Titration study

[Ron Poelstra]

Thank you Sleeprider!  Great information!  So, now the bottom line.  This doctor has seemed very reluctant to go the ASV route.  So, a two fold question; are you aware of a GOOD doctor in Colorado, specifically Colorado Springs, or is it possible to find a Teledoctor that would play nice with Medicare?

[Sleeprider]

Doctors that are reluctant to use ASV, don't understand ASV. We have a number of members using these machines that live in Colorado, and they are welcome to suggest a practice that is more comfortable with its use. Try contacting the following members by PM or email if available, and look at their threads linked in their profile to compare experience: I'm sure one or more will be willing to share any positive physician references. Also, reach out to suppliers in your area and ask which doctors they work with seem proficient in central sleep apnea and ASV machines.
Richdreher http://www.apneaboard.com/forums/User-richdreher
Bemused http://www.apneaboard.com/forums/User-bemused
Chombzzz http://www.apneaboard.com/forums/User-cbombzzz
C0mbe http://www.apneaboard.com/forums/User-C0mbe

Let me tell you quickly how I found these names. Search: Colorado and ASV Site:Apneaboard.com

[Ron Poelstra]

Thank you!

[Sleeprider]

Be sure to give your current doctor a heads-up that his reluctance to prescribe ASV or a trial on ASV is pushing you to look for a qualified physician that understands central apnea and its treatment. While you hope he will continue to work with you, it is understandable if he feels he lacks this expertise, and look forward to his cooperation in working with a new doctor if that proves necessary.

It's a bit of a run-on sentence, but if the guy has any ego at all, he might wake up. I would send this kind of note through the health messaging system if you have such a thing. Otherwise, I would want that message delivered in a way not filtered by the receptionist.

[Sleeprider]

Ron, I understand you have purchased a new ASV from Help Medical and been able to sleep with it, with AHI under 4 so far. Looking forward to you posting some Oscar information soon.

[Ron Poelstra]

Hi Sleeprider,

Here are some Oscar charts from my first few nights with the new machine on default (I think) settings.


   
   
   

[SarcasticDave94]

This suggestion isn't about numbers but comfort. I'd like you to consider the following changes:

Mode from ASV to ASV Auto.
Due to this, EPAP is now a Min Max range. So make EPAP Min 4 Max 15
Also you might want PS Max cut to 15. You'll probably never need that extra.

Recap...
Mode ASV Auto
EPAP 4-15
PS 3-15
This is actually ASV Auto default. We can move things around from there, but with the other numbers wise it was near perfect.

Try it and tell us how you like it or not. Post an OSCAR in as well.

As it is now, you start at EPAP 4 then any event requires PS to move upwards. Give yourself an EPAP range to deal with Obstructive and I'm sure it's going to feel more comfortable.

[Sleeprider]

Obviously this is much better than the large clusters of apnea, flagged as both central and obstructive.  I'll post one of your old charts below just for contrast.   Your tidal volume, resp rate and other respiratory parameters are unchanged,  but flow limit and AHI is very improved.  Given your event rate is as low as 1 per six-hours, I don't see any changes to recommend unless you have a comfort issue.  I hope you will let your doctor know these results and how you feel so he can learn and not do this to anyone else.  Have you addressed getting insurance reimbursement for out-of-network?  Not much doubt left that ASV is necessary and beneficial to you.

[Ron Poelstra]

Thanks to both of you!

Such great people on this forum!  I am so pleased to be a part of such a great group of people!

[Geer1]

Looks like ASV is working great for you.

Definitely make a up a summary of your results and share them with your doctor to try to get him onboard that ASV was required (and to get a prescription for one in case it is ever needed). Along with your results you can also include Resmed's documentation on central apnea and their recommendation to use ASV to treat it (page 29 of their guide https://document.resmed.com/en-us/docume...er_eng.pdf ). Hopefully this will get your doctor on board, a prescription and help future patients avoid the same hassle.