CPAPtalk.com

AdmiralCougar wrote:

Snoredog wrote:

AdmiralCougar wrote:

DanGr wrote:
Oh while at it, any mask recommendation? I don't think I breath using my mouth at all or very little.

Thanks for any Input,
Daniel

Snoredog wrote:

Sergey45 wrote:You can take a look at my mask’s diary. It’ll give you some ideas and directions to go (perhaps). Good luck.

You are starting to get annoying just like SPAM, it is obvious you only post to promote and peddle your own CPAP accessories. Your response has nothing to do with this persons question, it wasn't about masks at all.

Hey Snoredog, bit snippy today? You sounding like you need a huggle *huggles up Snoredog* OK just had to say he did ask about mask suggestions.

And Daniel good luck on picking the right equipment for you. I'm really glad they are giving you the choice, and not just shoving one or the other at you.

Christy

You have the gull to say that after as much complaining you've done?

I think I nailed it in the first post, pretty obvious from this end especially when you go to his mask review site and there is nothing but links to his preferred medical supply sites.

So I stand by what I said above.

You know Soredog I've always thought I liked you. I only mentioned anything at all because It looked like you over looked that line in the first post. I tried to be light hearted when I posted that, which for me has been real hard lately. I never intended to offend you. Apparently I've just been getting under you skin. I never thought I complained about any other user. Like your attack at both Sergey and then Me. Now I've never gone to Sergey's site. I've not felt I needed to research much on others mask choices because there are very few I know I could possibly stand wearing. Now if you hadn't said that Dan never asked the question I never would of said anything, and you could of pointed out that it's just a bunch of links to medical supply sites without attacking me as well. So your problem with me must be that I'm new and having a number of problems, and like most I'm not getting much support from those who should be giving it, and I brought them here. To a place where I thought was an environment where you could feel to ask for help, or vent if need be. Forgive me because apparently I was wrong. You wont be seeing that anymore because apparently this isn't the place to do that. Just so you know Snoredog, what you said really hurt.

To anyone else who may want to talk with me send me a PM, most I'll probably be doing for a while at least is checking my messages and a few of the threads currently up that I've taken interest in until they die out, because apparently I've been complaining to much.

Dan I'm sorry I brought this to your thread, I almost took it to PM's but I felt publicly assaulted. I wont post anymore here.

Snoredog wrote:look at Christine's history, she had a S/T for years and didn't see much if any improvement, they put her on the AdaptSV and she got her life back. So to me that was improvement.

Well, Christine (christinequilts) has almost pure Central Sleep Apnea, so the Adapt SV was made to order for her kind of sleep disordered breathing.

DanGR may have central sleep apneas that do need treating. Or may not. He may not need anything even remotely like an S/T machine OR an ASV machine. If it were me, I'd want that titration study looked at by StillAnotherGuest.

rested gal wrote:

Snoredog wrote:look at Christine's history, she had a S/T for years and didn't see much if any improvement, they put her on the AdaptSV and she got her life back. So to me that was improvement.

Well, Christine (christinequilts) has almost pure Central Sleep Apnea, so the Adapt SV was made to order for her kind of sleep disordered breathing.

DanGR may have central sleep apneas that do need treating. Or may not. He may not need anything even remotely like an S/T machine OR an ASV machine. If it were me, I'd want that titration study looked at by StillAnotherGuest.

That is true but I see it as totally different approaches. My understanding was the AdaptSV was designed to treat Complex Sleep Disordered Breathing which we know as a combination of obstructive and central apnea. While we are finding it is not as "rare" a disorder as first thought, Patients with this disorder could not use a autopap or any machine that changed pressure as it only made the condition worse.
So CPAP was the chosen therapy but then it also had its share of problems and was found it didn't address all the obstructive events without adversely impacting the Centrals seen hence the name Complex Sleep Disordered Breathing.

But it is a valid point with Christine's case, my understanding is she had a severe case of Central Sleep Apnea as her primary disorder yet the machine designed for CSDB worked for her. We have also seen in some cases with CSR that the AdaptSV may have helped there. I think they even include the waxing and waning seen with CSR in the brochure. In the past the S/T machine was the machine of choice for CSR but it no longer seems to be the case.

