Retest shows major changes

[racprops]

It can be a good idea to get a retest. I am finding that I have different Apnea that originally reported.

At this point I cannot figure out what happened.

My first sleep Doctor reported that I had Complex Sleep Apneas, with lots of centrals. He told me I needed a Bi-cap/ASV machine.

So I got a Phillip’s ASV machine.

I seemed to be doing OK but things were a little odd.

SO after three years of the Phillip’s system reporting hypopnea all over the place along with clear air and almost no obstruction apneas..

My retest has shown me to have NO centrals and to have obstruction apneas and lots of hypopneas.

It also reported that I can use straight CPAP, of a less complex APAP system. That I do better with a straight pressure and the only need is that if I stay on my side I sleep great on 10 CC/H2O, and if I get on my back I need 15 CC/H2O so a APAP will serve fine.

I have been told that my ASV machine might be overacting to my sleep and causing some problems on its own.

It reports NO obstruction apneas, it reports only clear air apneas and Hypopneas, I have been using bi level settings that was allowing these apneas…

OR is Sleepyhead miss reporting the info from the machine??

I now seem to be very different than originally reported.

Using this new report as I wait for my new machine to be ordered which should be link removed - Search for airsense-10-autoset-cpap-with-humidifier with a heated hose and new full/full face mask.

Meanwhile I have reset my old ASV system to 9.5 low and 10 as my high so that is nearly a straight CPAP machine, (read that the new machine does lower a little to help exhale.) It can also respond to my getting on my back with higher pressures.

Now for the past couple of days I am getting straight Zeros, NO apneas at all.

So the questions are:

Did my first Doctor mess up?? (Was he a quack??)

Or as he was offering to help me buy a machine pad the bill by ordering a most costly machine?? (I did not buy from him and used Second Wind CPAP)

Or did I become used to CPAP and no longer react as I had with my first sleep study??
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[DeepBreathing]

I don't know about the Philips machine, but Resmed ASVs don't report the type of apnea. They don't mess around with forced oscillation but as soon as an apnea is detected they start ramping up the pressure support and report an unknown apnea. My guess is the Philips does something similar but it may be reported as a clear airway apnea. Perhaps somebody more familiar with those machines can confirm this.

Did my first Doctor mess up?? (Was he a quack??)

Possible he got it wrong - docs are only human after all. Or maybe the re-test got it wrong?

Or as he was offering to help me buy a machine pad the bill by ordering a most costly machine?? (I did not buy from him and used Second Wind CPAP)

If the doc doesn't sell the machines (or have some kick-back arrangement) there's no incentive for him to force you into a much more expensive machine unnecessarily. If it's a question of a foul-up or a conspiracy, I'll go with foul-up every time.

Or did I become used to CPAP and no longer react as I had with my first sleep study??

I'm not a medical practitioner, so this is uninformed - I think it's very unlikely. We often hear of people developing centrals from xPAP therapy, but I've never heard of anybody losing their centrals and developing obstructive. The fact that your machine is reporting a lot of centrals and a lot of hypopneas indicates to me that it's not set up properly. (Don't forget that hypopneas are usually obstructive in nature). Minimum EPAP is too low and max PS may not be high enough. And being a Philips it has a bunch of other settings that need to be fine-tuned.

Give the APAP a go and see what happens. But I don't think we can automatically say the original test got it totally wrong.

[Sleeprider]

Let's say this is a first and leave it at that. I doubt your doctor would intentionally misinterpret apnea, but most people have to go through multiple tests to arrive at ASV. One has to clearly fail CPAP with lots of central apnea indicated, and usually bilvel as well.

Was ASV originally prescribed based on the diagnostic test without titration? You should have the test results that gave that recommendation.

[racprops]

Let's say this is a first and leave it at that. I doubt your doctor would intentionally misinterpret apnea, but most people have to go through multiple tests to arrive at ASV. One has to clearly fail CPAP with lots of central apnea indicated, and usually bilvel as well.

Was ASV originally prescribed based on the diagnostic test without titration? You should have the test results that gave that recommendation.

Yes he said I have lots of centrals and we did two nights testing and that was his prescription.

[racprops]

I will add this was a a**h*le Doctor, I fired him a week after I got my machine as he kept pulling ego trips and games on me.

First he claimed that ONLY his staff could set up the machine so I had to wait three days and the drive for 20 miles so his nurse could take 5 minuets to set it up, and then drive home. My system provide was given the prescription and could have preset it, this is standard practice..more of his grand standing.

At first I could not stand it so I got out the service manual and made a couple of changes, (lower pressure) which while not correct at least got me started...

I then had to wait a week to see him again and he insisted I bring the whole system to the visit.

When I waked in the nurse asked did I bring it all and I said yes BUT I think all they really need is the SC Card I held out to her...she looked funny and said yes and took it, leaving the system behind.

When I was seen by this Doctor he read my the riot act over my daring to make changes...then said he wanted me to use MY settings for a month and then come back and he will then correct them...So if I was really wrong then he was willing to risk my health to teach me a lesson.

Also he had offer to help me get a deal on a machine though him, so I think he did get a kick back...

I then figured it out with the help here and trial and error..

The Philips does claim to be able to report both Clear Air and Obstructive Apneas as well and other stuff, it was one of the reasons I got it over Resmed.

[Sleeprider]

Wow,what a story. I had a pretty simple Dx in 2008 of very severe OA, but have not seen a sleep specialist since. You make me glad I missed out, but we share in common the setup of our own therapy. I moved from auto CPAP to auto Bilevel, and that seems to be the best for me. I actually went to a DME (Remworks) this year to see if I could get an insurance-covered bilevel. So far (3-months), they have required all kinds of documentation from my doctor and not delivered anything. We'll see.

[metsfan302]

Mine is the other way around.

I started off with a refered sleep dr, took a sleep study, found I had Mild Obstructive Apnea was prescibed an auto cpap- AHI on that test was like maybe 7 id have to dig it out.

fast forward 3 years

I have a new dr, new sleep study and have servere obstructive and central apnea and will need an ASV

[shewhorn]

"Did my first Doctor mess up?? (Was he a quack??) "

Can't say but one thing that has struck me odd about sleep science and medicine is how one night of sleep study is considered to be an "adequate" data set. I don't think any scientist would ever agree with that. I'm pretty sure a single night of study (and sometimes another to figure out titration) is not enough data to draw any solid conclusions from (I mean... you can certainly tell if someone has apnea from that... but the nature of it and how it changes from day to day... probably not) BUT... INSURANCE is involved and as we know, some dweeb sitting in an office who has never examined you EVER is far better qualified than your doctor to determine what kind of care you should receive (as I roll my eyes into the back of my head). I get a sense that doctors are often forced to work with limited data sets due to the restraints placed upon them by the greedy insurance companies. That said... I'm not an M.D.

[justMongo]

Much like the physicist who extrapolates from a single data point.

[richb]

Sleep Docs are very reluctant to use machine data for anything. It may be that they are afraid that the machine technology might do a better job of diagnosis than their PSG technology from the 1960s.

RichB