Obst & Central Apnea - on ASV. why do most say- resmed vs dreamstation auto sv?

[Sleeprider]

What are you targeting for free testosterone with the gel? I would avoid very high doses, and consider a more normal level to be close to 500, especially for older men (50s 60s). It's pretty easy to cut back.

[My3rd3y3]

Trust me my Endocrinologist,  while a nice lady she definitely wont let me get too high of a dose lol.   

I am only 42 years old.  When I started this venture back in march my numbers looked lower then most women and 90 year old men,  i even started knitting :-)  My Cortisol levels are normal.

Testosterone, Free (Direct) = 2.2 pg/mL        Standard = 6.8 - 21.5 pg/mL
Testosterone,Total,LC/MS/MS = 30 ng/dL      Standard = 264 - 916 ng/dL  (Lowered from like 1350 a year or so ago)
........................

After taking 2 packets of gel for a few months I tested again and it was 

Testosterone, Free (Direct) =  6.1 pg/mL          Standard = 6.8 - 21.5 pg/mL
Testosterone,Total,LC/MS/MS = 257  ng/dL     Standard = 264 - 916 ng/dL   (Lowered from like 1350 a year or so ago I have been told)

She wrote me and said she was thrilled with the results and to continue the 2 packets.   I wrote her back saying its still really low -  she said to double up to 4 packets and retest in few months.    These are the results -

Testosterone, Free (Direct) = 22.8 pg/mL (High)    Standard = 6.8 - 21.5 pg/mL
Testosterone,Total,LC/MS/MS =  842  ng/dL          Standard = 264 - 916 ng/dL   (Lowered from like 1350 a year or so ago)

While that one number is just over the standard range,  My Endocrinologist writes me freaking out saying I need stop taking 4 packets.  My results were HULK LIKE NUMBERS and I needed to lower my dose to 3 packets.   Retested again after a month or so and below are the results on 3 packets.  (A little overboard if you ask me,   I wanted to be in the high end of the range,  heck she was ok with me at 257!).

Testosterone, Free (Direct) =  12.4 pg/mL             Standard = 6.8 - 21.5 pg/mL
Testosterone,Total,LC/MS/MS =  584  ng/dL          Standard = 264 - 916 ng/dL   (Lowered from like 1350 a year or so ago)

Above is with 3 packets and its what I continue to take today.   My drug/rehab counselor said I should look into getting the a different method of Testosterone delivery.   He,  while not having Low-T,  gets a pellet implanted into his thigh like once every 6 months and his T Level is always in the 1000 range.   I don't think my insurance covers that,  heck the gel I get now retail is like $2000 a month!  I know there are also injections you give yourself but she has never said anything about it.   Not sure if I should go to a diff doc or diff type of doc like a urologist?....   Since I have been to the Endocrinologist I have also discovered I have a tumor on my Pituitary Gland and also an empty sac on it as well.   Have learned that the Pituitary Gland is known as the Master Gland and controls all hormones.

[Sleeprider]

I use T-Cypionate and inject subcutaneous weekly with a 5/8" 24 gauge needle in my butt...just talented I guess. Anyway, its clean, painless and effective, with results being very predictable. T-cyp is much lower cost than gels.

[foxfire]

Has the type of pituitary tumor been identified? I assume that they have checked your prolactin levels and thyroid hormones?

Like Sleeprider I also inject T-Cypionate subcutaneously, much cheaper and less of a mess than gels. I know in the online forums everyone says you should get your T levels to the very top of the range, but I've spoken to a lot of older guys who say that they sleep much worse with high levels. At 42 I'd say your approaching the age where really high levels may not be optimal. Have you noticed any subjective difference in how you feel since starting TRT?

[My3rd3y3]

Went back to the sleep Doc for the 2 week follow-up after she bumped up the EPAP to 14 and leaving it on non-auto.   I showed her the 2 nights I was in the hoaspital how my AHI was 1.3 and 1.1 and said how they were giving me oxygen also.   She ordered another ASV Titration and stated to add o2 if it does drop that way insurance would approve it if needed?  Not sure how it would work if indeed I need added oxygen at night like is it with tanks etc or some machine that I hook up to the ASV?

Pretty weird too as I was informed from my sleep doc that I indeed had a successful ASV Titration back in 2016,  I have no memory of it but hey here it is lol.

I am able to swap my Resmed if I want to the Philips Dreamstation bipap auto sv with my DME.   However,  not one person has said I would like it,  you should switch etc,   seems everyone likes the Resmed Aircurve ASV and ontop of that I have pretty much sold my 2 year old Resmed Aircurve ASV so I would not have that to fall back on if I hated the Dreamstation...   


Page 1 


Page 2 



Page 3 



Page 4 



Page 5 



Page 6 



Page 7 

[Sleeprider]

I think the review of the 2016 findings is useful, and touching base with your sleep doc is more helpful than most of what we have been able to offer on the forum. She seems like a concerned and competent doctor that is open to finding an effective solution for you. I recall oxygen supplementation has been used to improve results in other individuals, however, I have been unable to find the study that documented that.

[My3rd3y3]

Well I got another ASV tritration tonight. With added oxygen hopefully so I can get that approved thru my insurance. Here’s to a good night sleep I hope

[My3rd3y3]

Had my ASV Tritration last night, Slept thru everything ok....

It was weird as I was on a that Philips System One Model that has all the featues - cpap, asv etc --- Well I don't think I like it at all, seemed to breath or blow when I was not ready for the next breath.... if that makes sense.

Upon getting woken up in the AM, She could not tell me much guess she is not allowed but said the best setting for EPAP was around 7.0 she thought. Now is this going to be an issue for my Doc as I do not have a Philips ASV - I have the Resmed ASV (Can exchange for the Philips, but seeing how that was it would take some getting use too)...

I thought it was weird they only have Philips at this Sleep Center, Ive used them before and they knew I am on a Resmed Machine.

Will see I guess when I get the full report.

[Gideon]

My Bilevel titration also was a nightmare.  I'm sure they used PR.  I was asleep and then they shifted to (I'm sure) PR in manual mode with a (it's standard) 4 cmw PS.  It tried to breathe for me, it was a, for me, VERY unnatural square wave breath pattern, absolutely hard for me to handle.  I told my doctor, I was trying to get the VAuto, that I had no problem with the pressure, but the change was extremely sudden, but I could get used to it.  NEVER had that feeling with the VAuto and walked out with an Rx for Mode "S" (manual) of 21 / 25.

[ruach]

Had my ASV Tritration last night,   Slept thru everything ok....

It was weird as I was on a that Philips System One Model that has all the featues -  cpap, asv etc    ---   Well I don't think I like it at all,   seemed to breath or blow when I was not ready for the next breath....   if that makes sense.

That is my biggest complaint about the Philips ASV - it forced me to breath according to it's pattern, whereas the ResMed goes along with my pattern. The Philips was so difficult to sleep through the night with. I would wake up, and I would be hearing the noise of the blowing from the device, and that combined with battling with the breath/blow, I would be awake most of the night. 

Since starting the ResMed ASV, I sleep so much better - I would not choose to change for a Philips - just my two cents