I could be easily wrong and there is still use for the S/T machine depending on the disorder, but it just seems we see more and more patients migrating to the AdaptSV machines and getting much better results than what they seen on a S/T, Christines is only one example. I think dllo recently switched to an AdaptSV and he had CHF or was close to it.

Argh, this can be so complex! (and I have read hours upon hours of information from this forum).

I almost sent the information for the Synchrony ST to my insurance, but the fax failed and I had to go so couldn't re-send it. Maybe it is a sign!

rested gal wrote:What kind of home study did you have to begin with? Do you know the name of the equipment they used for the home test? Presumably there was a belt around your chest or abdomen since they came up with a Central Apnea Index (which was so low as to be insignificant.) I wouldn't think there were any electrodes on your scalp monitoring any EEG stuff, were there?

I have everything from my home test (you can see some information in one of my previous message).

To answer your questions, home test was done using Stardust II and yes I had a belt around my chest/abdomen (mid-section I guess). No electrodes on the home test on my scalp. I had hoses in the nose (whatever they are called) and infrared on one finger.

In summary for 8h I had 12 Central Event, 310 Obstructive 16 Mixed and 12 Hypopneas.

rested gal wrote:But what really has me wondering... is whether the later study in the sleep lab was competently performed or competently scored. It's always possible that the tech conducting your titration rushed the cpap pressure changes and that you were having temporary centrals popping up just from the change from one pressure to the next.

Ok here is a summary (and translation) of both text (one from the tech on site and the other from some other tech I guess), hope this can help (sorry for typos and all its late and I am hurrying!):

Manual Titration, software Sandman, Mask = Flexifit HC405 (and yes I had like 20 sensors on me, legs, scalp, etc). Studies was about from midnight to 6am.

The text from the Inhalotherapeute (tech) on site:

... the patient goes back to sleep (I couldn't sleep so I read for a while to relax I am used to only go to bed at midnight) and it is only at 1:30am that he really fall asleep but with a very fragile sleep and many central apneas. This is a hard titrating. A few hypopneas obstructive and some snoring and CPAP raised to 7. But the patient wakes up again at 2:30am and start again doing Central Apneas and Hypopneas obstructive with desaturation up to 80% and awakeness.This will be reccuring the whole night. Unexpected situation the patient does Central sleep apneas in light sleep as well as hyponneas obstructive. The Bipap started at 2:40am with 7/4 and backup freq of 8 which will then raised to backup 12 then backup 14. sicne the Sptaneous frwquencies for the patient was 14 in deep sleep, pressure is always gradually incrase up to 16/8 to limit desaturation. The first REM happens at 3:30am when patient on left side with pressure of 14/6 and frequence 12. Everything goes well. Near end of night even with final parameters 16/8 FR14 as in ration 1:3.5, some hopopneas central and obstructive and desaturation 88% still present ion the light sleep only although less lenghty and desaturation less deep. Mask was well adjust during the night and minimal leaks...


The second guy (I guess he reviewed the session the next day):

... the patient goes to bed at 12:30am took about 30min to fall asleep on the right side... anomalies mostly central and some obstuctive as soon patient falls asleep. Snoring visible and pressure CPAP raised to 6, deep sleep appear, obstuction makes CPAP is raised to 7. Because more Central than Obstructive the tech engage with a bipap 7/4 backup 8 to be increased at 12 backup at around 3am. The patient maintain 'stade 1' - awake AD (not sure how to translate this - Awake, Stade 1, Stade 2, stade 3, Stade 4, Stade REM), Force increased to 9/5 then not long after pression raised to 12/6 on Central anomalies. Patient is on left side. Respiration normalized for a good while. Bipap raised to 14/6 and paradoxal sleep appears with regular breathing. Saturation maintain at 92%. Then a lighter sleep with unstables Stade with a mix of Hypopneas Obstructives, Central and Mixted and a saturation drop to 83%. We then raised to 15/7 with a backup frequence of 14. Patient still on the left. Respiration normalise again for any light sleep, deep or REM. at those bipap settings. Near the end of the night other anomalies of the 3 types appear again and force is raised to 16/8 and respiration is back to calm for a few minutes then the same trouble pattern seems to want to come back but it is the end of the study. Signed by an Ihnalotherapeute (french title of those tech).


