Juniper's questions

[stevew168]

The bottom line is that you will never get good results with the apap you are using. Since you have mostly central apneas, the best you can do is to reduce them somewhat. What you need is an ASV. Until you can get one, (assiming you don't have serious heart failure) you will have sub-optimal treatment.

What I did to get an ASV is to make an appointment with the registered sleep tech that supervises the sleep lab where I had my sleep study, since my the sleep doctor does not make appointments with new patients. She got me a brief consultation with the sleep specialist, since he comes in to do prescriptions from sleep studies. Since OSCAR showed I sometimes had CSR, he wrote a new prescription based on that, and I got my ASV a few days later.

[UnicornRider]

I was thinking about trying a lower minimum. But as I look over my history, my AHI  has been up and down and doesn't seem to correlate exactly to my pressure. For that matter, my CAs don't exactly correlate to my pressure either. 

 

 There are nights with Flow Limits that coincide with some of your CA Event Flags. Therefore some nights with higher CA incidents most likely are Positional apnea masquerading as CA events. Look for clusters of events. No relation to pressure setting.

       https://www.apneaboard.com/wiki/index.ph...onal_Apnea

   Try to become more aware of possible positional apnea.


  I hope this helps.

[stevew168]

 

 There are nights with Flow Limits that coincide with some of your CA Event Flags. Therefore some nights with higher CA incidents most likely are Positional apnea masquerading as CA events. Look for clusters of events. No relation to pressure setting.

If the central apneas are mischaracterized, and are actually obstructive apneas, why is the flow obstruction not 1? If the flow restriction is less than 0.25 for example, why is it not a hypopnea rather than an apnea?

[juniper]

The bottom line is that you will never get good results with the apap you are using. Since you have mostly central apneas, the best you can do is to reduce them somewhat. 

Thank you. So, an airsense 11 is an APA, not a CPAP.  (See how little I know!) Or wait, an APAP is a kind of CPAP. I think that's it, right?

[juniper]

If the central apneas are mischaracterized, and are actually obstructive apneas, why is the flow obstruction not 1? If the flow restriction is less than 0.25 for example, why is it not a hypopnea rather than an apnea?

This is where I get lost, but I am very interested in the discussion, as much as I can understand, as long as no one expects me to get into the weeds with them.

It's like a Catch 22. You need an awake and functioning brain to get your CPAP to to work for you, but you can't get get an awake and functioning brain until you get your CPAP to work for you.

[juniper]

 

 There are nights with Flow Limits that coincide with some of your CA Event Flags. Therefore some nights with higher CA incidents most likely are Positional apnea masquerading as CA events. Look for clusters of events. No relation to pressure setting.

       https://www.apneaboard.com/wiki/index.ph...onal_Apnea

Thanks, I've seen that article. I have an ergonomic pillow with a deep spot for back sleeping and high edges for side sleeping. I tried a cervical collar once. I could not imagine how someone could sleep with one. Perhaps the pillow and the collar interfered with each other in some way. So, what I am using is my pillow and tape.

[stevew168]

Thank you. So, an airsense 11 is an APA, not a CPAP.  (See how little I know!) Or wait, an APAP is a kind of CPAP. I think that's it, right?

Continuous positive airway pressure (CPAP) machines release pressurized air at a nearly steady rate throughout the night. In comparison, auto-adjusting positive airway pressure (APAP or auto-CPAP) machines continually adjust the pressure of air based on what the device determines the sleeper needs in a given moment.

ASV (Adaptive Servo Ventilation) adjusts the pressure breath-by-breath in order to maintain a target minute ventilation, along with a backup respiratory rate, in order to prevent central apneas. It also helps prevent obstructive apneas and hypopneas.

[juniper]

Since I had no centrals in my sleep study, isn't it likely I will eventually be able to figure out the right settings to get rid of them and not need an ASV? My AHI hovers above and below 5. My insurance/provider will probably not think I need an ASV. People have much worse numbers than I have.

[stevew168]

I don't know what cutoff for AHI with your insurance,but almost all of the records you posted show much more central apneas compared to all apneas and hypopneas (AHI).For example, Medicare covers ASV if your sleep study shows you have 50% or more central apneas compared to total apneas. If you have significant CSR and you can show OSCAR or other evidence, you can probably get a prescription for ASV like I did. The 50% or more centrals is not required. I believe you must to have tried an cpap or apap device for at least 3 months without success as well to get an upgrade.That is how I got my ASV.

This is a quote for Medicare:

AHI/RDI3 is ≥ 15 events per hour with a minimum of 30 events; or, b. AHI/RDI is ≥ 5 and ≤ 14 events per hour with a minimum of 10 events and documentation of excessive daytime sleepiness, impaired cognition, mood disorders, insomnia, hypertension, ischemic heart disease or history of stroke.

[juniper]

Very helpful, thanks. So I need to contact my provider and document these problems in case I ever need an ASV. Will do. 

My centrals are way more than 50%. I move from around 3 to 8 for AHI in what looks to me a random manner. 

Thing is, I didn't get the centrals until I was on the CPAP. I had none in my study.