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CSA. Cheyne Stokes? ASV or CPAP?
#1
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CSA. Cheyne Stokes? ASV or CPAP?
Hi All

First time poster here. I had been struggling with sleep for a few months before doing an at home sleep study privately. The results from the sleep study did not provide much information. I had an AHI of 7.5 with my lowest SpO2 of 91. I shared my concern of central sleep apnea with the doctor who dismissed me and said its very rare and unlikely. He advised me that it was most likely insomnia and I should commence with Sleep Hygiene, Sleep restriction and Sleep Efficiency programmes. I did this for a few months with no improvement. 

Prior to the sleep study, out of the blue, I would struggle to fall asleep and as I would fall asleep, I would stop breathing and wake up. This would happen a number of times before I would eventually fall asleep. I would then wake up a few times through the night with the same thing and then start the cycle over. Im a fit, healthy 32 year old male. I've been exercising and doing spinning classes twice a week for the past 2 months. I tracked my sleep with an apple watch (not sure if this has been useful at all). I also tracked my sleep to confirm that I do not snore. My wife has confirmed this too. 

Unfortunately I do not have private heath care/insurance and I would be lowest priority to go through the public health care system to get an in lab  sleep study so I could probably wait 6 - 9 months. I decided to buy a 2nd hand ResMed Mini Cpap in an attempt to reduce or stop the events from happening. This also never helped me at all, the Mini does not provide much data but it did show me the number of events which fluctuated between 5-20 events a night.

I have decided to approach a supplier who offers private trials and sales of ResMed machines. After explaining my situation and presenting my sleep study results I started a trial on a ResMed Air Sense 10 AutoSet. I have downloaded the info and used sleepyhead to view it. It seems to confirm what I had suspected. The events are not very high but what bothers me is the duration and that I continuously wake up from it. If I were sleeping through the night I probably would not notice aside from headaches, sighing and yawning during the day. I assume my chemoreceptors are not functioning correctly and my CO2 levels are not in balance. 

Looking at my charts, does it look like Cheyne Stokes or periodic breathing? You'll also note note the length of the Centrals are between 10-24 seconds. 

Because I'm going private I'll buy which ever machine will be best for me. If an ASV is recommended, there is one that is available for me to purchase. I would like to stop wasting time with the Air Sense if the AirCurve ASV would be better? I have reduced the pressure to 6.2 max which seems to reduce the number of events but not the duration. I'm aware of the restriction on the LVEF for the AirCurve ASV PaceWave. Any assistance would be greatly appreciated.

Kind regards
Jonno

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#2
RE: CSA. Cheyne Stokes? ASV or CPAP?
Jonno, welcome to Apnea Board. Your results with the Autoset are interesting with all events being central. Your pattern of sleep disorder is fairly common. Shortly after going to sleep your pressure rises from your ramp of 5.0 to a higher pressure. You seem to have 6.4 as a maximum pressure and EPR that keeps your exhale pressure at 4.0. It will help if you minimize the monthly calendar so we can see more respiratory statistics and settings. While the event rate is low, you find it disruptive to sleep. Your previous sleep results do not indicate a problem that would normally qualify for medical intervention or insurance reimbursement.

We need to get a better look at normal respiration where you are sleeping but not experiencing events so we can evaluate what the flow looks like, and we may want to evaluate what your therapy looks like without EPR to see if that helps. Let's consider this an evaluation period of your response to some different CPAP variables, that we hope will lend some insights to your problem/needs. I would like to see you try a night of fixed pressure with EPR and ramp off, and a fixed pressure of 6.0. You can still use Autoset mode with a minimum pressure of 6 and maximum pressure of 6 and the device will record flow limitation. If you change to CPAP mode it will disable flow limitation scoring. This should provide a look at your baseline respiration without the influence of bilevel (IPAP/EPAP) pressures. Your respiratory flow seems to vary from breath to breath and in addition to seeing the full night, I'd like to sample some zoomed screenshots of 3-4 minute duration where we can clearly see the flow wave shape. Remember to swichoff the calendar by clicking the triangle or F9.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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#3
RE: CSA. Cheyne Stokes? ASV or CPAP?
Hi Sleeprider. Thanks for taking a look at the info I posted. I'll try the settings you have recommended. I'll be away for 2 weeks and won't be able to take the device with me. But I'll definitely post an update as soon as I'm back. I've also minimised the calendar and taken 2 zoomed images as requested.
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#4
RE: CSA. Cheyne Stokes? ASV or CPAP?
Images are much better and clearly show the respiratory stats and settings I was looking for. It will be a process to optimize and minimize CA, so when you're ready we can continue.
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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#5
RE: CSA. Cheyne Stokes? ASV or CPAP?
Hi SleepRider. I tried the settings you recommended last night but I felt I could not exhale against the constant pressure of 6. I also tried 5 but 4 was the only pressure I could exhale against. I have attached 3 Images below from last night. 

If I reach my max of 5 mb, do I need to remove images from earlier posts?
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#6
RE: CSA. Cheyne Stokes? ASV or CPAP?
Hi Sleeprider. Im back home and keen to try any recommendations you have.
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#7
RE: CSA. Cheyne Stokes? ASV or CPAP?
Try this

Get a tall glass of water and a straw.
Place a straw near the bottom of the glass and blow bubbles.

Does this feel any different than exhaling with your CPAP?

What's the difference?
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#8
RE: CSA. Cheyne Stokes? ASV or CPAP?
Hi Gideon. I just tried what you said. It’s a pretty similar feeling. The deeper the straw, the greater the pressure. Similar to the cpap pressure. 



Regards 
Jonathan
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#9
RE: CSA. Cheyne Stokes? ASV or CPAP?
And how much trouble did you have blowing thru the straw?
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#10
RE: CSA. Cheyne Stokes? ASV or CPAP?
When the straw was at the bottom of the glass, the effort required to blow was more than I feel I’m able to naturally exhale in my sleep. I felt the same with the cpap, when the constant pressure was above 4 it overpowered the pressure of my exhale. I would definitely be able to overpower the pressure with force while I’m awake.
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