Then they send this information to an expert lung doctor working for that lab, here is what he had to say:

Some summary of the above then:

Impression:
Study compatible with a syndrom apneas-hypopneas complex (underlined by the doctor not me!) rather well controled with BiPAP 16/8 + FR 14 (we could increase IPAP to 18 ).
A control of saturation, under treatment, will be useful especially if the clinical answer is mitigated

Note: It does say COMPLEX in his impression, maybe that could be it for me to have the Insurance pay for the Auto SV2 if it would be a good xPAP for my case.


And my Lung doctor basically copied BiPAP 18/8 FR 14 on my prescription, I don't think he knows much about more complex apneas.


Soooo does this help? Heck if this can help I can try and post the rest of the data!

rested gal wrote:I'd want several more expert opinions (not from the doctor in charge of the lab or the pulmonologist who has prescribed a timed back up rate) about the titration study before I'd accept that I had a significant enough problem with centrals to warrant the expense of an S/T and the possible discomfort and sleep disruptions of using a timed back-up rate that I might not even need.

Unfortunatly this is easier done than said, I am not sure where to turn to get more answers, my lung doctor is not a specialist (took a while to get an appointment and had to be a reference from a generalist doctor). Fortunatly I found this forum. If after reading this some think I might need to re-do a night study or something maybe I can see to get it (those are very costly though!).


--------------------------------

Snoredog wrote:I agree, I think the S/T machine is rapidly becoming a dinosaur in the presence of these new AdaptSV machines. For example look at Christine's history, she had a S/T for years and didn't see much if any improvement, they put her on the AdaptSV and she got her life back. So to me that was improvement.

Well that is why I am wondering if I should just try and push to get a Respironics Auto SV2, although I don't know if the insurance would pay for it. Also, like many were asking me in here, it seems my Central Apneas might not be that bad.

Snoredog wrote:That back up "Timed" mode is old school, if a machine can stabilize your breathing then you don't need that backup timed mode. The FR=14 rate is simply the back up breathing rate you need (your doctor's best guess or from the titration) when the patient stops breathing. Value seems a bit high to me but I could easily be wrong.

That is the other question, if I don't really need the backup mode, I would probably best served with a normal Auto BiPAP of some kind...


About Snoredog reply to Rested Gal:

Snoredog wrote:That is true but I see it as totally different approaches. My understanding was the AdaptSV was designed to treat Complex Sleep Disordered Breathing which we know as a combination of obstructive and central apnea. While we are finding it is not as "rare" a disorder as first thought, Patients with this disorder could not use a autopap or any machine that changed pressure as it only made the condition worse.
So CPAP was the chosen therapy but then it also had its share of problems and was found it didn't address all the obstructive events without adversely impacting the Centrals seen hence the name Complex Sleep Disordered Breathing.

But it is a valid point with Christine's case, my understanding is she had a severe case of Central Sleep Apnea as her primary disorder yet the machine designed for CSDB worked for her. We have also seen in some cases with CSR that the AdaptSV may have helped there. I think they even include the waxing and waning seen with CSR in the brochure. In the past the S/T machine was the machine of choice for CSR but it no longer seems to be the case.

I could be easily wrong and there is still use for the S/T machine depending on the disorder, but it just seems we see more and more patients migrating to the AdaptSV machines and getting much better results than what they seen on a S/T, Christines is only one example. I think dllo recently switched to an AdaptSV and he had CHF or was close to it.

Although I am far from an expert compare to you guys, I kinda feel the same way... If those ASV are top of the line and can work for almost anything (granted it might be an overkill), why not just go for them whenever we can?

Anyway, now I need to go Not-Sleep if I want to Not-Be-to-sleepy tomorrow at the job!

Regards,
Daniel

P.S. Is the Respironics Harmony 2 = to the BiPAP ST Gray model or something? If I am to get a ST it could be a good alternative to the Synchrony ST.

