Little Olive - Therapy Adventure

[UnicornRider]

I believe Steve may be correct, you could very well end up on an ASV. 

 That being based on me not being cognizant of NZ national health care system, but it would explain the letter your sleep clinic sent with referral to the cardiac assessment and follow up with referral to Respiratory and Sleep Services. They want to ensure there are no underlying Cardiac issues that could be aggravated by the *PAP you finally end up with. While the Respiratory and Sleep Services will most likely review how your ResMed AirSense 10 AutoSet performed in all of the various modes as well as your cardiac and previous health reports. then hopefully they will Titrate to determine which model of machine and which mode and settings best suits your needs.

https://www.apneaboard.com/wiki/index.php?title=Prescription_-_CPAP_-_APAP_-_BIPAP

 Our ApneaBoard Wiki could use an update for the New Zealand Health Care approach to CPAP . I hope, between this thread and your personal experience, you will feel qualified to provide an update to the WIKI to cover New Zealand so that other new users will have a path to follow.  Should you undertake such an assignment, your efforts will be well rewarded recognized.

https://www.apneaboard.com/wiki/index.php?title=New_to_CPAP_%E2%80%93_The_Process

Please read the links, perhaps it will help some, and you will recognize our need for Your input.

It will also help you to prepare some questions to post here on the board, so you go into the follow up referrals more knowledgeable than you were before.

As always, any questions, concerns or comments, please post back.

[Little Olive]

    Hi All,  I've had a bit of a meltdown over feelong so bad, and  although have been looking at Oscar, have taken a break from worrying over how things are going.  Thanks everyone for the latest comments, that I failed to respond it, sorry..

OK  I have looked at getting the oximeter that will record my night oxygen, but all the sales are from online places I am not familiar with. I'd rather purchase more expensive items from a familiar retailer. But I'm still looking. 

I think I have worked out how to do a zoom, so I will add one on my last Oscar today and hope it's good enough to see some detail. 

I am happy to provide some info on the NZ health system with regard to sleep apnea.  And following on from that, I still have not received a date to see the respiratory services.  I was told on the phone that my referral will be triaged as follows:  Urgent - to be seen within a month, Sermi-urgent within 3 months and Routine up to 6 months.  So when I see them will depend on how they triage my referral. 

Above is the fairly good night

[Little Olive]

Here is the fairly bad night

[Little Olive]

And here is the Ugly

[Little Olive]

Last night it looks like pressure topped out at my set max of 14.6 so I guess Id better raise it to 15 ? Re the other changes from last week, they did not go well, so I tried to do them one at a rtime instead of all at once, but I ended up back at 6.6 min and 14.6 max., and that at least felt comfortable but still having a lot of centrals. As for if I will be given an ASV, at this stage I have no idea. But when I see the guys at the respiratory department, I will certainly discuss with them.

I hope you are all doing OK !

[UnicornRider]

I know you are seeking a Pulse/Oximeter so I would like to refer you to the product review section of the forum. Ratchick is a forum member who is highly dependant upon her Oximeter. She has reviewed several different models. I utilize the Wellue "Checkme O2 Max", we actually have and read 4 each of the "Checkme O2 Max" daily. Our household got hit by a nasty respiratory illness last September, as a result my mom ended up on supplemental Oxygen, the other three of us, because we could respond to the audible and vibratory alarms by hyperventilating, were suggested not to start on O2 unless it is absolutely necessary. Although we all tested negative for Covid, Flu and RSV, the medical staff suggested it may take 6, maybe 9 months, possibly as long as a year to fully recover. It has been 8 months and although we have greatly improved, we still need the prompting that the alarms provide.

      Back to Ratchick, she did a very good review of the "Checkme O2", then got the newer "Checkme O2 Max", I will let you read the the review starting with post #9, you can go back and read from the start of the thread to get a fair comparison of the earlier model "Checkme O2" with the Contex CMS50F.

   https://www.apneaboard.com/forums/Thread...#pid427997

You are wise to hold out until you can afford to purchase the best you can, If you go with the Wellue "Checkme O2 Max" actually any of the brands Amazon has a very good return policy and if you get a non responsive vendor, Amazon will make it right or make the vendor respond.

   I have had good luck getting Wellue to respond to issues I have had. I should add my experiences to that thread.
I need to attend to my Minions, they are starting to revolt.

I will review and respond to your charts later.

