lazarus wrote: ↑
Wed Sep 13, 2023 9:25 am
That said, if I were between a rock and a hard place in which that ideal was unavailable to me in the medical red tape of the country I lived in for some reason, and it was my father, I could see myself obtaining a gray-market-ish ResMed autobilevel (VPAP Auto), reproducing what has worked in a ResMed APAP with EPR, and then watching OSCAR charts to see what a 4cm PS (then 5, then 6, etc.) did for him, just as you originally suggested, while making sure I did not increase AHI.
Although it is not ideal, I have known of some with overlap of OSA and COPD (just as an example) who did some minor dial-winging with a ResMed autobilevel with some success with some increasing of their own comfort and decreasing of AHI.
I am neither encouraging you nor discouraging you--just passing along what I think I know and what I believe I have seen, as some guy on the Internet. It wouldn't be my preference as an approach, but I also understand the concept of not allowing the perfect to be the enemy of the good, simultaneously keeping in mind the balancing principle of "striving to better, oft we mar what's well.”
Thanks for the feedback, originally I had tried to go through the NHS to get his sleep apnea investigated, but this was during the height of Covid and his doctor wasnt that interested. Thankfully, unlike Bilevel or anything with IVAPS or ASV, its not so difficult to get access to CPAP machines in the UK. You can get an HNS approved home sleep test done for a relatively small amount of money and this allow's you to purchase a CPAP machine.
I started going back through his medical records to see if there was any avenues to pursue.
ENT examined him with an endoscope and said they didnt see any issues, although it was about 4 years ago and his posture has declined further since then.
I mentioned I did get him to see his doctor who assesed his breathing as being ok, despite it looking bit odd.
He did see another doctor who said they thought something wasnt right, and put a referral in the system about a year ago but no response since then. I will chase this up.
Whilst researching on this forum I did see a number of posts by Rick Blaine and saw one post with a reference to a specialist who could assist with providing Bipap machines, although I forgot to save it and need to look for it again. I think Bilevel or possibly Ivaps would be the only two options anyway. He doesnt have central sleep apnea and can breathe under his own steam so I dont think ASV would be relevant anyway. Its probably easier to get a prescription for Bilevel than iVAPS. It may be possible to get a second hand bilevel and if nothing else I can see how he gets on with that vs his existing CPAP treatment.