AdmiralCougar wrote: So your problem with me must be that I'm new and having a number of problems, and like most I'm not getting much support from those who should be giving it, and I brought them here. To a place where I thought was an environment where you could feel to ask for help, or vent if need be. Forgive me because apparently I was wrong. You wont be seeing that anymore because apparently this isn't the place to do that. Just so you know Snoredog, what you said really hurt.

Snoredog's problem has nothing to do with your being new. Snoredog's problem is a direct result of your pointing out the fact that DanGR did ask about masks.

When snoredog considers a spade a spade, he will always attack anyone who suggest it may be a rake. It's automatic, I doubt he controls it.

snoredog wrote: I don't come here for any popularity contest or to socialize and complain, I come here to help those with problems encountered with their cpap therapy

snoredog wrote:You have the gull to say that after as much complaining you've done?

Attacking other people when they disagree with you does a lot to turn off people who need help especially newbies who haven't discovered your SOP.

Snoredog will only "help" those who take his word as immutable law and admire his knowledge. Maybe he doesn't want to be loved, but if you don't admire him, if you poke good natured fun at him, if you point out he's not infallible, you are going to be personally attacked. One of snoredog's favoirite attack theme is the tune "why do you complain instead of doing what I told you".

You can take or leave snoredog - but treating the whole forum as though it had snoredog's rules of engagement does a disservive to both yourself and other forum members.

This is not snoredog's forum.

O.

DanGr wrote:Argh, this can be so complex! (and I have read hours upon hours of information from this forum).

I almost sent the information for the Synchrony ST to my insurance, but the fax failed and I had to go so couldn't re-send it. Maybe it is a sign!

rested gal wrote:What kind of home study did you have to begin with? Do you know the name of the equipment they used for the home test? Presumably there was a belt around your chest or abdomen since they came up with a Central Apnea Index (which was so low as to be insignificant.) I wouldn't think there were any electrodes on your scalp monitoring any EEG stuff, were there?

I have everything from my home test (you can see some information in one of my previous message).

To answer your questions, home test was done using Stardust II and yes I had a belt around my chest/abdomen (mid-section I guess). No electrodes on the home test on my scalp. I had hoses in the nose (whatever they are called) and infrared on one finger.

In summary for 8h I had 12 Central Event, 310 Obstructive 16 Mixed and 12 Hypopneas.

rested gal wrote:But what really has me wondering... is whether the later study in the sleep lab was competently performed or competently scored. It's always possible that the tech conducting your titration rushed the cpap pressure changes and that you were having temporary centrals popping up just from the change from one pressure to the next.

Ok here is a summary (and translation) of both text (one from the tech on site and the other from some other tech I guess), hope this can help (sorry for typos and all its late and I am hurrying!):

Manual Titration, software Sandman, Mask = Flexifit HC405 (and yes I had like 20 sensors on me, legs, scalp, etc). Studies was about from midnight to 6am.

The text from the Inhalotherapeute (tech) on site:

... the patient goes back to sleep (I couldn't sleep so I read for a while to relax I am used to only go to bed at midnight) and it is only at 1:30am that he really fall asleep but with a very fragile sleep and many central apneas. This is a hard titrating. A few hypopneas obstructive and some snoring and CPAP raised to 7. But the patient wakes up again at 2:30am and start again doing Central Apneas and Hypopneas obstructive with desaturation up to 80% and awakeness.This will be reccuring the whole night. Unexpected situation the patient does Central sleep apneas in light sleep as well as hyponneas obstructive. The Bipap started at 2:40am with 7/4 and backup freq of 8 which will then raised to backup 12 then backup 14. sicne the Sptaneous frwquencies for the patient was 14 in deep sleep, pressure is always gradually incrase up to 16/8 to limit desaturation. The first REM happens at 3:30am when patient on left side with pressure of 14/6 and frequence 12. Everything goes well. Near end of night even with final parameters 16/8 FR14 as in ration 1:3.5, some hopopneas central and obstructive and desaturation 88% still present ion the light sleep only although less lenghty and desaturation less deep. Mask was well adjust during the night and minimal leaks...


