Hypopneas vs Centrals – How to Optimize?

[Sleeprider]

To add just a little to bonjour. You have poor efficacy with CPAP and going to bilevel would not be hard at all through your doctor and insurance, in part because you have COPD. If your insurance is pretty good, this is a good option, but remember you will fail bilevel with central events. It's a good time to have a candid conversation with your doctor letting him know the problems you are experiencing and asking his opinion on the best way to proceed. Your combination of flow limitations, hypopnea and RERA reaaly need pressure support from bilevel to resolve. Your complication of central apnea and periodic breathing when any pressure support is present is only resolved by ASV, and that would be the ideal solution. As Bonjour suggests above, EERS is a possible alternative. One last question, do you live at a higher altitude?

[optimalsleep]

Your complication of central apnea and periodic breathing when any pressure support is present is only resolved by ASV, and that would be the ideal solution.

I strongly agree.....

[sheepless]

I'll take a stab at interpreting your ca and h. I think you asked about the h, in particular. take this with a grain of salt because I'm no expert; just been around AB a few years.

imo the ca were real and the h was obstructive.

[jeffwpb]

Thanks Fred for the options.  For the short term, I will use CPAP at 8/0, that's all I can do right now.  Sounds like the VAuto may work or may not work, depending on settings, so there is uncertainty in my mind about whether I will end up in the same place anyway and need the ASV.  I think it would rather put that money towards an ASV which sounds like the better choice.   But ASV seems to be a serious undertaking with a lot of settings I have no idea about.  I read somewhere about heart issues that may preclude use, but that may not be valid now.  While I am asymptomatic for heart issues, I did have a calcium scan 2 years ago (doctor wanted to convince me to take a statin) and learned that my Agatson score is >500, so I will need to sort that out before committing to ASV I think.  Money is not the issue for the ASV, or for a VAuto for that matter, as I mentioned I can buy it myself without the dance with the DMEs. To Sleepriders suggestion, I will contact my doctor and see what she says about all this.  Intrigued by EERS, so I will do some more homework on that to see what it entails.  If it is simple to test, I may just do that to see whether it has any impact.  If anyone can point to a place to learn more that would be great.   Sleeprider, I live in Central Ohio, so high elevation is not an issue.  I am also wondering about your comment about COPD.  I don't have that, at least I don't think I do, did you get that from the data I showed?  Thanks to all of you for all the insights! Jeff

[Gideon]

EERS http://www.apneaboard.com/wiki/index.php...ace_(EERS)
Basically you block the mask vent on a mask, attach a length of coraflex tubing (6,12,or 18 inches) add a new vent, attach to CPAP hose. The different lengths are how you adjust how much you rebreathe.  coraflex comes in long lengths that you cut at 6 inch intervals. so you need 3 feet min of the coraflex.

[jaswilliams]

Jeffwpb

The ASV settings on a Resmed are a doddle it’s fully automatic and does a great job. You just need a prescription or find one on a site such as dotmed who have a Resmed S9 Vpap adapt for $150 you would need to add a humidifier and heated hose but a great starting point for self treatment the supplier ems supply is reliable as I have purchased two machines from them exactly as described.

[SarcasticDave94]

Scratching info about COPD...