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6 weeks in on bipap, still centrals, still sleepy
#11
RE: 6 weeks in on bipap, still centrals, still sleepy
you can count on the asv user 'clique' here for support. :-)
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#12
RE: 6 weeks in on bipap, still centrals, still sleepy
(07-01-2019, 05:58 PM)bemused Wrote: So to update. I reached out to my doctor and she is fine with trying the ASV (Let's hear it for Kaiser) -- just wants to do an echocardiogram first to make sure my heart is fine.
So I will likely be needing some help with the ASV once I get it.
Thanks for all your help!

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It doesn't get better than that!  Looking forward to helping you explore the new and correct option!
Sleeprider
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#13
RE: 6 weeks in on bipap, still centrals, still sleepy
Great news were here ready and waiting to help
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#14
RE: 6 weeks in on bipap, still centrals, still sleepy
I really appreciate all the support Thanks 
Sadly, there is a long line ahead of me for echocardiograms (the downside of Kaiser). My appointment is five weeks out. Then there is the wait for results, the prescription, and the DME. So I am likely close to two months away from the ASV. In the meantime I have another question -- not sure if this warrants a new thread but figured I would put it here for continuity's sake.

Because my AHI was not all that high on the studies -- except the last home one and I think that was an anomaly -- but the RDI was, I assumed I had UARS. But in looking at my Oscar charts from the beginning, I don't have that much flow limitation, and a lot of the flow rate looks pretty normal, except  -- I have long periods of what I was thinking of as "jagged breathing" and that I thought was probably arousals. But looking closer the pattern is very regular.  So I am wondering if this is periodic breathing. This section from last night is typical:

[attachment=13442]

The longest period last night was about an hour:
[attachment=13443]

But a few nights ago the patterns repeat much of the night:
[attachment=13444]

So is it periodic breathing? Or something else? I increased the pressure support and actually felt like I slept better last night. Should I increase it some more? Ironically the centrals have settled down, though raising the PS seems to bring them back (which might be a good thing from the POV of getting the ASV). But from what I understand the ASV helps with periodic breathing as well. Luckily my doctor seems ok with the ASV either way. But I am wondering if I can just address this with the bilevel, since I have at least six weeks to play with it.
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#15
RE: 6 weeks in on bipap, still centrals, still sleepy
Looks like periodic breathing to me nothing your machine will do about it an ASV is needed but your num AHI number may be too low to get an ASV paid by insurance easily
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#16
RE: 6 weeks in on bipap, still centrals, still sleepy
So I wasn't sure if I should continue this thread or start a new one. I picked up the ASV today -- the Resmed Aircurve. The initial settings to me seem crazy high, since my OAs and hypopneas were controlled at much lower settings, but I had a lot of long periods of what looked to me like periodic breathing -- which I'm really hoping the ASV will help.  Should I change them, or try it for a night or two -- I'm concerned that big swings will cause aerophagia and/or wake me up:

Min EPAP 5
Max EPAP 15
Min PS 3
Max PS 15
auto rate

Thanks!
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#17
RE: 6 weeks in on bipap, still centrals, still sleepy
There will be an adjustment period. No one would use an ASV, if they didn't need one. ASV has large pressure available, but will only use what it needs. You have been set basically the default settings. Get some charts up for opinions.
This titration guide may help.
https://www.resmed.com/us/dam/documents/...er_eng.pdf
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#18
RE: 6 weeks in on bipap, still centrals, still sleepy
Let us know how you do after the first night. The settings are default, and can be fine-tuned if needed later. Many users of the ASV suggest the "blowback technique". If you feel the machine is out of sync or excessive pressure, blowing back at the machine seems to tame it.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#19
RE: 6 weeks in on bipap, still centrals, still sleepy
Will do, thanks!
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#20
RE: 6 weeks in on bipap, still centrals, still sleepy
So. Last night was surprisingly comfortable. Took me a long time to go to sleep, and I was awake off and on much of the night, but kept the thing going the whole time--didn't take the mask off once in almost 9 hours. I think many of the centrals I was experiencing on the bpap were sleep-wake transition, because during the times I was awake I could tell each time the machine pushed me to breathe -- which actually felt pretty good--and there were a lot of them. But I was able to relax and just go with it. Other than that, some minor aerophagia but nothing I can't live with, and likely that will fade.  So I think adjustment is going to be smoother than I feared (fingers crossed). Also, this was the first night in memory that I didn't get up a single time to pee Shy .

As far as numbers -- 0.4 AHI, which is amazing, and all of the events were hypopneas. Big surprise when I looked at the report, because the pressures were a lot higher than I could have ever tolerated on the bpap -- every time I tried to raise the PS there it set off a string of centrals. I did have a lot of flow limitations, way more and bigger than on the bpap. Not sure what that's about.

Anyway, I am feeling encouraged -- it does seem like this could be what I needed all along.

Here are the Oscar pics:
[attachment=13965]
[attachment=13966]
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