The second guy (I guess he reviewed the session the next day):

... the patient goes to bed at 12:30am took about 30min to fall asleep on the right side... anomalies mostly central and some obstuctive as soon patient falls asleep. Snoring visible and pressure CPAP raised to 6, deep sleep appear, obstuction makes CPAP is raised to 7. Because more Central than Obstructive the tech engage with a bipap 7/4 backup 8 to be increased at 12 backup at around 3am. The patient maintain 'stade 1' - awake AD (not sure how to translate this - Awake, Stade 1, Stade 2, stade 3, Stade 4, Stade REM), Force increased to 9/5 then not long after pression raised to 12/6 on Central anomalies. Patient is on left side. Respiration normalized for a good while. Bipap raised to 14/6 and paradoxal sleep appears with regular breathing. Saturation maintain at 92%. Then a lighter sleep with unstables Stade with a mix of Hypopneas Obstructives, Central and Mixted and a saturation drop to 83%. We then raised to 15/7 with a backup frequence of 14. Patient still on the left. Respiration normalise again for any light sleep, deep or REM. at those bipap settings. Near the end of the night other anomalies of the 3 types appear again and force is raised to 16/8 and respiration is back to calm for a few minutes then the same trouble pattern seems to want to come back but it is the end of the study. Signed by an Ihnalotherapeute (french title of those tech).


Then they send this information to an expert lung doctor working for that lab, here is what he had to say:

Some summary of the above then:

Impression:
Study compatible with a syndrom apneas-hypopneas complex (underlined by the doctor not me!) rather well controled with BiPAP 16/8 + FR 14 (we could increase IPAP to 18 ).
A control of saturation, under treatment, will be useful especially if the clinical answer is mitigated

Note: It does say COMPLEX in his impression, maybe that could be it for me to have the Insurance pay for the Auto SV2 if it would be a good xPAP for my case.


And my Lung doctor basically copied BiPAP 18/8 FR 14 on my prescription, I don't think he knows much about more complex apneas.


Soooo does this help? Heck if this can help I can try and post the rest of the data!

rested gal wrote:I'd want several more expert opinions (not from the doctor in charge of the lab or the pulmonologist who has prescribed a timed back up rate) about the titration study before I'd accept that I had a significant enough problem with centrals to warrant the expense of an S/T and the possible discomfort and sleep disruptions of using a timed back-up rate that I might not even need.

Unfortunatly this is easier done than said, I am not sure where to turn to get more answers, my lung doctor is not a specialist (took a while to get an appointment and had to be a reference from a generalist doctor). Fortunatly I found this forum. If after reading this some think I might need to re-do a night study or something maybe I can see to get it (those are very costly though!).


--------------------------------

Snoredog wrote:I agree, I think the S/T machine is rapidly becoming a dinosaur in the presence of these new AdaptSV machines. For example look at Christine's history, she had a S/T for years and didn't see much if any improvement, they put her on the AdaptSV and she got her life back. So to me that was improvement.

Well that is why I am wondering if I should just try and push to get a Respironics Auto SV2, although I don't know if the insurance would pay for it. Also, like many were asking me in here, it seems my Central Apneas might not be that bad.

Snoredog wrote:That back up "Timed" mode is old school, if a machine can stabilize your breathing then you don't need that backup timed mode. The FR=14 rate is simply the back up breathing rate you need (your doctor's best guess or from the titration) when the patient stops breathing. Value seems a bit high to me but I could easily be wrong.

That is the other question, if I don't really need the backup mode, I would probably best served with a normal Auto BiPAP of some kind...


About Snoredog reply to Rested Gal:

Snoredog wrote:That is true but I see it as totally different approaches. My understanding was the AdaptSV was designed to treat Complex Sleep Disordered Breathing which we know as a combination of obstructive and central apnea. While we are finding it is not as "rare" a disorder as first thought, Patients with this disorder could not use a autopap or any machine that changed pressure as it only made the condition worse.
So CPAP was the chosen therapy but then it also had its share of problems and was found it didn't address all the obstructive events without adversely impacting the Centrals seen hence the name Complex Sleep Disordered Breathing.

