[Diagnosis] Questioning CPAP when experiencing proportion CA events

[Aussie Lee]

Hi
Only recently diagnosed and about to have first appointment with sleep technician after my at home sleep study. 
I am in Australia.
Sleep physician has diagnosed severe apnea
AHI 61
Average apnea/hypopnea length 32.9 sec (full reort attached)

But when looking at the respiratory events graph there is a significant proportion of CA events with a majority of OA events.

I'm questioning the recommendation for a CPAP trial rather than BIPAP due to the CA Events. 

What are your thoughts and recommendations? 

Many thanks
Leonie

[SorryIamNormal]

Please see this post:

http://www.apneaboard.com/forums/Thread-...#pid324189

My advice is to just buy the bipap machine yourself.

[Aussie Lee]

Study report attached

[sheepless]

although vauto has a couple settings apap doesn't have that seem to help with ca, it's my understanding that only asv is designed to treat ca & mixed apnea. if you had significant ca in your sleep study then you might need asv. if you are experiencing pressure induced treatment emergent ca, which is quite common, it'll dissipate in time.

[Aussie Lee]

Thanks SorryIAmNormal for the reply but as i live in Australia and I presume don't have the USA insurance issues of having to trial CPAP first before bpap. 

 I am confused that the doctor recommend CPAP when i believe he is free to recommend whatever therapy is required.

Or are we also subject in Australia to this graduated approach to machine selection and therapy escalation?

If this is the case then it seems absurd to me

[Aussie Lee]

Thanks Sleepless
I'm extremely new to all this and still learning all the terms

So what you are saying in effect is that given the study results I would be better served with an a s v machine

Well that opens up another can of worms?

Looks like I've got a whole heap of new study ahead of me

[SarcasticDave94]

I didn't see the event counts breakdown for OA vs CA, and as I'm US, my take may not count for you in Aussie, but for me to get ASV I had to have 50% or more CA events. My example is my numbers were 124 CA to 24 OA.

Again based in US, most insurances want to see CPAP BPAP and maybe ST machine fails before ASV.

[sheepless]

I hadn't seen your study before postiing. the first one you posted (page 2?) is out of focus so it's hard to read but appears to show a fair number of central apnea,. fewer than obstructive apnea, though, if I'm reading it correctly. it's fair to ask your doctor what they expect to do about the centrals. typically, at least in the US, if after 1 - 3 months they don't subside with cpap/apap, you can make a case for a different modality that will help. if you're lucky (and need a different machine, an open question at this point), your doctor will listen to your appeal for better treatment, but right or wrong, it's very common for almost everyone to start on cpap or apap.

[Aussie Lee]

I didn't see the event counts breakdown for OA vs CA, and as I'm US, my take may not count for you in Aussie, but for me to get ASV I had to have 50% or more CA events. My example is my numbers were 124 CA to 24 OA.

Again based in US, most insurances want to see CPAP BPAP and maybe ST machine 

From my guesstimation looking at the sleep study graphs I'm experiencing 70% OA and 30% CA


Other Aussies might be able to enlighten me further but it is my understanding that we don't have to go through the escalation of trials that our friends in the US do.
Insurance only provides a small portion of the cost in Australia unless we are on a pension or benefits where the machines are provided free of charge.
Unfortunately I don't fall into that category and so will be paying for it myself.

[Aussie Lee]

I hadn't seen your study before postiing.  the first one you posted (page 2?) is out of focus so it's hard to read but appears to show a fair number of central apnea,.  fewer than obstructive apnea, though, if I'm reading it correctly.  it's fair to ask your doctor what they expect to do about the centrals.  typically, at least in the US, if after 1 - 3 months they don't subside with cpap/apap, you can make a case for a different modality that will help.  if you're lucky (and need a different machine, an open question at this point), your doctor will listen to your appeal for better treatment, but right or wrong, it's very common for almost everyone to start on cpap or apap.

Thanks again Sleepless,

I appreciate your insight 
. 
While I've read the wiki on machine selection I'm confused as to which asv machine to choose should i be offed one.  The wiki doesn't seem to be clear on this. 

As I'm purchasing the machine myself... with very little subsidy from health insurance...i want to get this right at that get go. 
Do you have a recommendation!?