[Little Olive]

Thank you,. Wow that sounds like a really bad infection you  all had. There are so many bad bugs around.  I never leave the house without a mask these days for fear of respiratory bugs. A reason I dont like going out now is that it would mean wearing a mask in the day and a mask all night as well.

 Looks like I cant buy that model of wellue on Amazon, as they only ship to NZ from Amazon Australia.  There is the wellue ring model, ....is that worthwhile?  I can also buy that locally. 

Not great last night, Looks like the mask pressure crashed and I wasn't getting enough air, because the cheyne-stokes bogeyman visited me.    I find it scary, that this happens without the supplemental air when sleeping.   In my sleep study without the air, I had 89% cheyne-stokes ,nonstop pretty much all night, for 7 1/2 hours. Another reason to persevere with therapy.

[UnicornRider]

  I was told on the phone that my referral will be triaged as follows:  Urgent - to be seen within a month, Sermi-urgent within 3 months and Routine up to 6 months.  So when I see them will depend on how they triage my referral. 

   
    Will you be able to look up online what criteria they use to establish the different levels of triage, especially with O2 Desaturations?

     It could put an "Urgent" status on your case if you have a  recording Pulse/oximeter that shows the level of desaturation being serious. Your "Sleep Study" did not put a % measurement on your SpO2 Drop, but the bar graph did appear to be well occupied.

   That very well could be the key to getting you into the Sleep/Respiratory Center quicker.

                        The OSCAR Reports you posted, "The Good", "The Bad" & "The Ugly"! ( Que in some Spaghetti Western Music)
  Any time I see clusters of events, especially when they include different categories of events, CA, OA, UA, & H,  and they are inconsistent from night to night, I have to think positional. Looking at "The Good" you can see Flow Limits driving pressure across the night especially when you get to ~0540. 

     Raising your upper pressure limit may not help because it is very difficult to blow through the obstructions with pressure. 
 
   EPR does tend to increase your CA events, as it tends to wash out more CO2 from your lungs, we do use EPR to reduce Flow Limits, so reducing EPR may reduce the occurrence of some CA events, at the risk of driving your pressure up in APAP mode in response to Flow Limits. 

     If you want, you could try reducing EPR in the APAP mode at your current pressure settings, then after recording several OSCAR Reports at variations (EPR 2 & EPR 1) you could transition to a simulated CPAP mode( EPAP = IPAP) to try constant pressure with various EPR settings, Then try straight CPAP mode no EPR.

   Meanwhile documenting everything in OSCAR. So with this in mind, keep a file of the Bad & Ugly. Before your meetings with medical staff print out a few OSCAR Reports at different settings & modes to take in with you.

   With a different model of ResMed, (VAuto or ASV)  you would have timing and tuning features to tweek thus bringing the relief you need. With corrected position of course.

   I hope this outlines a plan of attack (Que in more Spaghetti Western Music)

     for when you go in to see the medical staff.

    Your documentation and updating the Wiki could expidite access for future NZ *PAP users.

  Take care

[UnicornRider]

If you can purchase the Wellue Ring model locally, could they special order a Wellue "Checkme O2 Max" for you?

I do not know all of the capabilities of the Ring O2 monitor, The 72 hour long battery life, 10 hour roll over recording sessions with 4 each sessions, remote bluetooth monitoring with IPhone were all selling points for us in addition to the shared wellue features. Your needs will dictate which features are desired.

For now, the printable documentation of Wellue's " O2 Insight Pro" software, ability to import to OSCAR, and OSCAR Report printability and documenting your sleep session are primary importance. So the Ring O2 may be the one to satisfy your needs.

The replaceability of the sensor ring was a big selling point for us, because we knew it would be a long haul before we were weaned off of the Alarms it provides. I do not think the sensor is replaceable in the Ring O2. I think I do remember "Uncle Nick" saying something about the Ring being the only model available in the land of OZ.

  Wearing Masks day and night does add a bit of thrill to "Date Night" 

[UnicornRider]

Here is a Wiki article that will help, although it is geared towards the American Medicare system. It does contain the "Key words and tricky phrases" medical personnel will be looking for during triage and follow up. I am sure you have experienced most of them.

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

Besure to put all CSR documented Oscar Reports into your "Bad & Ugly" folder to print out for your appointments, and make a list of all of the symptoms you have experienced, to carry with you. You can leave printed material with the medical staff, it will be better than trying to remember off the top of your head, and augment their written notes more in-depth.

You want to stress the worst nights on your curren machine, forget the good nights.