But it is a valid point with Christine's case, my understanding is she had a severe case of Central Sleep Apnea as her primary disorder yet the machine designed for CSDB worked for her. We have also seen in some cases with CSR that the AdaptSV may have helped there. I think they even include the waxing and waning seen with CSR in the brochure. In the past the S/T machine was the machine of choice for CSR but it no longer seems to be the case.

I could be easily wrong and there is still use for the S/T machine depending on the disorder, but it just seems we see more and more patients migrating to the AdaptSV machines and getting much better results than what they seen on a S/T, Christines is only one example. I think dllo recently switched to an AdaptSV and he had CHF or was close to it.

Although I am far from an expert compare to you guys, I kinda feel the same way... If those ASV are top of the line and can work for almost anything (granted it might be an overkill), why not just go for them whenever we can?

Anyway, now I need to go Not-Sleep if I want to Not-Be-to-sleepy tomorrow at the job!

Regards,
Daniel

P.S. Is the Respironics Harmony 2 = to the BiPAP ST Gray model or something? If I am to get a ST it could be a good alternative to the Synchrony ST.

Here is a link to the CSDB paper:
http://www.talkaboutsleep.com/message-b ... hp?t=13557

If you have access to the journal boards you can probably access the original.

It describes what defines CSDB. If you truly have that disorder (sounds like you do), then you need to forget about the S/T machine and go with the AdaptSV. If you buy that S/T machine and it doesn't settle down or stabilize your breathing you have wasted a lot of money and are back to square one. The AdaptSV is known to stabilize your condition so that is where I would put my money.

Respironics makes one, so does Resmed. These are basically auto machines. The Harmony is a S/T in the Classic shell same as the Remstars (Syncrony is even an older model it is in the case even older than the Harmony).

This is the newest machine:
https://www.cpap.com/productpage-advanced.php?PNum=2471

With the US Dollar currently being so low, you may be better off ordering it from CPAP.com, could save you some money, I would at least check with them.

ozij wrote:
Snoredog's problem has nothing to do with your being new. Snoredog's problem is a direct result of your pointing out the fact that DanGR did ask about masks.

When snoredog considers a spade a spade, he will always attack anyone who suggest it may be a rake. It's automatic, I doubt he controls it.

Attacking other people when they disagree with you does a lot to turn off people who need help especially newbies who haven't discovered your SOP.

Snoredog will only "help" those who take his word as immutable law and admire his knowledge. Maybe he doesn't want to be loved, but if you don't admire him, if you poke good natured fun at him, if you point out he's not infallible, you are going to be personally attacked. One of snoredog's favoirite attack theme is the tune "why do you complain instead of doing what I told you".

You can take or leave snoredog - but treating the whole forum as though it had snoredog's rules of engagement does a disservive to both yourself and other forum members.

This is not snoredog's forum.

O.

Since you "think" you know me so well, you left off the most important part, the part where I tell people like you to kiss my ass.

ozij wrote: When snoredog considers a spade a spade, he will always attack anyone who suggest it may be a rake. It's automatic, I doubt he controls it.

snoredog wrote:Since you "think" you know me so well, you left off the most important part, the part where I tell people like you to kiss my ass.

Q.E.D.

O.

Bah, anyway you could take the fight elsewhere please? This information gathering is important to me and might affect my life quite a lot in the future!

Regards,
Daniel.

DanGR wrote:In summary for 8h I had 12 Central Event, 310 Obstructive 16 Mixed and 12 Hypopneas.

Those results from the home sleep study using the Stardust II don't indicate significant central apneas to me. Sounds like good old OSA. But I'm no doctor.

That said, a hallmark of Complex Sleep Disordered Breathing is that it will show up in very specific ways once cpap is applied. In your later titration night, however, there's no way to know yet if the titration was performed well or not.
Central apneas showing up during a titration can be due to many reasons that have absolutely nothing to do with CSDB (Complex Sleep Disordered Breathing, also called CompSAS - Complex Sleep Apnea Syndrome.)

