Central Apnea

Snooze_Blues wrote:

dllfo wrote: Hope I answered your questions....

Yes, thanks. Sounds like they developed these servo ventilation units just in time to help you survive despite several serious issues.

Let me throw in one more question...

Did the Encore Pro software come with your machine or did it cost extra? I'm assuming you have it, but maybe you don't.

I can't figure out if an individual can actually buy Encore Pro these days. It doesn't seem to be listed for sale any longer on cpap.com, or other sites I've visited. Everyone seems to be pushing the EncoreViewer software now and it looks to have a lot less features and capabilities, although it's likely more layperson friendly (simpler to install and use). But it doesn't look like EncoreViewer is listed in the SV offering on cpap.com, only Encore Pro, so hopefully, I could get myself a copy of Encore Pro somehow.

I appreciate the responses.

I'm probably getting a bit ahead of myself since I've been told I'll first be placed on a simple CPAP device, but will probably need an "adaptive servo ventilation" device eventually.

RosemaryB wrote:

Is it that you want the software so you can be on the cpap for less time? If so, that's good thinking.

I've never heard of insurance paying for it.[/quote]

Rose...,

Yes, the doctor says that might be possible as I am in the middle of a thus far successful march toward a lower BMI (weight). I started at 215 (at my max) and am down to 180 (at my min, but I do flux a few lbs week by week). My goal is a BMI of 22 - 24, or roughly 150 - 160 lbs. I bicycle and that is a good, and fun, way to do it for me, plus I have dropped a few bad eating habits.

But nearly as much as getting off the thing, and to help with that goal, is to know what the heck is going on at night while I'm asleep, or what seems to pass for sleep architecture in my case. I'm a software guy from way back and to have hardware with no metric monitoring software is for me, unacceptable.

I certainly don't expect insurance to pay for the software. I just want to know if I can buy it. It looks like it is highly discouraged for "patients" by the vendors and the sleep labs. Apparently, ignorance is bliss in sleep data.

Congratulations on the weight loss! That will help your health in many ways.

I just wanted to clarify my statement about "being on the cpap for less time." I meant "being on the cpap for less time before you get on the SV unit." I wasn't clear about that.

Respironics does seem to support patient software use. That's why they made Encore Viewer. I think the only difference between that and Encore Pro is that the viewer (patient) software doesn't have the feature where you can change your pressure using the software. Most people who change pressure don't use the software anyway, so it's not a big issue.

I don't know if James Skinner's Encore Pro Analyzer works with it, or how (or if) any of the software works with a more sophisticated machine like the SV, though. You could do a separate post asking about that and those who know are likely to chime in.

First, let me qualify some of my answers. My memory is poor. I have to look things up quite a bit, the morphine had ruined my memory functions.

I never had a CPAP, I went straight to the Respironics BiPap Auto. My initial sleep study showed I had Complex/central sleep apneas, Cheynes-Stokes Respirations, PVCs and halitosis. So they put me on a BiPap Auto. It worked well for about a year...then my problems started up again.

They tested me locally for the standard stuff and I passed the PST, PFT,
Methachlomine Challenge Test, etc. Pardon my spelling please. BUT I still had low Pulse Ox reading most of the time. I bought my own pulse ox measurement device (can't remember the name) and I kept a log of my low
pulse ox. After a few weeks of this I was put on oxygen. Then, as I was sitting in my LazyBoy recliner, I finished a sentence while talking to my wife and could not get any air in. I made about 3 steps towards the oxygen before I hit the floor. EMTs arrived, I spent the day in Critical Care. I suspected Vocal Cord Dysfunction due to severe GERD. The government took me off Nexium because it was too expensive, I went back on prevacid and my GERD returned with a vengence. A nurse in Mercy San Juan Hospital saw a group of doctors standing around me, listened, then proceeded to explain VCD to the respiratory staff. I need to use Heliox. Mercy San Juan did not have any Heliox. That was Wednesday, by Friday I had 4 E bottles and an H bottle of Heliox. Heliox has stopped several attacks in the last several months. But my pulse ox was still low and I was fatigued all the time.

Long story short is I was sent to the National Jewish Hospital (NJC) for a week of lung tests. NJC in Denver, CO is the #1 Respiratory Hospital in the
USA - for 10 straight years. They kept me a second week and a third and a fourth....I had a hole/tear in my heart that allowed my desat blood to cross over into the oxygenated blood...= low pulse ox. My sleep study was so bad the head of that department called my Primary doctor, asking him to come up and review it with him. That was before they found the hole/tear in my heart. I have not seen the write up from that test, but Medicare did not blink an eye when my Pulmonologist wrote up the medical necessity form to put me on the SV.

