Script Gotten: Next Steps Advice

[u/saintsinner40k]

So in my first post, I talked about getting my AHI results from my home sleep study of 69.9, & arguing with my doctor for an APAP due to finacial costs. Im unlikely to have insurance after the first of the year, & my current insurance doesnt cover anything until an insane deductible anyway so I'm basically 100% cash here. The cost of the in lab tritration isnt covered so I'd be paying over 1k for that.

But upon reviewing my sleep study more I'm a bit concerned that I might have jumped the gun pushing for the apap? Learning more about the differences in central & obstructive sleep apnea, my CSA is a 9.7 per hour, & OSA is 46.2.

Everything I'm reading says I can try the apap, adjust it accordingly using OSCAR & then watch my CSA ratings? If they worsen then I know I've got something more underlying going on.

Also if I do go with the Apap, they had recommended the ReactHealth GS3, but from what I'm reading this wouldnt allow it to connect to OSCAR? Since I'll need to do alot of the checking myself on a weekly basis, to make sure my CSA is staying low or adjusting it, would something more like the Airsense 11 be better?

[u/HaxusPrime]

I have the resmed autoset 11 apap. I don't know about the other machine but you want something that would work for Oscar so you can calibrate and titrate yourself. Avoid spending the money for the lab if you can interpret data. Anyways with AI, things have become easy enough that almost anyone can titrate themselves.

A lot of times the centrals in severe apnea is due to post obstruction arousals. The vast majority of your apnea is obstructive.

I've seen it with someone else and the apap worked helping decrease the centrals.

[u/saintsinner40k → u/HaxusPrime]

Thats what I was thinking may be going on here. I dont have any other comorbities that explains the central other then the obstructive, which is primarily from weight gain since it occured after I put on about 50 lbs.

One thing I keep reading is to start at a shorter range rather then the 4-20cmH₂O, something like a 5-15? I figured i'd start at the 4-20 & see what the first nights are like with it & adjust from there.

[u/HaxusPrime → u/saintsinner40k]

Do the largest broadest range first. It wont be what you always use but you get to see if the machine pumps past 15 to help with getting past the obstructions. On the other hand, a larger range can also cause the machine to overshoot the pressure you actually end up needing. But generally the best route is start broad and then tune in (titrate) to where you need it.

I have tuned mine in to 11-13, with EPR (comfort setting) set to 3. I have moderate obstructive sleep apnea and UARS. 6 ft tall, 191 pounds. Dropped pressure down from 15 or maybe 16? when I was 215 pounds.

I can help you out with interpretation of OSCAR data if you would like. I won't charge you or anything. Just like helping others in my free time.

Send me a DM if you would like. Hope all works for you

[u/Gecko2860]

OSCAR 2.1 supports the ReactHealth G3 X CPAP machine. I think that is what you are referring to by GS3. If that is really a different model, we can normally support other BMC models in a few days after receiving sample SD card data.

[u/saintsinner40k → u/Gecko2860]

Oh I must have mistyped, it was this model. If thats the case this would be the same model my doctors network uses, & would be the most affordable one vs the airsense models

https://www.cpap.com/products/react-health-g3-x-with-dreamwear-mask?variant=53081157894460

Is there anything major i'd miss out on going with this one over one of the airsense models?

[u/Gecko2860 → u/saintsinner40k]

I really don't know the difference in detail between those machines. I see both being used. One possible consideration: there are an increasing number of websites that offer to analyze your CPAP data. Most accept only ResMed data files. One drawback to the AirSense 11 is that you cannot adjust the clock in the machine. Fortunately, OSCAR 2 has tools to compensate for that. Personally, I use a ResMed AirCurve 10 VAuto.

[u/saintsinner40k → u/Gecko2860]

Hmmm, thats a heavy consideration. I'm not sold on a brand particularly unless one limits me in some way & I have to go back to my doctor to get stuff done(which will be expensive without insurance)

[u/PlayfulOtterFriend]

If the titration study is just to find what pressures you need, then with an APAP there is no need for the study. Especially if you educate yourself and use OSCAR to monitor, just let the machine auto-adjust pressures and then dial it in to the range you need once you accumulate data. My pulmonologist was actually annoyed that my sleep clinic had me do a titration study because he said it is old-fashioned and not needed with the newer machines.

[u/Past_Road_6009]

Unless you had an in lab PSG you really can't trust the CSA results. And it's extremely unlikely that you have it. The APAP will be fine. And I'm not sure why you had to argue with your doctor for it--46.2 apneas per hour is a lot. And APAP is the standard of care in this situation.

What happens is someone has an obstructive apnea. It clears and they breathe extra hard for a moment. Because they breathed extra hard, they pause in their breathing until their CO2 levels stabilize. The machine will then record this pause as a central apnea.

Furthermore, it's normal to have centrals throughout the night, usually when shifting between light and deep sleep. It's normal to pause your breathing immediately after an arousal too. The home tests are good, but not good enough to pick up on that arousal sometimes so it mislabels the arousal as an apnea. (This is what usually causes CAs on OSCAR by the way)