The tech's report you kindly posted looks to me like it could easily have been a botched titration. But without charts and graphs from the titration night it's impossible for anyone to know what went on.

The tech's report sounded to me like there was a lot of confusion on the part of the tech about what was going on and what to do. The tech may or may not have done the right things. If putting you on bi-level with a backup rate during the titration was not the right thing to do, then the whole exercise may have caused problems, resulting in a recommendation for a machine that you don't need and might not even treat you well.

That's why I keep saying it's important to get a very knowledgable second opinion about your titration study before deciding on a machine.

About getting a second opinion, I sure understand and sympathize with you on this:

DanGR wrote:Unfortunatly this is easier done than said, I am not sure where to turn to get more answers, my lung doctor is not a specialist (took a while to get an appointment and had to be a reference from a generalist doctor).

StillAnotherGuest (a very knowledgable manager of a top notch accredited sleep lab and a poster on this board) would be who I'd turn to.

On Click here to go to page 31 of the very long thread about the ASV machine:

Excerpt from a post by Christinequilts on that page:

The most important conclusions about ASV overall have been:
1. You have to know what you treating before you treat it....but that goes with any aspect of sleep medicine and any type of machine, period.
2. You have to have central disordered breathing to benefit from ASV technology...it doesn't do anything for obstructives that strait CPAP can't do...and may even do worse.
3. The Adapt is mask specific and no masks that severely restrict air flow should be used with it.
4. Doctors have a lot to learn about ASV and not all of them are aware of basic treatment parameters, let alone how or why it 'works' yet.



Dan, Christine's point 4 is sooooo important, imho. Just because the pulmonologist who works for the sleep lab said "Complex" and underlined it doesn't mean that's so -- IF the titration was messed up.

Perhaps I'm too cynical, but I think many, many busy "sleep doctors" just sign off on whatever the sleep tech comes up with, rather than take the time to really look closely at the study itself -- not even at a few epochs of the raw data.

I've often said, I'd want an extremely good sleep tech and scoring tech doing the study. To heck with whether the doctor who was going to get paid to "interpret" the study knows anything at all or even glanced at it. The techs (most of all the scoring techs) are the ones responsible for our diagnosis and our Rx, imho, even though it's the "signing off" doctor who gets the big bucks for taking a moment to glance at the tech's report and add a canned "ditto" to it.

A combo of centrals, obstructives, and mixed apneas do not mean a person has Complex Sleep Breathing Disorder. It's more "complex" than that and has to do more with when the centrals occur while using cpap as well as the amount of them, as I understand it. I could be wrong.

On page 32:
Excerpts from a post by StillAnotherGuest:

It will be interesting to see their definition of CompSAS, and one would expect that it would include central apneas. And also how they specifically define period breathing. Everybody is leaning towards persistent central apnea index (CAI) > 5 after treatment to define CompSAS, so I'm maintaining that if you have a central apnea index of "0" you don't have CompSAS, and if you don't have CompSAS or CSR, being put on an AdaptSV is a monumental waste of time and effort.

---

there has to be careful patient selection where you want to even consider ASV. You can see in the Morgenthaler study their mean AHI post-CPAP treatment was 34.3. If the persistent CAI is only 5 to maybe about 20, one needs careful consideration before deciding to try AdaptSV, because runaways can create more problems than you fix.


More topics of interest about centrals:


Thanks from a newbie


Discussion about central apneas starting here on page 3.Take special note of the posts on the next pages (p. 4 & 5) by Christinequilts and StillAnotherGuest

Dan, what I'm getting at with these links is that there is no clear indication that I can see (but I'm sure no expert) in the titration report you kindly posted that you have the type of central apneas associated with Complex Sleep Disordered Breathing or Central Sleep Apnea -- the latter being what an ASV machine was specifically designed to treat...central apneas, not obstructive apneas. If you have mostly OSA with just some centrals, or especially if the titration was CAUSING centrals to pop up that wouldn't have happened in a better handled titration, then it could be quite a mistake to get either an ASV or (a lesser mistake) an S/T machine.

DanGR wrote:If those ASV are top of the line and can work for almost anything (granted it might be an overkill), why not just go for them whenever we can?

