How concerned should I be about the length of these Centrals?

[LookingForward]

I'm still in process of waiting for the results of last sleep study. It's been three weeks since the test. I haven't heard anything. I'm transitioning from an AirCurve 10 VAuto to and ASV machine because of a crazy amount of centrals. In the last week, I've had two nights where I had a central that lasted nearly a full minute, take a few short breaths then right into another 39 second central then right into two more long centrals. In the picture it shows that first central to be broken into two but I don't see an actual breath in between the two so the total length of the two combined is 54 seconds. I called my insurance today just to make sure they haven't received a request for the approval of the ASV machine and was told no. They also said that if the doctor doesn't put urgent on it that it can possibly take up to a month for them to approve. Then of course I have to wait for the DME to do their part and order the machine. How concerned should I be about the length of the centrals?

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[Matt00926]

I am not sure if you have a thread/post history on here where others have discussed your therapy with you, but have you tried lessening the pressure support (difference between IPAP and EPAP)? It doesn't seem you have any OSA events aside from central apneas. For some people pressure support can cause centrals that otherwise wouldn't have happened.

[LookingForward]

Yes, I do have another thread and probably should have posted it on there. I think this will post the link: http://www.apneaboard.com/forums/Thread-...ice-needed

SleepRider has made some good suggestions and I am able to reduce the centrals but not eliminate them. At his suggestion of the lower pressure, after a few nights I just was feeling starved for air. 

I also have difficult doctor who doesn't appreciate me learning all that I'm learning on here and was really upset with me for thinking I should change my pressure settings and wasn't happy that I could find a program like Sleepyhead and see for myself what was going on. Maybe I'm wrong but I was concerned that the doctor would just totally stop cooperating with me if I made any adjustments, so I switched it back to what the sleep study showed. 

I feel like after I get the ASV then I probably won't care much if the doctor gets upset. He isn't looking at the data on his own anyway. I did still show the need for the ASV even on lower pressure though so thought I better not rock the boat too much until I get the correct machine. 

Am I wrong about that?

Moderators, if I should have added this into the original thread, please feel free to move it. I just thought I could get a quicker answer to my question this way.

[Sleeprider]

Wow! You're right back where we started because your doctor is an egotistical a**h*le. Is this medical diva actually talking about scheduling youmfor ASV titration? It seems the least he can do for subjecting you to this pain

If you are going to continue to follow his advise, at least get a recording oximeter so this guy doesn't do you permanent harm Supplier #19 is a good source. If your SpO2 is near 88% more than 5 minutes per night, you need to get appropriate treatment and a doctor that gives a sh*t about your health rather than his wallet. Your respiration rate is down to 10.8 with clusters of CA of long duration. I'm worried about you. Why isn't your doctor?

[SarcasticDave94]

Time to put the machine at settings that help for the right now rather immediately. Meaning whatever Sleeprider had helped you obtain with the current device. And that means ONLY until you get an ASV.

I have zero authority to order you around, but let the Duck doc take a flying leap anywhere if he/she has hurt feelings for your taking charge of what's best for you the patient. Change those settings!

Prepare yourself to fire this self-centered primadona Duck. He/she only cares about themself, certainly not YOU the patient.

FWIW I had a nice 90 second Central event that Sleeprider pointed out to me on my PSG test on the BPAP level, which was part of my evidence for pushing to get the ASV.

Best wishes on successes and for the fortitude to do what's best for YOU.

[LookingForward]

I did have the Titration test for the ASV machine three weeks ago, on October 24. My pulmonary/sleep doctor is the one who is supposed to read the results and get back to me. I haven't heard a word. He did admit at my appointment in September, when I took in my printed Sleepyhead pages that I was hypoventilating because of the centrals and said that he would order the titration for the ASV. Since then I haven't heard a word from him. He has been upset with me for learning all that I have and not just taking his word for everything. He was not happy that a program like Sleepyhead exists and I knew how to use it and could see for myself what was happening. So I was concerned about contacting him about the titration results and getting the process of insurance approval started for the ASV. But with Thanksgiving next week, that's going to lengthen the time that the insurance will approve the new machine. My doctor also isn't the least bit interested in me trying to get another appointment with him until I'm in that 31 days to 90 days range of medicare requirement to see him.