NO ONE in the Sacramento area had the Respironics unit. Apria said they did not expect to be trained on it and be able to sell it for some months, as did the others. Apria said they had to schedule some meeting to determine THEIR liability if they sell me the unit. I told Apria their charter with Medicare and Tricare was to provide medical equipment, not second guess our doctors, if they were unwilling or unable to sell me a required piece of medical equipment, I would call Medicare and Tricare to inform them Apria was defaulting on their contract and we need to find a company who can do it. I got the machine a couple days later. I gave Apria a waiver of liability for the settings on this machine. My doctor and I (plus a couple of RTs I met while out of Calif.) worked it out just fine.

Encore Pro 1.8.65 is available if your doctor gives you a prescription for it.
Respironics sells to the DME, the DME sells it to you. I have 1.8.65. I have not tried to change my pressures with the Smart Card and software. It is very easy to do it with the buttons on the machine. My Respironics BiPap Auto could be changed through the smart card, I guess the SV can be changed too, but I haven't tried it.

I hope that answered a few more of your questions...

dllfo wrote:Encore Pro 1.8.65 is available if your doctor gives you a prescription for it.
Respironics sells to the DME, the DME sells it to you. I have 1.8.65. I have not tried to change my pressures with the Smart Card and software. It is very easy to do it with the buttons on the machine. My Respironics BiPap Auto could be changed through the smart card, I guess the SV can be changed too, but I haven't tried it.

I hope that answered a few more of your questions...

First, let me just say, holy mackerel! It sounds like you are lucky (if you can consider such misfortune as "luck") to be alive! My issues, of course, pale in comparison, but hey, they're all I've got. And I can relate to the memory thing. I'm hoping that might improve a bit on a CPAP. I sat down here 10 minutes ago and have already nodded off once, and it's only 3:30 pm here.

Thanks for answering the Encore Pro v1.8.65 question. That is what I've been wanting to know and couldn't find the answer. At least I know I can get it if I can get some assistance from my doctor, even though it no longer shows up on any online DME sales sights that I can find.

I've been dragging my feet, trying to get an autoPAP before I realized it would probably aggravate my centrals. Two days ago I got a letter from the sleep doc saying I should consider getting going with my CPAP acquisition ASAP since my condition was "severe" (I thought it was just moderate) and wasting time was simply going to accelerate the onset of all the many issues he included in the letter, presumably to scare me in to acquisition and compliance. I think it's working, but I now need to decide between two machines, the Respironics M Series Pro and the Resmed S8 Elite, and I think the biggest personal considerations in my case are two:

1. the software available for each (i.e. is one better than the other), and

2. which Adaptive Servo Respiration device is mostly likely to be prescribed for me later, should it come to that, after analyzing my response to CPAP therapy for a month or however long the Doctor chooses to wait based on a likely follow up sleep study. It might be nice to be able to use the same software from my CPAP purchase on the VPAP ASR if that is in my future. With the card reader, the software looks like it will cost over $300 after tax and shipping. But on the other hand, that's not a huge amount if I have to spend it twice, I suppose, assuming my health is improved in the interim.

But I think I'll start a new thread for that. Maybe search the archives a bit to see if that question has already been answered. Thanks again. And best wishes to you in your treatment.

I want to weigh in on this thread

the software available for each (i.e. is one better than the other), and

2. which Adaptive Servo Respiration device is mostly likely to be prescribed for me later, should it come to that, after analyzing my response to CPAP therapy for a month or however long the Doctor chooses to wait based on a likely follow up sleep study. It might be nice to be able to use the same software from my CPAP purchase on the VPAP ASR if that is in my future. With the card reader, the software looks like it will cost over $300 after tax and shipping. But on the other hand, that's not a huge amount if I have to spend it twice, I suppose, assuming my health is improved in the interim.

I have been on the ResMed ASV since June 2006. I like it and have not had an opportunity to try the Responics machine. Centrals and CSDB are certainly prevalent in any of my 5 PSGs over the years. I started on CPAP, went to BiPap and then tried the ASV not long after it became available.

Rested Gal can certainly point us to a link with a long 34 + page discussion on Central Apneas and the ResMed and Respironics approaches. they are different.

For your comment on software, the CPAPs and BiPaPs report the Apnea/Hyponea Index (AHI). As far as I know there is no such measurement index for the software and data from an ASV.

So even if you monitor your results, with CSDB and lots of centrals, there may not be a nice clean index available for you to read in the software summary.