I think there's a big misconception about an ASV being "top of the line." As I understand it, the ASV is not "top" of anything. It is one of a kind. It is in a class by itself...a unique machine designed for a very specific purpose...to treat CENTRAL apneas. It may or may not handle obstructives well. It's a champ at dealing with true primary Central Sleep Apnea and with the kind of central apneas seen in the Cheyne-Stokes respiration pattern typical of many CHF (Congestive Heart Failure) patients. It's a miracle machine for those people.

But to think an ASV can work well for "almost anything"...I don't think that's the case. In fact, I think it could give very poor treatment for someone who has primary Obstructive Sleep Apnea.

Which all goes back to:
Gotta know what you need to treat before you try to treat it. And before you select a machine to treat it with.

rested gal wrote:

Snoredog wrote:look at Christine's history, she had a S/T for years and didn't see much if any improvement, they put her on the AdaptSV and she got her life back. So to me that was improvement.

Well, Christine (christinequilts) has almost pure Central Sleep Apnea, so the Adapt SV was made to order for her kind of sleep disordered breathing.

DanGR may have central sleep apneas that do need treating. Or may not. He may not need anything even remotely like an S/T machine OR an ASV machine. If it were me, I'd want that titration study looked at by StillAnotherGuest.

Just thought I'd jump in here.... It appears to me that ChristineQuilts has passed away.

She is not responding to email or snail mail, and has not sent out masks that have been paid for.

Either that, or she has become incapacitated.

Cheers,
Barbara

Hey all,

Here is an update, I spoke with many peoples about all this (many from this forum, you guys can be so helpful!) and even got to get a second opinion from an expert that reviewed the data from my manual titration.

It seems I might in fact suffer from CSDB (which means the analyst might have mean that when he wrote Complex) and that probably an ASV PAP might be a good/better/best solution for me.

I managed to get an appointment tomorrow morning with my Lung doctor to review my test data and I will talk to him about ASV PAP and hopefully he can prescribe me this directly if he thinks it could help as opposed to me getting a ST PAP. I might ask him for more test in lab if needed, etc.

What I would like most at this point is differences between the ResMed AdaptSV (Autoset CS2 in Canada) and the Respironics BiPAP AutoSV (AutoSV2 in Canada), I couldn't find much info that compare both (I have seen the picture posted by SAG but it was done by Respironics so might not be fair to ResMed). At this point I think I am more inclined to go with Respironics.

If you have any last minute tips for me don't hesitate to post them here or send me PMs. I will be sure to read this before my appointment early tomorrow morning!

Regards,
Daniel G.

DanGr wrote:I have seen the picture posted by SAG...

Which picture? This one?

BiPAP AutoSV 10/5 Addressing "Central Apnea"



SAG

StillAnotherGuest wrote:

DanGr wrote:I have seen the picture posted by SAG...

Which picture? This one?

BiPAP AutoSV 10/5 Addressing "Central Apnea"

SAG

Nope the one from this post:
viewtopic.php?t=16527&highlight=asv

Update:

Well I met with my lung specialist today to try and see if we could work on defining if I really do CSA/CSDB and the BEST way to treat it (an alternate source thinks I might do CSDB after reviewing my titration data). He didn't really want to talk about it or change my prescription or anything, just want the plain old BiPAP 16/8 FR14 (which means the DME has to follow those settings). Basically the old way to treat CSA befor ASV models.

So I went ahead and met with a generalist doctor to get a new reference to see another lung specialist for another opinion (in Quebec Canada you need a reference to be able to go see most specialists). Not only I have it but the name is not specified so I can try and find any lung specialist /neurologist I want in the hope to find one that know more about CSDB and ASV xPAP!

If you live in the Montreal area feel free to suggest good ones!

Also, it seems the private lab that did my titration might be able to do ASV titration if I need one (I guess I would be a good reason for them to upgrade, or it is easy to set it up maybe).

So everything looks good, hopefully I can confirm 100% about the CSDB and get the proper treatment and xPAP, I can't wait to sleep well!

Later,

Daniel