[CPAP] BIPAP to AIRMINI

[SarcasticDave94]

Reasons for ASV? 83 CA to 27 OA, their own recommendation said if ST failed you go to ASV. Highlight that part and show him.

Impression:

1. Primary central sleep apnea

Recommendations:

No definitive pressure can be extrapolated from the titration, however since he had mostly obstructive hypopneas on the best tolerated pressure, consider BiPAP ST 16/12 cm back up rate 12 BPM. Otherwise consider ASV titration.

C'mon man. Tell doc polite and firm, get with it, OR refer me to someone who will go by their own recommended actions. Their paperwork says it yet they won't do it. You need to state the ST experiment phase is failed and you're done with it. Time to go to ASV now.

[cathyf]

...the ResMed 'MyAir' app scored my January 2, 2022, therapy at 95 points out of 100 ...  The ResMed dashboard also indicates more than 20 events each hour.

A couple of months ago I started this thread: Why I hate MyAir more than the heat of 1000 suns!  and you have just provided another data point.

These people are evil...

[MMH1]

Thanks - good way to open the discussion, receptive or not.  My LV EF is > 60%.  

Bill

[SarcasticDave94]

FWIW my echocardiogram in '17 had me score LVEF 55% and I got an ASV. Then in spring '20 a new cardiac doc had me do echocardiogram and chemical stress, LVEF 63% and a diagnosis of PVCs, it's not ASV usage related.

[MMH1]

Thanks !

[MMH1]

Proposal made, my doc has ordered an ASV, only cost is for a range of settings workup.  Based on the machine that seems unnecessary, but is a hoop as you suggest to move on.  Thanks for your guidance.

[SarcasticDave94]

OK congrats. Keep us updated and ask questions when you have them.

[Sleeprider]

Pretty good result from your proposal. Could you summarize the conversation a bit? Many members here have more hoops than a titration to jump through.

[MMH1]

You advised to go through hoops, if necessary, to replace my AirCurve 10 ST with an ASV machine.  My events were 20+ per hour, and the October 2021 study focused on the number of CA events.  I've done the hoops and am picking up an ASV machine tomorrow.  I've pulled from the two studies for comparison below.  It's interesting that CA is largely absent form the current study.  Does the ASV set up make sense?  I can send the full studies if that helps.

A material personal health update:  I had an ablation performed between the two studies.  I was AFIB for the 1st study and sinus rhythm for the 2nd.  I remain in sinus rhythm.  Of note, heart BPM dropped from 81 sleeping to 57 sleeping. 

The 1st study from October 2021 (AFIB) recommended :

Impression:
• 1. Primary central sleep apnea
  
• Recommendations:
  No definitive pressure can be extrapolated from the titration,however since he had mostly obstructive hypopneas on the besttolerated pressure, consider BiPAP ST 16/12 cm back up rate 12BPM. Otherwise consider ASV titration.

The 2nd study from March 1 to titrate for an ASV study and recommendation:

• Respiratory:
  There were a total of 1 apneas consisting of 0 obstructiveapneas, 0 mixed apneas, and 1 central apneas. A total of 31hypopneas were scored. The apnea index was 0.22 per hour and thehypopnea index was 6.79 per hour resulting in an overall AHI of7.01. AHI during rem was 15.8 and AHI while supine was 8.07.
• CPAP Titration: 
  The PAP titration was initiated with ASV EPAP 10cm of water PS 4/15 cm and the pressure which was slowly titratedup in an attempt to eliminate sleep disordered breathing andsnoring. The final pressure tested during the study was EPAP 10cm PS 4/15 cm water and at this final pressure the patient wasobserved in the supine REM sleep stage. The apnea hypopnea indeximproved to 5.5 per hour and O2 nadir 88%. The average O2saturation was 94%. He spent 1.3 min of sleep time below 88% O2saturation. Snoring was resolved.The patient utilized airfit N20 mask with heated humidification. The PAP was well-tolerated andthere were minimal air leaks. Supplemental oxygen was notrequired.
• Impression:
  Obstructive sleep apnea
• Recommendations:
  I recommend ASv EPAP 10 cm PS 4/15 cm with airfit N20 mask.

Thank you !

[MMH1]

You advised to go through hoops, if necessary, to replace my AirCurve 10 ST with an ASV machine.  My events were 20+ per hour, and the October 2021 study focused on the number of CA events.  I've done the hoops and am picking up an ASV machine tomorrow.  I've pulled from the two studies for comparison below (full studies are available).  It's interesting that CA is largely absent form the current study.  


A material personal health update:  I had an ablation performed between the two studies.  I was AFIB for the 1st study and sinus rhythm for the 2nd.  I remain in sinus rhythm.  Of note, heart BPM dropped from 81 sleeping to 57 sleeping. 

The 1st study from October 2021 (AFIB) recommended :

Impression:

• 1. Primary central sleep apnea
  
  
• Recommendations:
  No definitive pressure can be extrapolated from the titration, however since he had mostly obstructive hypopneas on the best tolerated pressure, consider BiPAP ST 16/12 cm back up rate 12BPM. Otherwise consider ASV titration.
  

The 2nd study from March 1 to titrate for an ASV study and recommendation:

• Respiratory:
  There were a total of 1 apneas consisting of 0 obstructive apneas, 0 mixed apneas, and 1 central apneas. A total of 31 hypopneas were scored. The apnea index was 0.22 per hour and the hypopnea index was 6.79 per hour resulting in an overall AHI of7.01. AHI during rem was 15.8 and AHI while supine was 8.07.
  
  
• CPAP Titration: 
  The PAP titration was initiated with ASV EPAP 10cm of water PS 4/15 cm and the pressure which was slowly titrated up in an attempt to eliminate sleep disordered breathing and snoring. The final pressure tested during the study was EPAP 10cm PS 4/15 cm water and at this final pressure the patient was observed in the supine REM sleep stage. The apnea hypopnea index improved to 5.5 per hour and O2 nadir 88%. The average O2saturation was 94%. He spent 1.3 min of sleep time below 88% O2saturation. Snoring was resolved.The patient utilized airfit N20 mask with heated humidification. The PAP was well-tolerated and there were minimal air leaks. Supplemental oxygen was not required.
  
  
• Impression:
  Obstructive sleep apnea
  
  
• Recommendations:
  I recommend ASv EPAP 10 cm PS 4/15 cm with airfit N20 mask.
  

After reviewing, does the ASV set up make sense?  

Thanks