DSM, another regular on this board, indicated that he heard from his neck of the woods (Australia) that ResMed (started down under) was working on a software mod to report some type of index, and the assumption was they were trying to get it ready and approved by US FDA. I don't know if this is a fact and haven't seen anything on it.

If they ever do something like this, recording and analyzing your own data would be more user friendly for a CSDB sufferer using ASV.

The approaches for the ResMed and the Respironics machines appear to be quite different. I happen to like the ResMed but found it was only most effective for me when treated with an added twist of more CO2, using
a CO2 rebreathing technique developed at Beth Israel Deaconess Hospital in Boston (teaching hospital for Harvard medical school). However that may not necessarily be the right answer for you.

For me the ASV algorithm needed a bit of help from the CO2 rebreathing technique known formally as EERS.

All i can say to you in general is continue to ask questions and learn, because many of the professionals out there don't have much experience with treating CSDB. And if you get a good doctor and a good DME your are the exception to the norm.

At least in St Louis you dont live at altitude like I do.

Welcome to CpapTalk.

Lubman

Snooze, hang in there. Complex sleep apnea is tougher to treat, but can be managed with the right combination of settings, wether it be the newish ASV or a BiPAP with a rate. The letter about getting on the CPAP is because, while you are indeed having centrals, you are also having obstructive apneas, which need to be treated. "But what about the centrals", you ask. Recent studies suggest that, over time, centrals will decrease with compliant CPAP use (for some people, not everybody). The point is, don't delay therapy for your obstructive apneas while trying to figure out all this other stuff.

BTW, "type 1 hypopneas" are tech-speak for a hypopnea where your O2 level dropped at least 4% (minimum, maybe more). "type 2" are hypopneas where the minimum desat is 3% (althought Medicare won't recognize. It's an insurance thing, unfortunately)

Oh, and BTW, the number of "normal" centrals is the same as the number of "normal" obstructives.......5/hour.

Hi Some people do better on straight cpap

I am one of them.

I have a sweet point at 9CM

Above or below that my results are not so good

At that around 1.0 -1.2 Ahi

C-flex at 2 seems overall best for me

No flex sometimes gives me lower number but is not as confortable

Other possibilities for improved theraphy made be found in the choise of interfaces

Some interfaces work better than others for any given individual

My theraphy improved as I went from the Bravo to the Mirage Swift II to the Nasal aire II

And results with the NA II were dependant upon the manner in which it was worn

Ponytale style with shortened tubes did the trick for me

And hose management issues

I have a swivel plant hanger mounted up over my bed and the hose hangs down from it

Breatheright strips and sinus rinses I find also help

Good luck

Sleepdeprived



[quote="Guest 2"]I have come to the conclusion that my wife , who has been on APAP for over six months, must have Complex Sleep Apnea because her AHI is never below 5 irregardless of what pressure is used. Her 90% pressure always goes to the highest pressure on the machine with apneas and hypopneas increasing as the pressure increases during the night.

Her sleep test titrated pressure was 6 but that was like no treatment at all. To make a long story short, her best pressure results are 10 - 12 but even then her AHI is most ofen near 10.

She has been 100% compliant, wears a chin strap, tapes her mouth, has done everything according to everything on this forum, yet it appears APAP is not working for her.

Is there any help available here concerning Complex Sleep Apnea besides simply the need of VPAP?

This thread is really interesting ... another case where I'm learning so much from this forum.

To add a small footnote to the EncorePro Vs. EncoreProViewer differences, the biggest difference that affects us as users is that apparently EncoreProViewer only shows the current data and does not store the data in a SQL Server Database. What that means is that if you want to track data over time, you'll need to enter it into Excel or something similar by hand if you use the Viewer version. Since EPA works off the database, I doubt that will work with Viewer unless it has been modified.

Mindy

Lubman wrote:DSM, another regular on this board, indicated that he heard from his neck of the woods (Australia) that ResMed (started down under) was working on a software mod to report some type of index, and the assumption was they were trying to get it ready and approved by US FDA. I don't know if this is a fact and haven't seen anything on it.

Release to the US market is often delayed by the FDA compliance processes (that's "your government at work" for you!). According to this message "after the holidays", is the current estimate for US release of the next Adapt SV model.

Cheers,

Bill

Release to the US market is often delayed by the FDA compliance processes (that's "your government at work" for you!). According to this message "after the holidays", is the current estimate for US release of the next Adapt SV model.

Cheers,

Bill

Bill,
Do you know if the next model is a hardware revision or simply a software revision which may be available in Australia as an upgrade to the previous machine?

Lubman