3.0, PS max 15.0. We typically coach users how to reduce those maximum pressures and end up with excellent efficacy and comfort. Just saying, your doctor has to do what he feelhes is due diligence and pays his bills, so most will ask for titration, then proceed to dispense with default settings Anyway, I have coached many members that had no titration, and sometimes no prescription, to successful use of ASV, usually within a couple sessions. There is a good argument for just dispensing the device at default settings, optimizing from experience and demonstrating efficacy with the device data. Saves a lot of time and money, which may be at odds with your doctor's objectives.

[CLCCW]

Great to know, Sleeprider... I will keep the group posted. I like my pulmonologist but suspect he is less a sleep specialist. I know he has been consulting with a specialist (I recognize the name of the guy from the write-ups on my sleep test). I have good insurance, so this won't be financially burdensome at this point, I don't think. Would like to get in lab by end of year since I've met my deductible this year!

[Sleeprider]

An interesting thread came up recently by someone claiming to be a physician. I have elaborated on some of my thoughts on therapy in that thread https://www.apneaboard.com/forums/Thread...erspective Loggerhead's take on the pulmonologist sleep specialists should be relevant to you.