I don't know what to change the settings to and not feel starved for air while I wait. I have gone back and forth in wanting to dump the doctor but didn't want to have to find a new doctor, wait for that first appointment and hope that I've found one that will help me. It seems to wait on my current doctor is still going to be faster. And that getting the ASV faster even though I have to put up with him is still the best option.

And I do have a Oximeter but I may need to wait until tomorrow night to try it. I don't think it's charged right now.  If you want to make a suggestion for a change in setting for tonight, I will change it. Thanks so much for the help.

After I get the new ASV machine, I doubt I'll ask this doctor for help at all. I'll be asking all of you to help tweak the settings and not involve the doctor.

This is another recent night of very long centrals. I think this is worse than the first pictures. I did have more leaks but the length and amount of the centrals is really bad.

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[Sleeprider]

There Is no reason not to contact his office and remind them you are experiencing a very high level of central apnea, are uncomfortable, snd concerned this is endangering your health. Request/demand the prescription. You should call daily until they do something. If they don't respond to appropriately treat you in a reasonable time, hire a malpractice attorney and watch how fast that changes. This kind of behavior and neglect is subject to discipline by the Ohio State Medical Board. You have rights, and this doctor should not bully you for rightfully engaging in your own treatment when it can be proven a more effective approach can be implemented.

There is no reason to use an ineffective pressure prescription. Change it to what works best for you. This is a bridge to ASV, not a cure, but you must minimize these apnea. The test is in and you need ASV. I strongly recommend you consult an attorney. It won't cost anything and will inform you of your options.

[SarcasticDave94]

There Is no reason not to contact his office and remind them you are experiencing a very high level of central apnea, are uncomfortable, snd concerned this is endangering your health.  Request/demand the prescription.  You should call daily until they do something.  If they don't respond to appropriately treat you in a reasonable time, hire a malpractice attorney and watch how fast that changes.  This kind of behavior and neglect is subject to discipline by the Ohio State Medical Board.  You have rights, and this doctor should not bully you for rightfully engaging in your own treatment when it can be proven a more effective approach can be implemented.

There is no reason to use an ineffective pressure prescription. Change it to what works best for you.  This is a bridge to ASV, not a cure, but you must minimize these apnea. The test is in and you need ASV.  I strongly recommend you consult an attorney.  It won't cost anything and will inform you of your options.

I agree with this.

FWIW to LookingForward, your comments and sentiment on not changing the doc till the ASV path finalizes, I found myself in that exact circumstance just over 1 year ago. I did stick with that doc, but I did the calling DAILY to the doc, the insurance, and/or the DME. Yes, literally, EVERY SINGLE DAY. I did get through finally to their thick heads and I do now have the ASV. Believe it or not, the insurance was advocating for me. The CS reps placed urgent/expedited flags on my file status for everything involving the pre-auth on to finalization stages. NO sarcasm, the insurance really did help me a lot.

Sincere best success. Prepare for more stress, but get on the phone and persuade these 3 to help you.
Somehow the phrase "abandonment of the patient" may apply in some form IMO.

[SarcasticDave94]

BTW if you're interested, here's my thread on the ASV path.

READ IF YOU WISH BY CLICKING HERE

[LookingForward]

BTW if you're interested, here's my thread on the ASV path.

READ IF YOU WISH BY CLICKING HERE

Thanks for the comments everyone. I will read your journey, Dave. I need all the help I can get to start making these phone calls tomorrow. As for tonight, I think I'm going to take Sleeprider's suggestion and change my settings this way from my original thread "BiLevel Machine...Advise needed" post #25:

"Personally, I think you could do very well in Vauto mode at EPAP min 9.0, PS 4.0 and IPAP max 16.0."