Think I'm getting a handle on this. Or am I?

[SarcasticDave94]

Sorry I didn't even see the chart earlier. OK is it possible the reason you're needing to use 18/14 is positional apnea? Do clusters appear with whatever the collar is you're using? If not, you may want to consider backing 14 down somewhat. Also the ramp may become an issue as it's holding you to 4 for 20 minutes. Oddly in that chart, events didn't get past. However that is dependent on sleep onset timing.

Also, what was the reasoning behind the ST? There may be at some point opportunity to get a better machine of we were aware of diagnosis. Nothing like lung disease etc, just apnea?

I did look at the other threads, some of those charts do look like there's a positional apnea aspect. By positional, I'm meaning the Apnea Board version not doctors. So chin tucking and kinking the airway not back vs side sleeping.

[spudhorse]

So Sarcastic Dave,

Without a note of sarcasm on my part, I don't understand a single thing you said in your first paragraph. I'll try to understand it tomorrow. Perhaps there's an APNEA AI out there.

I have two other collars on order so we'll see if can continue to make progress.

The reason behind the ST -- "Here's your machine. Good luck." I do believe the insurance wouldn't approve another machine.

Just apnea.

[SarcasticDave94]

That's rather odd they would choose the ST when a VAuto would likely do better with pressure ranges instead of EPAP and IPAP in static, single pressures. That is at least based on what I recall on the settings on those machines.

[spudhorse]

Just deleted a very long post. Let me just say that I can't tell how much of my apnea experience is due to incompetence, greed, or a system designed for failure. This board is the only ray of hope to get something useful from the therapy.

[SarcasticDave94]

Do you have a copy of the sleep study that got you onto the ST? Mostly if it were a lab test, there's multiple pages. Regardless of whether you desire to post it here, for self advocacy as a patient, politely demand it from the prescribing physician. If they hesitate, your Uno reverse card is HIPAA, which permits you to have your report.

If you obtain it, maybe you'll want to post a redacted of personal identifying info version. Being on ST is somewhat rare, much less rare for doctor and staff to hand you a strange box and say use it and you'll be better.

[spudhorse]

Sleep study attached in two posts.

I appreciate the interest and the help.

---

Sleep study continued

[SarcasticDave94]

OK well you've got an interesting and complex issue. I see their reasoning, although flawed, for placing you on ST. I don't see many Central events, but they must have recognized it as an issue. It's recommendation 1 about ASV if other device X fails.

Insurance dictates a fail system you are expected to follow when it comes to centrals, and really any Apnea. They expect you to prove you need something by failing to get well. Cool idea huh? Specific to centrals, by the way centrals can be idiopathic meaning unknown medical in cause, so let's stick with that unless you've got some severe brain issue. They'll rather say that's the case than treat with ASV, which said ASV is mentioned in your test report, again that item 1 under recommendation.

The required fail method means you'll normally go to fail CPAP, regular BPAP, ST, then ASV. So if centrals (CA) are the underlying issue, it's time to complain constantly that ST isn't doing it. Demand going onto the ASV.

This would likely force you to titration for ASV, and a heart echocardiogram to get a passing grade in LVEF 45% or higher. Any heart conditions you know of? If you have to think about it the answer is likely no.

Bouncing back a bit, did they even trial you on regular BPAP like ResMed AirCurve 10 VAuto? If CA aren't a big issue, VAuto will likely be better than ST. If CA are an issue, ASV is better than the ST.

We can help make the case for either, we're not the doc, just Internet guys discussing apnea. But we can coach how to go about either.

The big issue isn't necessarily insurance but the doc. You'll need to convince doc you need ASV or VAuto. If so, possibly testing then a new script for a machine that'll replace ST. Insurance accepts this action, because of that failure plan.

Ask us questions about any aspect.

[spudhorse]

Bouncing back a bit, did they even trial you on regular BPAP like ResMed AirCurve 10 VAuto?

 No.

Let me take some time to get up to speed here so I can ask more intelligent questions.

One of the "problems" is that this is a smallish and very understaffed hospital. The "doctor" (who I've never spoken with) is 130 miles away in Boise. My contact is a physician's assistant (PA) who's a complete waste of time. Other than being rather creepy, the sleep study person seemed competent. 

Thanks much for all of this!

[SarcasticDave94]

So it appears at every turn your therapy will be between a rock and a hard place. Welcome to Apnea treatment.

Either way it appears to me you'll need to practice some complaining about the therapy is failing to produce good things. They recognize ASV so that's a positive actually.

Seriously, you'll need to think long and hard about the therapy. Make notes on what's good and bad. Be detailed.

Lacking rest. Uncomfortable. Machine harshness. Things on that line. It'll focus on your thoughts and what you feel, subjective aspects.

[spudhorse]

Here's the reply I received about why I'd been given an ST machine:

So looking at your concerns, which are valid, and looking at your sleep study and current bipap data, I am surprised you aren't feeling better.
 
I would definitely state that you have complex sleep apnea per study (mix of obstructive and central) which is at time difficult to treat. At our last visit we increased your back up respiratory rate and your events have dropped by 5 per hour, that being said, your current back up rate is 14, you are actually averaging 15-17 breaths per minute while wearing machine. It is only triggering a breath 30% of the time when needed. 
 
You aren't really having any apneic moments currently on your data download, you are having mostly hypopneas (by definition is a 30% reduction in respiratory effort) sensed by machine with an exhale sensor. I reduced your pressures slightly (18/14 to 16/12) to see if that helps it feel more comfortable. 

which, of course, doesn't address the question at all.

I'm giving some thought about a next step which is kinda hard when you've been "blown off" (pun intended).