Newbie, reaching out for some help here!

[Wheel357]

Hello, a year ago I had a "mild" stroke from Afib event apparently triggered by apnea. Since that time I got proactive and bought a mandible positioning device while waiting for a sleep study. My first sleep study shows "severe apnea." I asked for a second study to determine if the mouth device was working, as it seemed to be a positive at that point. The second study indicated worse apnea with the device than without. I then bought a pulse oximeter to monitor my 02 saturation levels, to prove to myself whether or not the study was accurate and wake me before my desaturation gets to dangerous levels. Sure enough I was able to confirm those indications. While waiting for a third study to determine CPAP needs I have been able to confirm sleep positions for me that exacerbate my apnea events as measured by oximeter where sleeping on my right side tends to be best at saturations of 88 or higher and any other will result in levels of 72, left side being worst of all.
   SO, the results came back and the doctor asked for more time to review them. I am told my apneas require high pressures to control and he MAY see the need for ASV therapy. Now, this doctor does little to instill confidence in him but so far any results he gives I have been able to confirm to be true. I specifically asked after my previous studies if there may be a central apnea component going on and was told there was not. My study with CPAP was successful in my opinion, I slept very well and had a vivid dream state, unusual for me. My question is, what should I accept for my first machine when he tells me he won't prescribe a BIPAP or ASV for my condition even though he says I likely need it? So far he will not give more than general opinions on course of action and I need to get a plan in place to deal with the problem regardless of the lack of confidence I feel with this doctor!

[Melman]

Welcome to the forum. If you can't get a BIPAP or ASV the best machine is the Resmed Airsense 10 Autoset or Resmed Airsense 11 Autoset. Be sure to specify autoset as there are several Resmed airsense 10 and airsense 11 models. The airsense 11 is the newest model but it is functionally equivalent to the airsense 10.  Request a copy of your most recent sleep study and post it here with your personal information redacted. We will then be better able to advise you.

[staceyburke]

If it is a bi level you want a resmed s10 Vauto or resmed s10 ASV. And I completely agree with the resmed s10 or s11 AUTOSET if it is a cpap.

[SarcasticDave94]

Agreed with Melman and Stacey. The correct machine choice depends on the test results. The brand will be ResMed regardless. Get your results posted and we'll help you know the best answer.

[WakeUpTime]

The differences between BiPAP and ASV are significant.  They shouldn't be seen as levels of "better".  That was a mistake I made for years.  As SarcasticDave94 has mentioned in the past, for someone with Central Apneas, a BiPAP may actually make the condition worse.  I used a (Philips) BiPAP for years, assuming it was a best balance for xPAP tolerance and minimizing my AHI.  I switched to a regular APAP (AirSense 10 AutoSet) and saw my centrals significantly reduced so that I don't need to consider an ASV.  That device also has pressure relief, but I've found that keeping it minimal provides the best "sweet spot" of minimizing my AHI.  Lastly, ResMed's AutoSet sleep algorithms are an amazing improvement for me, over the Philips algorithms.  I'd describe the ResMed algorithms them as highly intelligent, responsive and effective - unless Philips has significantly updated their sleep algorithms on more recent DreamStation devices.

[Wheel357]

Thank you for the replies, maybe there is hope for this sense of helplessness I have with the study process so far. I requested a copy of my study reports today and they emailed them to me. Study one and 2 are one page dissertations that I have severe apnea. Study 1 lists my AHI 50 with frequent desaturations. Study 2 showed a deterioration of all markers with oral appliance in place AHI 72.5 and deeper desaturation levels. Study 3 is the real deal with CPAP test. It shows central apneas of 50, obstructive of 77 mixed at 0, hypopneas at 140, central hypopneas 0. As soon as I figure out how to post this report onto here, I will be happy to do so. This report is 11 pages long and if you guys can tell me the critical information needed to understand the issues I will try to narrow it down as required? The test started CPAP at pressures from 5 thru 15 they switched to BIPAP pressures at 17/13 and ended at 24/20.

[Sleeprider]

Wheel357, ask your doctor for detail results of your studies. It will help you to understand the types of events (obstructive, hypopnea, central, arousal) and the sleep stage and body positions that are a problem. If you have any of those studies, please redact personal information and post it. An 11 page report may be best to post from a dropbox account with a public link. Our attachment limit is 1-MB per attachment, so if you want to post it that way, you may need to break it up. See the link in my signature on attaching files. The forum automatically limits your ability to post external links until you convert to a regular member at 4-posts. Feel free to drop me a PM if you host the page on dropbox, or just make a couple more posts.

[Ratchick]

With that amount of centrals, I would be leaning to ASV... but definitely post that report as soon as you can, so we can see what happened at different pressures etc during the titration.

[Wheel357]

Thank you. I have the report.redacted it and slimmed it down to the most relevant pages. As soon as the posting requirement is reached and I can post it to the forum I will. This one should be 3!

[Wheel357]

The sleep doctor seemed to be of 2 minds on the ASV or bipap. At that point he told me he would not give me a referral for any specific therapy type, asked for more time to review the file and hung up. There is no doubt sleeping in ANY position except the right side is a no no for me. I don't move around much when sleeping and this study was done sleeping on my back. Since that time my personal experimentation has shown NOT to do so. The data files will be uploaded as soon as the post limit will allow me to do so.