Need some help (data review)

[nudave]

Your initial sleep study does mention significant number of centrals with no improvement on cpap. I don't know why this wasn't addressed unless they were thinking that they might be related to the the PLMD.

An in depth discussion with your doctor is needed to figure out the best course of action and what level of centrals is acceptable or what they they want to do about it.

That is sound advice and the same advice I would give you.

[avi123]

justbreathe, I could not find any pressure recommendation in your sleep study. But the pressure of 9 cm that you set in your S9 Elite could have wiped out all the Obstructive apneas in the following graph and left only the Centrals plus the emergent Centrals:

https://docs.google.com/document/d/14fl ... t?hl=en_US#

[justbreathe]

I have an appointment with the RT at my DME tomorrow morning. She said to bring my SD card. Hopefully they will adjust my pressure down as I think that is causing the increase of Centrals I am experiencing. In my tritation they never got over a pressure of 8. From 6-8 the Centrals went up with each increase of pressure.

How do I post a copy of my Sleep study and titration in the body of the post as I have seen other?

Thanks for your continued help.

[Pugsy]

How do I post a copy of my Sleep study and titration in the body of the post as I have seen other?

Right now you are using the URL link and pasting url address between the url brackets. Creates a link to the image.

Instead click on the Img button next to thee URL button and past the address between the IMG brackets.

Use preview and you should see your image with no link.

[avi123]

I have an appointment with the RT at my DME tomorrow morning. She said to bring my SD card. Hopefully they will adjust my pressure down as I think that is causing the increase of Centrals I am experiencing. In my tritation they never got over a pressure of 8. From 6-8 the Centrals went up with each increase of pressure.

How do I post a copy of my Sleep study and titration in the body of the post as I have seen other?

Thanks for your continued help.

I would take the S9 Elite flow generator section to the RT to be checked.

[justbreathe]

When I try this is all I can get. What am I doing wrong.



I have tried this too.

[Pugsy]

I went to your image link. Right clicked on the image. Chose "copy image location".
Back to here. Clicked on the Img button on the editor, I get this
put xxs in to show brackets

Then I put mouse cursor in between the IMG brackets (where the xxx shows now), right click mouse and paste paste. I get the image location showing in code.
Preview gives me image like this.

[ozij]

Respiratory revealed apneas and hypopneas for an overall AHI of 24.7/hr. Snore was mild. PLMS were scored at 69.1/hr. Of these events 25.5/hr were scored with arousal

The cpap may be recording those PLM related arousal's as central apneas.

There is no way for you, or us, or any medical professional to "diagnose" you based on the CPAP data -- you can safely ignore Avi123's attempts to supply you with a diagnosis.

Here's what we know:
You are known to suffer from periodic limb movement of sleep.
Additionally, you were diagnosed with obstructive sleep apnea based on your PSG.
Many of you restless leg movements during the PSG were related to breathing interruptions - this is not uncommon people.
Additionally,25.5 of the Periodic Limb Movements caused arousal.
Untreated, your sleep is badly disrupted by breathing problems (you obstructive apneas and hypopneas) and additionally, it it disrupted by your PLM's.

Please note that Periodic Limb Movements of sleep are not the same as Restless Legs.
Sometimes, once the disordered breathing problems are treated, the periodic movement problems are revealed because a person finally sleeps deeply enough for them to appear.
Sometimes, once the disordered breathing problems are treated, restless leg movement problems disappear since they were actually responses to breathing interruptions.
To complicate matters further: for some people, once the obstructive problem is properly treated, central apneas (that is, non-obstructive breathing interruptions) appear - only on CPAP.

To summarize all of the above, based on your PSG and CPAP reports:
You seem to have a number of different issues disrupting your sleep:

1. Breathing interruptions
2. Restless leg movements -- possibly caused by the breathing interruption
3. Periodic Limb Movements
4. A possible adverse response to the air pressure supplied to alleviate your breathing problems -but the CPAP may simply be recording your arousals

Because there are so many interacting variables, I totally agree with this "An in depth discussion with your doctor is needed to figure out the best course of action".

[avi123]

Respiratory revealed apneas and hypopneas for an overall AHI of 24.7/hr. Snore was mild. PLMS were scored at 69.1/hr. Of these events 25.5/hr were scored with arousal

The cpap may be recording those PLM related arousal's as central apneas.

How could the S9 Elite CPAP do that if each Central Apnea (Black flag) is correlated with a flow stoppage on the FLOW graph.

Do Periodic Limb Movements and Restless Legs cause Flow stoppages?

[ozij]

Do Periodic Limb Movements and Restless Legs cause Flow stoppages?

In justbreathe's PSG the PLM were reported to cause arousals.
Arousals can cause disordered breathing.
Disordered breathing can be reported on the CPAP as central apneas.
This only means the justbreathe's breathing is disordered. It does not mean the state of sleep disorders his breathing by affecting his breathing control.

[avi123]

not important

[justbreathe]

Here are the results of my sleep titration. I talked with the RT today and she got the OK from my doctor to adjust my pressure. She will come by tomorrow to change it from 9 t0 6. I was told that If I changed it myself I would not be compliant and could possibly lose insurance coverage.

If I still have trouble with the centrals then we may try an asv but first I must demonstrate that I can not be treated with cpap.

[avi123]

Here are the results of my sleep titration. I talked with the RT today and she got the OK from my doctor to adjust my pressure. She will come by tomorrow to change it from 9 t0 6. I was told that If I changed it myself I would not be compliant and could possibly lose insurance coverage.

If I still have trouble with the centrals then we may try an asv but first I must demonstrate that I can not be treated with cpap.

justbreathe, welcome to Medicare Land!

In this land, your insurance, doctor, PSG clinic, RT, DME, etc. are under Medicare rules.

Even if your PSG's clinician, and your doctor reached a conclusion that an ASV machine is the one for you, they can't put it down on paper.
They need (actually want) you to go thru a fixed process.

Check: E0471 device requirements by Medicare or by Cigna

[justbreathe]

I am with BCBS: Here is their requirements.


Noninvasive Respiratory Assist Devices
Coverage of bilevel PAP device with a backup rate or an adaptive servo-ventilation (ASV)
device may be considered medically necessary in patients with Complex Sleep Apnea syndrome
when the central apneas have failed to respond to:
a. Reduction in the administered CPAP or bilevel pressures in the sleep lab (’down
titration’); and
b. Acclimation/desensitization to pressure therapy by a trial of auto bilevel PAP in the
home setting with appropriate, gradual acclimation measures for a period of at least four
weeks, followed by a bilevel PAP titration in the sleep lab for determination of
definitive treatment pressures; and
c. Evaluation and treatment of underlying medical conditions or etiologies (e.g., thyroid
disease, opiate use, renal failure, etc.);
and when the back-up rate or ASV device has been shown to be effective in the sleep
lab.

Their policy is found here: http://www.bcbsnc.com/assets/services/p ... evices.pdf

[avi123]

justbreathe, but Dr. Barry Krakow said in a recent interview that there are sleep doctors who know how to bypass the time gap required to spent on CPAP and BiPAPS and they get the insurers to approve ASVs right away.

Listen to the interview:

Dr Steven Park interviews sleep specialist Dr. Barry Krakow:

http://sleeptreatment.com/images/storie ... n-park.mp3