advice for my new user friend

Bonnie wrote: My concern was the comments made by the doctor that my machine would not handle the centrals, is that true? Is there a particular model better suited for centrals?

that much of what the doctor said is true. the autoset, while a great machine for people with normal sleep apnea, won't do anything for centrals.

it flags them, and then ignores them, becuase it doesn't have the specialized programming to deal with them.

for someone with complex sleep apnea, or central sleep apnea, you typically need what den mentioned, an ASV, or Adaptive Servo Ventilator such as the S9 VPAP Adapt or PRS1 AutoSV. it tracks each breath, and when i sees you start having shallower breaths, or you stop breathing, it increases pressure, *per breath*, which will push air into your lungs, then it drops the pressure so you exhale naturally.

here's a sleepyhead trace from an ASV and someone with complex sleep apnea. you can see the pressure going up and down (the blue mask pressure trace) with each breath.

Wulfman... wrote:Sometimes I wonder if ResMAD just collects their "sub-standard", left-over parts (aka "floor sweepings") and tries to come up with a way of foisting them off on the poor, unsuspecting users. Any profit is better than none. Ethics be damned. Then, they get doctors like this one to conspire with them. Grrrrrr......

the sad thing is that there's no physical difference in any of the many machines between the elite and the adapt, they've all got the exact same hardware. I haven't gotten the chance yet to pop open an escape* but I'd be willing to bet it's the same harware as the 3500$ adapt, it's just dain bramaged.

Bonnie wrote:Sorry, it is the Escape he prescribed.

Now I am wondering if he is a sleep doc or something else? She needs another doc in any case.

If she accepts this machine I think it will be harder for her to get changed to another model. A lot depends on her doc and insurance. Help guide her.

Jay Aitchsee wrote: It is extremely rare for people to be "cured" of sleep apnea simply by loosing weight, IMO.

Got any data to back up this claim? I see a number of members making the claim, but so far all that I've seen in terms of evidence is their opinions. I also have seen research that indicates that for very meaningful pct of OSA sufferers, their OSA is directly related to/caused by excess weight and can be "cured" by weight loss.

There are a large number of people who have structural issues that cause their OSA. For these people, weight loss has zero impact (some are already thin so losing large quantities of weight would be dangerous). For people who are obese (50+ lbs over their optimal weight), weight loss has a reasonable chance of curing their OSA, but not all can be cured by weight loss, since their weight condition is actually caused by their OSA (and not other way around). Heck, there are threads in this forum where people indicate INCREASED pressure requirements, after weight loss. This latter group gives the perception, to OSA sufferers that weight loss can't work, but actual research indicates that it may.

I personally have lost over 15% of my body weight (started at 280 lbs) and have seen my require pressure go from 11 CM to 4.5 CM (I actually do fine at 4, but a little better at 4.5). I'm still 50 lb over my optimal weight. I know that when I was 20 lbs lighter than I am now (8 yrs ago), I had no OSA symptoms. Given the reduction in pressure (approaching the magical 4 cm threshold) and the fact that I didn't have OSA symptoms until I gained an excessive amount of fat, I believe that if I continue to lose weight, I'll eventually be able to lose the CPAP. While I definitely don't believe in a case of 1 being "proof" of something, I also don't believe that there's anything that's unique about my situation.

In the end, if you are grossly overweight with a high fat pct, try losing weight to see if it cures your OSA. Heck even if it means lower pressure, the CPAP therapy will be easier to tolerate. If neither of these occur, then the other health benefits from weight loss are certainly worth the effort.

bv1800 wrote:Jay Aitchsee wrote: It is extremely rare for people to be "cured" of sleep apnea simply by loosing weight, IMO.

bv1800 wrote:Got any data to back up this claim? I see a number of members making the claim, but so far all that I've seen in terms of evidence is their opinions. I also have seen research that indicates that for very meaningful pct of OSA sufferers, their OSA is directly related to/caused by excess weight and can be "cured" by weight loss.

Yes, bv1800, you are right. I usually try not to make statements without supporting evidence. I did, however, qualify it as my opinion. And it is my opinion based largely on anecdotal evidence, admittedly on shaky ground. I did not mean to imply that weight loss was not a good thing or that it might not help in lessening the severity of OSA. It was, rather, a counter to the implied statement by the physician provided by the OP that all the subject had to do was lose weight to be "cured" of sleep apnea.

