White Beard....I forgot I hadn't answered your last note. They sign as Diplomate, American Board of Sleep Medicine. Does that mean they are certified? They are both MD's. As I told Mobius, the Sleep Doc said my pressure was too high for the ASV. According to the website, it will take a pressure of 25. I am working with a Pulmonary Doctor who specializes in Sleep Apnea. My problem with him is he didn't take the Sleep Clinics recommendations. I've only seen him once. I do go back in about three weeks. Hopefully the Smartcard will tell him something he believes.
Thanks for your good luck wishes!
_________________ AHI=101 Lowest oxygen 73% Started CPAP 7/22/08
Respironics BiPap M 23/18 with 3L oxygen
Resmed Ultra Mirage FF mask
Humidifier set at 3
Seajay515, Searching for a doctor who will prescribe a therapy without preconceived ideas is not as easy as one would think. Last year I went and got print outs of my sleep studies and took them to a new doctor. I was not sure, but I thought I had central or mixed apnea. Since Central Apnea is a neurological condition I looked for and found a sleep doctor with both respiratory, sleep and neurology credentials. Fortunately I found one in my nearest city. You may want to contact the people at Rochester Minnesota Mayo Clinic. They are the people who spearheaded the use of ResMed's VPAP Adapt SV for Central Apnea patients. Doctors from all over the country go there to study then return home to their own cities. There may be someone in your area who studied there who also has neurology as well as sleep credentials. And by the way, the setting my new doctor prescribed for my VPAP is lower than the setting I was at on my Bi PAP. Good luck, Hope you can find a doctor to help. Tnhosehead
I think to have a shot at trying to figure out what's going on, the first thing you have to do is get a hold of the complete studies, all of them, including all of the graphs that analyze sleep architecture, respiratory event placement, oxygen levels, etc. The "on again, off-again" consideration of ASV certainly suggests that an attempt may have merit.
Some specific things to look at:
1. Moderate to high altitude may generate central apnea (Periodic Breathing Associated With High Altitude), although people will usually acclimate after a period of time.
2. The use of supplemental oxygen is not explained. Is it needed to treat persistent central apnea? Is the period breathing due to altitude persisting? Is the oxygen baseline itself low, and unrelated to SDB? Everyone's oxygen level drops with altitude, but to need 3 LPM supplemental?
3. A BiLevel titration that ends up at 25/20 seems extraordinarily high. Generally, EPAP is increased only to address obstructive apneas, then the other events (hypopneas, flow limitation, etc.) are addressed with IPAP. If you original sleep study showed only 7 measly obstructive apneas and a ton of hyponeas on ambient pressure, it seems quite unlikely that one would need to end up with 20 cmH2O EPAP.
4, Right, an ASV would not match those pressures (or at least the ResMed Adapt SV anyway. Actually, you can generate those parameters with the Respironics AutoSV). But the comparing the ASV approach to traditional BiLevel approach is like comparing apples to aardvarks. They have little in common, those values are totally irrelevant. Besides, when you're treating central apnea (and we still have to closely look at that), high pressures must be avoided.
5. Within the complete results is a table detailing the respiratory events at each pressure. While the 25/20 pressure sounds great in reducing AHI to 2, that should be closely examined. For instance, if it occurred for only a brief period (a few minutes) and/or during a period where events would not be expected to occur anyway, then that may not, in fact, be the "ideal pressure".
Just as a side note the new ResMed VPAP Adapt SV enhanced is capable of the higher pressures. They not only added the AHI an AI to there displayed data, they also increased the pressures of the machine, it is listed as operating pressure range is 4-25 cm H2O. And your right Morbius you can't compare BiPAP to the ASV. When I was on BiPAP I was 20 over 16, my average pressure on my ASV is 12.2 to 12.6 when checking the detailed data once in a while it will go up to 20 but not often! Maybe that Doc doesn't know about the Enhance Version?
seajay515 I know how that goes my sleep center had been recommending ASV for over a year and my Doctor ignored them, he said he didn't believe in ASV the technology was to new! It wasn't until I changed Doctors did I get titrated to the ASV and got the machine! And Boy what difference it has made!
_________________ White Beard with a White Beard
Resmed VPAP Adapt SV Enhanced, HumidAire 2i, ResLink with Model 8000 Flex sensor Pulse Oximeter, and ResScan 3.5 software. Respironic EverFlo OPI Oxygen Concentrator 3 lpm
EEP 9.0, min PS 6.0, max PS 16.0
Just as a side note the new ResMed VPAP Adapt SV enhanced is capable of the higher pressures. They not only added the AHI an AI to there displayed data, they also increased the pressures of the machine, it is listed as operating pressure range is 4-25 cm H2O.
Right. And EEP (their equivalent to EPAP) is now up to 15 cmH2O, but I doubt if SJ needs the 20 she's on now, or even a lot of the 15 either. Setting up any ASV at max parameters just wrecks the entire approach, worsening the baseline situation as well as handcuffing it's ability to perform as a "bilevel" bilevel.
l. The first study showed oxygen saturation typically in the 89% range with cyclic desaturations to 79-81%. The lowest oxygen saturation
was 73%. All studies done in supine position.
2. Seven days later I had a total knee surgery and came home on 2L of oxygen. This is the first time I knew I needed oxygen. I used it only
at night and the surgeon said it's not unusual for patients to need it after surgery.
3. The third sleep study had oxygen added at 2L along with a backup respiratory rate if central apneas persist.
4. The Pulmonary office quick tested me with their Pulse ox three times and my oxygen was always in the 95% range without any oxygen.
It does seem like the sleep center is getting rid of the central apneas with the oxygen. I have lived in Colorado for 40 yrs. You both have given me a lot to work with. I'd like to show your observations to the Pulmonologist if I think he can handle someone else's opinion! Some Doctor's have huge egos!
_________________ AHI=101 Lowest oxygen 73% Started CPAP 7/22/08
Respironics BiPap M 23/18 with 3L oxygen
Resmed Ultra Mirage FF mask
Humidifier set at 3
Seven days later I had a total knee surgery and came home on 2L of oxygen. This is the first time I knew I needed oxygen. I used it only at night and the surgeon said it's not unusual for patients to need it after surgery.
That's a little bit of wordplay, because I think it is unusual to require supplemental oxygen after surgery (although usual/unusual is relative). Knee surgery itself has absolutely nothing to do with oxygen requirements. You need at least one other contributing factor, like underlying pulmonary disease, high altitude, advanced age, relatively strong pain medications, SDB, overweight, underlying cardiac disease...
The sleep study was ordered because of my high blood pressure 138/100 on the day the Cardiologist saw me. I've always had low or normal pressure. I also had gained weight in a short period of time and couldn't loss any. After my surgery I was on up to 6 Vicodin a day. I'm down to one on a PRN basis for my severe arthritis. The last sleep study was done on the 6 Vicodin days. Why wouldn't the Clinic just tell me to wait. They never seemed bothered by my meds and in fact let me take one before the study to make sure I went to sleep! I meet most of your "something else" problems for the oxygen!
_________________ AHI=101 Lowest oxygen 73% Started CPAP 7/22/08
Respironics BiPap M 23/18 with 3L oxygen
Resmed Ultra Mirage FF mask
Humidifier set at 3
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