CPAP Trial .. still not sure

[Oompa]

Thanks for the analysis!

So from what I understand during the 'auto' test as the pressure increased so did the occurrences of CA hence why they possibly tried on a lower fixed pressure?

Attached is my sleep study, apologies for the quality and hope it is detailed enough

[Gideon]

Ok and thanks for the sleep study.

They gave you a diagnosis of severe OSA per your OP.
Your study had roughly 50% OSA and 50% mixed and central Apnea

Your dailies show 1/3rd to 1/2 Central and Mixed events with an occasional excellent night. Your numbers are typically above the you are treated value ofcl 5 AHI

The inconsistency you see in your nightly charts is typical of what you can expect.

How would you like to proceed with your treatment.

1. Optimize your therapy with your current machine which is the best machine for OBSTRUCTIVE Apnea which was your diagnosis, and continue to get inconsistent numbers.

Or

2. The hard road. Work toward eliminating your central apnea and most likely achieve AHI scores well under 5 by getting an ASV machine to treat your apnea.

Obviously you are much better off now then before you started cpap therapy. And we will help you either way.

[SarcasticDave94]

As bonjour mentions, you've got 2 routes to take: attempt to make the current machine do it's best to assist via setting optimization or attempting to get (and prove) an ASV like I have. Either way, there are Apnea Board members that have been successful on choosing choice A or B. In other words, we will assist either way you choose. Each of those choices, obviously, means doing different actions. Mostly though, I've noticed that people attempt to make the current machine work for them via optimization. Then, if that fails to produce great results, they move to getting another machine to help.

Again, we will help as much as possible either way you choose. Best to success.

[Oompa]

Wow great info... I guess the struggle with a 4 week trial is even though the numbers are showing a significant improvement I probably haven't had a chance to fully adapt and therefore see the benefits 

The immediate dilemma is this machine goes back next week.  They are suggesting the fixed equivalent is the way to go and while I welcome the savings I am questioning if i won't be in a position in a few months where I should have got the automatic

As a geek at heart I'm more then happy to do the research and tweak as I go but obviously this only has limited benefit throughout the night

[Fats Drywaller]

The immediate dilemma is this machine goes back next week.  They are suggesting the fixed equivalent is the way to go and while I welcome the savings I am questioning if i won't be in a position in a few months where I should have got the automatic

A clarification, based on what bonjour and Sar-Dave have said: An ASV machine is in a higher tier entirely, not just APAP. The Resmed ASV machine is in the product line called Aircurve 10 rather than Airsense 10. The bad news is that it's much more expensive, but the good news is that your loaner machine is going back anyway, so presumably you have an opportunity to replace it with an ASV.

In other words, if they're suggesting fixed-pressure CPAP, they're leaning in the opposite direction from where you apparently need to go.

[Gideon]

You still want the auto machine!!! It is more flexible. You haven't tried a narrow band. You can use it in CPAP mode or not. "THEY" want likely want the fixed variant because "THEY" make more money from it because "THEY" get paid the same either way. Both are the same billing code to insurance.

Machine life is 5+ years. Do you think your needs will change in that period? Mine do!
Which way do you want to go?

[Gideon]

Your statement is I will not accept a less capable machine especially while my therapy doesn't meet the less than 5 AHI standard for an extended period of time. I consider anything over 5AHI a failure. Besides I'm still not feeling better.

[Oompa]

Your statement is I will not accept a less capable machine especially while my therapy doesn't meet the less than 5 AHI standard for an extended period of time.  I consider anything over 5AHI a failure.  Besides I'm still not feeling better.

This is great and exactly what I'm thinking.. can imagine the same sales guys trying to 'upgrade' me in 6 months time.  

Unfortunately here (Australia) I'm responsible for the gap between fixed->auto->ASV so my challenge will be getting auto at the right price

[pholynyk]

Supplier #2 has a good reputation and ships to Oz. There have been many threads about importing made in Australia machines back into Oz from the USA. If you are paying out of pocket they are worth looking at.

[Sleeprider]

Based on your sleep studies, and optimization of results on CPAP, I don't expect significant further improvement using fixed CPAP, and I think you need to start getting your mind around moving to ASV. Everything you have done to date has been right for optimizing therapy for complex apnea. You are working with some well informed people in that regard, and I would have recommended the same. Unfortunately your complex apnea will always lead to inconsistent results on CPAP, that will likely continue to fall below therapy objectives. You have idiopathic central and mixed apnea, mixed with obstructive apnea, with or without CPAP therapy.

Your trial has taken you to the best results that can reasonably be expected with CPAP, and your current results are probably close to as good as it gets. We have a saying here about continuing to do the same thing, and expecting different results. This is the definition of "insanity" according to Albert Einstein, and it applies in your case. Consistent efficacy will occur once you move to ASV. For your consideration the price of a Resmed Aircurve 10 ASV is $2149 USD from both Supplier #2 and Supplier $33, both of which ship internationally. Use this to compare to your costs locally in AU.