Sleepy Head loses Notes

[ROBBY98]

Want a particular day or particular spot?
What works best?

[ROBBY98]

The second image.."Last night expanded" has the flow rate expanded.
So look at that image and the describe ha you'd like it enhanced.
K?

[ROBBY98]

FLOW RATE EXPANDED
[attachment=9487]

[Sleeprider]

That's it. The flow limitation is apparent where the green line comes through and the breath afterwards. Then you just don't seem to have much effort and lapse into a CA. Thanks for posting the image. Normally for flow limitation, we'd like to add some EPR so you have more pressure support for inspiration, but that probably triggers more CA events.

[ROBBY98]

So What's your take on this?
Where is the whole thing coming from..the root cause?
Why does it vary from day to day?
Think a sleep doc will recognize the need for ASV instead of CPAP?
Any medications you heard of that help?
Seeing what you seen from the graphs, is it worth changing the pressure on the current machine?
Ideas? At least short term?

[Sleeprider]

So What's your take on this?
Where is the whole thing coming from..the root cause?
Why does it vary from day to day?
Think a sleep doc will recognize the need for ASV instead of CPAP?
Any medications you heard of that help?
Seeing what you seen from the graphs, is it worth changing the pressure on the current machine?
Ideas? At least short term?

We have a lot of people come to the forum with results that are marginal or poor and where most events are central and hypopnea.  We have not really investigated enough to conclude a root cause.  If you can obtain your sleep study results that break-down the types of events that would help see what your untreated baseline condition is.  Central apnea can occur for many reasons and is sometimes "idiopathic", or unrelated to a known medical condition.  It can of course be related to health or heart conditions, but is often a side-effect of CPAP treatment as a result of less CO2 being in the blood stream.  For most of the people I have coached with this pattern, the most consistent result is the inconsistency of results.  It seems one night will be great and we finally hit on the magic numbers, then the next night will be off the charts AHI unrelated to any changes in therapy.  Here is a wiki on the subject http://www.apneaboard.com/wiki/index.php...ackup_Info

This pattern of CA and H events is poorly understood by most sleep doctors and the sleep labs are especially bad at identifying titration solutions, mostly because you will have fairly long periods of time with no events, then experience a central cluster unrelated to outside therapy or interventions. It takes time and some experimentation with pressures and EPR or pressure support to fully understand what this pattern is, and how it responds to changes in therapy strategy. It's worth doing so that when you discuss the problem with your doctor, you will understand what works best and what causes more problems. 

The long-term best solution that completely clears this up is ASV. An experimental approach that increases the expiratory rebreathing space (EERS) has reduced centrals in some members that had therapy onset central apnea http://www.apneaboard.com/wiki/index.php...ace_(EERS)   Justifying ASV is a long process, and the article I already linked describes the steps for obtaining insurance reimbursement.  It helps to have a diagnosis for central sleep apnea, however where complex sleep apnea is emergent with CPAP treatment, the patients must first fail CPAP (this is your current step), trial and fail bilevel, then trial bilevel with a backup rate (ASV).  Each step may have physician evaluations and sleep testing or titration.  The process is difficult enough that a number of forum members have resorted to self-financing and grab a machine off resale marketplaces like Craigslist or OfferUp.

You should obtain copies of any sleep studies. We can help you to understand what's there if anything. Start researching complex apnea and central sleep apnea. The problem is far more common than the medical community acknowledges and is easy to resolve, but relatively expensive compared to CPAP.  Finally we should try doing a few things with settings to see what works and what doesn't.  Hopefully Bonjour (Fred) will pop in and help as well.

[Gideon]

One minor correction,  this Wiki article iJustifying_Advanced_PAP_Machines
The one Sleeprider pointed to has medical jargon articles for this.

But yes CA is generally consistently inconsistent.

Fred

[ROBBY98]

OK....
Good answers...
Let me digest.
I'll post the sleep study.
It's in a faxed form...hard to read...but I will request the original master...then post.