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AHI consistently 0.0 on ASV, still don't feel any better
#1
AHI consistently 0.0 on ASV, still don't feel any better
I was diagnosed with complex sleep apnea and have been on ASV therapy for the past 5 years. My AHI during this time is consistently 0.0. My subjective sleep quality is no better now than it was before I started. I still feel like I've been hit by a bus most mornings. My now former sleep doc told be that my apnea is treated and if I don't feel any better then maybe I should try antidepressants (the battle cry of clueless docs everywhere). A few months ago I by chance happened to find out about a doc in a nearby city that specializes in treating complex sleep apnea. After meeting with him he suspects that I might be experiencing micro-arousals due to the pressure cycling of the ASV treatment routine. He wants to conduct another sleep study on me that he will personally oversee to try EERS, acetazolimide, and straight CPAP therapy. Anyway, that isn't going to happen for another 2 months so I though I would post here and see if anyone has any suggestions. Attached is a typical night of SH data for me, I added a comment to the time period between 4:15 and 5:15 where there was no pressure cycling and the doctor said was probably the only part of the night where I wan't getting micro-arousals.
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#2
RE: AHI consistently 0.0 on ASV, still don't feel any better
Have you had your family Doctor check you for other causes? There's a lot of other reasons besides sleep apnea that can leave you with no energy.
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#3
RE: AHI consistently 0.0 on ASV, still don't feel any better
(03-10-2018, 04:36 PM)Walla Walla Wrote: Have you had your family Doctor check you for other causes?  There's a lot of other reasons  besides sleep apnea that can leave you with no energy.

Yes, over the years I've been treated for hypothyroidism and hypogonadism to no effect, for 2 years I tried all kinds of AD's, again no benefit, also tried all kinds of alternative treatments, things you do when your desperate. Unfortunately modern medicine has sliced and diced the human body into discreet specialties that don't talk to one another so it's impossible to find someone who will look at the whole health picture.
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#4
RE: AHI consistently 0.0 on ASV, still don't feel any better
Not trying to set off any alarms, but is when the last time you had a cardiac work up, there is some concern of ASV and low ejection fraction.
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#5
RE: AHI consistently 0.0 on ASV, still don't feel any better
A couple of things come to mind -

It's not normal to get zero AHI all the time. Even "normal" non-apneacs get a few events in the course of the night. Are you seeing the zero on your machine's screen or just in SleepyHead? It may be that some of the SleepyHead parameters are set wrongly.

I believe the setup of your machine could be causing most of your problem. The "pressure cycling" you refer to is pressure support kicking in to help you inhale. Your exhale pressure is locked on 4 which is way too low for most people. In addition, it's set to straight ASV mode, which is not optimal. Depending the age of the machine, it should be able to provide an ASVAuto mode. If you have this, use it.

I'd suggest the following changes: If you don't have ASVAuto mode (older S9) then raise your EPAP pressure to around 7.0 You should see an immediate improvement.

If you do have ASVAuto, turn this on and set EPAP min = 6.0, EPAP max = 9.0. Keep PS at 3.0 - 9.0

Try these settings and monitor your results closely. If you don't already have the clincian's manual (which you will need to change the settings), you can get it from this link: https://www.apneaboard.com/adjust-cpap-p...tup-manual

Good luck, and let us know how you get on.
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#6
RE: AHI consistently 0.0 on ASV, still don't feel any better
(03-10-2018, 06:03 PM)Hojo Wrote: Not trying to set off any alarms, but is when the last time you had a cardiac work up, there is some concern of ASV and low ejection fraction.

Had a full cardiac workup a year and a half ago. Cardiologist assured me everything was fine in that dept.
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#7
RE: AHI consistently 0.0 on ASV, still don't feel any better
(03-10-2018, 08:28 PM)DeepBreathing Wrote: A couple of things come to mind -

It's not normal to get zero AHI all the time. Even "normal" non-apneacs get a few events in the course of the night. Are you seeing the zero on your machine's screen or just in [url=http://OSCAR Page ----> CLICK HERE ./]SleepyHead[/url]? It may be that some of the SleepyHead parameters are set wrongly.

I believe the setup of your machine could be causing most of your problem. The "pressure cycling" you refer to is pressure support kicking in to help you inhale. Your exhale pressure is locked on 4 which is way too low for most people. In addition, it's set to straight ASV mode, which is not optimal. Depending the age of the machine, it should be able to provide an ASVAuto mode. If you have this, use it.

I'd suggest the following changes: If you don't have ASVAuto mode (older S9) then raise your EPAP pressure to around 7.0 You should see an immediate improvement.

If you do have ASVAuto, turn this on and set EPAP min = 6.0, EPAP max = 9.0. Keep PS at 3.0 - 9.0

Try these settings and monitor your results closely. If you don't already have the clincian's manual (which you will need to change the settings), you can get it from this link:  https://www.apneaboard.com/adjust-cpap-p...tup-manual

Good luck, and let us know how you get on.

The machine itself and ResScan also always report 0.0 AHI as well. My doctor is convinced that the algorithm Resmed uses to determine AHI is flawed, especially for ASV therapy. He recently published a paper that discusses this (among other issues with ASV treatment): "Estimation of adaptive ventilation success and failure using polysomnogram and outpatient therapy biomarkers" google it if your interested, not sure if I'm allowed to post a link.

You are correct, my old S9 does not have AutoASV mode. I'll bump up the EPAP to 7.0 and see how it goes tonight. Thanks for the suggestion.
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#8
RE: AHI consistently 0.0 on ASV, still don't feel any better
(03-10-2018, 09:01 PM)foxfire Wrote: The machine itself and ResScan also always report 0.0 AHI as well. My doctor is convinced that the algorithm Resmed uses to determine AHI is flawed, especially for ASV therapy. He recently published a paper that discusses this (among other issues with ASV treatment): "Estimation of adaptive ventilation success and failure using polysomnogram and outpatient therapy biomarkers" google it if your interested, not sure if I'm allowed to post a link.

Looks like an interesting paper. Thanks for sharing it. Has your doctor looked at the mentioned biomarkers of reduced ASV efficacy as they relate to your treatment?
-Amin
Nothing I say on the forum should be taken as medical advice.
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#9
RE: AHI consistently 0.0 on ASV, still don't feel any better
It's OK to post links to non-commercial sites such as CPAP manufacturers or journals. The abstract of the paper mentioned above is here: https://www.ncbi.nlm.nih.gov/pubmed/29471442 The paper itself is behind a paywall here: https://academic.oup.com/sleep/advance-a...m=fulltext
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#10
RE: AHI consistently 0.0 on ASV, still don't feel any better
Please tell your doc office where you did your last study to mail you the whole study result with the whole EEG(this is what you want). I had 1-5 apnea events per night at 10 - 8 pressure and my saturation didnt go below 97% and it only helped that I didn't faint every week anymore. I still felt sh*t. When comparing the EEG, it turned out i was not getting any stage 3/4 sleep. I switched(myself) to Bipap 17 - 12 and went again, this time i had almost an hour of stage 3/4 sleep and since then i feel way better, my doctor still doesn't approve this change by the way.

Get the EEG.
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