best machine for someone who used to have complex SA

[kolchak]

Hi
After being diagnosed with complex apnea in 2007 & using a respironocs auto sv for 4.5 years, the machine died last month. Based on my experience being off the hose for a couple weeks & the results of a sleep test done 8/11 showing I no longer have central apnea (or a medical need for XPAP), I'm wondering what type of machine to get?

Anyone with the patience to read this please forgive the length & probably incoherence. Due to schedule, time, memory, intelligence, etc limitations I've never completely understood the concepts, terminology or technology involved in reading sleep tests or setting an SV machines. My Doc admittedly knows less than I about SV's and was never been able to fine tune my treatment - Thank God for this forum and some of incredibly helpful / astute SV users!

I was originally RX'ed an SV when they 1st hit the market ~ 2007 due to a "complex apnea" (central & obstructive). Initial test showed RDI of 29, AHI was 20. RDI during REM was 73. Average Sa02 in sleep was 95%, min was 84% and was under 90% for 2% of sleep, & some centrals lasted 50 seconds..

I requested a 2nd test 8/11 to see if anything had changed & test showed my AHI fell to 3 (was moderate at 20) and RDI was 9. According to the Doc these results and lack of any centrals means I could stop using the CPAP. I explained I planned to continue & he encouraged it since there were no negatives involved.
I asked the Doc since test showed all time was spent in stages 1 & 2 (majority in stage 1) and my Encore reports showed historically most of my RDI occurred in the last few hours of sleep, was it possible to know the extent of my current SA?
I further explained that while I've felt 100% better since CPAP came into my life but still feel lethargic / groggy in the morning and occasionally awake with head aches. I typically sleep 6 to 6.5 hours but when I get up in under 4 hours I typically feel sharper.
My breathing seems to get shallower in the last couple hours during deeper sleep. Unfortunately he wasn't but wasn't interested or capable in helping me explore the implications of this any further.

Fast forward to 5/12 & I continued using my machine until it passed away. I posted a question here asking for opinions about current SV machines thinking it was my best option. John responded with great information, even offering me a loaner however I thought the process of getting a new machine would be easier / faster. After a couple weeks the medical co. said my insurance company wouldn't cover an SV machine based on results of the test but they'd allow it with an explanation from the Doc. My doc has agreed to write the letter but before submitting it I want to be sure an SV machine is actually necessary and best fits my needs.

In addition to the recent test showing no centrals, the main reason I may not pursue an SV is because while being of the hose I felt essentially the same as being on it. I have an adjustable bed and kept it at a slight incline. One night, I tried sleeping with the bed flat - big mistake! I woke up needing to pee several times (sorry I forget the official medical term for this condition) and was simply exhausted, cloudy, humorless, etc all day - basically the way I felt for a decade before getting on CPAP. The next night the bed was inclined again and I've felt fine. The DME has since provided a loaner machine - the updated respironics SV which has a few settings I've never seen before. Unfortunately the upgraded machine won't read my data card so there is no more current data.
I have an apt with a new Doc recommended by the DME and hoping he can piece together this puzzle based on the 2 tests and some Encore reports I'd printed between 09 & 11.
If ones issues are caused by snoring, slow shallow breathing and occasional obstructive events, is there any harm in using an SV or is that overkill?

[chunkyfrog]

It has been pointed out many times on this forum that sleep tests are not infallible.
Due to your symptoms, it sounds like you may need yet another sleep test; or perhaps a multi-night home study.
Ideally, a doctor should be able to tell whether you still need the advanced machine.
Insurance coverage should not be an issue on whether or not you get therapy; but may affect what you can afford.

[kolchak]

Thanks, i guess the key is finding a good dr for primary support intead of relying on the smarts & kindness of people here.
If i need another test at least the at home variety might be an option

[chunkyfrog]

Bump;
I am not qualified to answer Kolchak's question; hence the sidestep (sorry)
If anyone with applicable experience has some ideas; well, please speak.