In support of losing weight, I can use myself as an example. At 10 lbs overweight as I am now, 185 vs 175, my pressure requirement to eliminate obstructive apneas is approximately 2cmH20 higher, 11 compared to 9, than when at 175. Again anecdotal, but as I lose weight (again), I expect my pressure requirement to decrease (again). Unfortunately though, I do not see a target weight that will allow me to forgo the use of CPAP. But that doesn't mean that you won't be able to lose CPAP when you reach you goal weight. I wish you great success.

Jay Aitchsee wrote: Yes, bv1800, you are right. I usually try not to make statements without supporting evidence. I did, however, qualify it as my opinion. And it is my opinion based largely on anecdotal evidence, admittedly on shaky ground. I did not mean to imply that weight loss was not a good thing or that it might not help in lessening the severity of OSA. It was, rather, a counter to the implied statement by the physician provided by the OP that all the subject had to do was lose weight to be "cured" of sleep apnea.

In support of losing weight, I can use myself as an example. At 10 lbs overweight as I am now, 185 vs 175, my pressure requirement to eliminate obstructive apneas is approximately 2cmH20 higher, 11 compared to 9, than when at 175. Again anecdotal, but as I lose weight (again), I expect my pressure requirement to decrease (again). Unfortunately though, I do not see a target weight that will allow me to forgo the use of CPAP. But that doesn't mean that you won't be able to lose CPAP when you reach you goal weight. I wish you great success.

Jay,

You did include the "IMO", so it was obvious that you were simply stating an opinion (and I probably shouldn't have jumped on your statement, like I did).

From my perspective, I seem to see these statements every time weight is brought up as a possible solution. I, too, do not want to give people false hope, but I also don't want to give them no hope. If this is the motivation to get someone to lose weight (it was the last straw on the stack that I needed to get serious about losing 80+ lbs that I needed to lose), then great. I'm still facing the possibility that I'll be on CPAP for the rest of my life (had this exact discussion with my PCP, yesterday during my annual physical). If that's the case, then I'll do it and it'll be a lot easier doing so while needing 4.0-4.5 CM of pressure, than the 11 CM that I needed when I started treatment. I know that right now, I sleep much better hooked up to the machine than not, so I'm not changing a thing until I have absolute proof that I don't need the CPAP.

I'm sorry to see that you are one of the people for whom weight loss appears to have zero chance of curing your OSA (even at 185, you couldn't have needed much more than 10% weight loss to reach your optimal weight). Then again, you have a condition that is treatable, so I guess that it could be far worse.

After nine plus years of this therapy and this forum, my observation is that in the majority of cases, OSA CAUSED the weight gain. Years ago I posted a link to an article on the forum from one of the medical publications suggesting that.
And, there are many people who have OSA and CSA who are normal weight or even skinny. Weight loss can help them?

And, yet another "WTF?".......this doctor was concerned about Centrals but suggested that "weight loss" could help? (on top of prescribing a non-data-capable CPAP machine)


Den

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Wulfman... wrote:After nine plus years of this therapy and this forum, my observation is that in the majority of cases, OSA CAUSED the weight gain. Years ago I posted a link to an article on the forum from one of the medical publications suggesting that.

Agree that this is a common occurrence, please point to my suggestion that it's not (I believe that I even stated the case). I would point out that if 51% of the cases, where obesity is an existing condition, that OSA CAUSED obesity, there are 49% where it didn't and in those 49%, weight loss MAY cure OSA.

Wulfman... wrote: And, there are many people who have OSA and CSA who are normal weight or even skinny. Weight loss can help them?

Again, I'll point out that I stated that this is quite possible. Now you point out where I said weight loss will help. Even in this case, this isn't 100% of people with OSA. Even if it's 50% (and I would wager that actual data would indicate that these cases don't come anywhere close to 50%), then we're still looking at a net of almost 25% of people for whom weight loss MAY cure their OSA. I contend that 25% is hardly "extremely rare".

That said, for the Dr to automatically conclude that obesity "caused" Centrals is absurd.

I'm going to go over all her option/issues with her this weekend. And have her join the forum to ask the questions that concern her and get her a good machine so she can get started on this. Knowing her as I do I have no doubt she will do well. Thanks everyone for the suggestions and comments.