New user- 2 week CPAC results + sleep study

[kiwi man]

Thanks for the clarification Bonjour. I really appreciate your advice



OA   3
H   84
CA 20

"This means that a bunch you apnea is idiopathic (unknown cause) centrals" is this comment referring to the H 84? what is the difference between a central? and unknown cause central? is my H definitely related to centrals?

[Gideon]

"Thanks for the clarification Bonjour. 



OA   3
H   84
CA 20

"This means that a bunch your apnea is idiopathic (unknown cause) centrals"  Are you taking any drugs, especially opiiods or nerve or muscular drugs, any strokes or seizures? CHF?
is this comment referring to the H 84? No
what is the difference between a central? A central is where you make no effort to breathe from any cause.
and unknown cause central? Simply that we do not know the reason.
is my H definitely related to centrals? Unknown, they are commonly obstructive in nature, Sleep Labs simply do not6 score Central Hypopneas and lacking that they are assumed to be all obstructive.  That is likely to not be the case.  By a very careful and detailed eveluation of the flow rate chart on a breath by breath basis for the entire night we might be able to determine that some are but seriously without the setup that a sleep lab has, with breathing indicators built synched into the charts it is very difficult. 

[SarcasticDave94]

My serious take on this is IF your CPAP isn’t the right machine:

Step 1) AB members will do everything possible to read your data and assist you with editing the settings on whatever machine you’re using now. It might be successful, but given the sleep study info it’s possible your success would be limited. Successful then you stop here. Not successful you move on.

Probable step 2) If you do fail to gain acceptable treatment results on this machine, you will most likely be required to do it all again with a bi-level machine. Include board assist in chart readings and edit settings suggestions. Successful then you stop here. Not successful you move on.

Possible step 3) From bi-level you may now do all things over yet again on either an ST or ASV. This stage depends partly on the doctors involved and if/when you take a LVEF test which involves an echocardiogram, an ultrasound of the chest and heart. Results of this will include evaluation from a cardiologist and grading of that LVEF as a percentage, 45% or higher equals a pass for ASV allowance. Note if you’re bad enough with heart issues to be unable to pass the LVEF you’ll know by being pretty bad off. Some doctors and/or insurance may require ST machine here. Include board assist in chart readings and edit settings suggestions. Acceptable results stop here. Unacceptable move on.

Possibly step 4) this step exists if step 3 was an ST machine issuance. If said ST and Apnea Board assist results in failing to medically treat, here’s the ASV.

Crazy and rather insane to think what torture some of us go through to get the best and correct machine for getting the right treatment. May whatever you face be as easy as possible. We’re here to help. I personally did the above minus the the ST stuff. At the bi-level part I discussed ASV without mentioning ST on purpose.

[kiwi man]

Sarcastic and Bonjour that is some excellent information!

I see the sleep doc again tomorrow and thanks to many of you, I will go in a lot more educated and ready with some questions.

[kiwi man]

Hey All,

My AHI pre-CPAP was 12, with CPAP it is consistently 8, so according to the CPAP machines results haven't been great.

I did a Pulse oximetry test with a CPAP on Monday night. Results attached.

The sleep specialist said basically the CPAP machine is reading incorrectly and the Pulse oximetry before and after clearly shows a large benefit.

I have 1.5 weeks left on the sleep trial. Sleep specialist basically says it's working and I can choose to keep the machine afterwards or not, it's up to me.  She did raise the pressure a little bit yesterday.

Is there any reason to believe what the sleep specialist is telling me? i asked a similar questions before the Pulse oximetry test and many of you said that test isn't the conclusive. Anyway, I thought I would post the results. Seems like the sleep specialist is basically telling me to like it or lump it- she is done with trying to affect the AHI readings on the CPAP, she doesnt even seem to view them as important.

Thanks,
Kris.

[Gideon]

After reviewing your before and after studies there is a considerable improvement in your desats.  If it were me I would continue your treatment but . . . 

There is evidence that you originally, pre-treatment, had 25% of your measured breaths had Flow Limits.  That is a lot.  That stat alone tells me that you should continue treatment.

The but is that IMHO you have the wrong machine.  The ResMed equivalent of your machine, the AutoSet would be a much better machine for you because it would better manage your obstructive events such as the flow limits.

You know I was considering the possibility of an ASV machine. Tell your doctor that you would like to continue treatment but you would like to try a different machine.  Ask your doctor if you could trial a ResMed ASV machine,  That you have had consistently high Central Apnea and based on that you expect your hypopneas to be approximately 50% centrals.  That you read that an ASV can resolve your central apnea.

[kiwi man]

Thanks for the info again Bonjour! You have given me a lot of information to go-away and research. I don't understand flow limits but I will certainly look into that and thank you for your advice on the ASV machine- it certainly sounds like a good option if I can convince the sleep therapist.

Thanks!

[Sleeprider]

The pauses in your breathing are real and can be confirmed and viewed by zooming in on the flow rate chart where the events occur. You can see the flow line goes flat, which means no air is moving and you can see the duration. The machine is not mis-reporting the data, your sleep therapist is trying to convince you CPAP is good enough because that makes his job easier than recommending ASV, which the government does not want to pay for. The fact is you had CA events before CPAP, and CPAP does not treat CA. So logically, you will continue to experience CA, and your Auto CPAP will not increase pressure to treat obstructive events because the algorithm is designed not to increase pressure in the presence of central events, because higher pressure will make those worse. So you continue to have CA, and your obstructive apnea and hypopnea are not adequately treated. You need ASV which will treat obstructive events with enough EPAP pressure to maintain your airway, and will adaptively apply pressure support to maintain your breathing rate and volume to prevent CA and hypopnea.

[pholynyk]

My DME has said, and I have confirmed, that ASV is not included in the Ontario government ADP for breathing devices. It's quite possible that the doc isn't even considering ASV because the government doesn't mention it. You and your insurance company will bear the full cost of an ASV machine.