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Can I optimize my treatment?
Can I optimize my treatment?
I've been lurking around in these forums for a few months now and have finally decided to post to get some advice on my current treatment.

I was diagnosed with idiopathic non-ischemic cardiomyopathy this past April with an EF of 30%.

In addition to all the lifestyle changes and medications that go along with heart failure treatment I decided to finally address my sleep apnea which I knew I must have. I did an at home sleep study in the beginning of May. I have attached the results to this post.

The following is the doctor's interpretation of the study:

Quote:This home sleep study demonstrates severe obstructive sleep apnea, worse in the supine position. Mixed + central apnea index was elevated and there was a dense cluster of central respiratory events towards the beginning of the recording at presumed sleep onset; clinical correlation for these findings is recommended. Average oxygen saturation was low at 92%

I purchased a Resmed AirCurve 10 VAuto and began treatment toward the end of May. I use a F20 full face mask as well.

Also since my initial diagnosis I have dropped 25 pounds and my EF has gone up to 40% (measured at the beginning of August).

I managed to get my AHI to under 3 AHI from 38AHI.

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RE: Can I optimize my treatment?
It seems I mostly have what is being reporting as  CA events now. I am attaching past 3 nights as well for review. These are typical nights for me lately.

In general I'm not feeling much better. I am not sure if it is my medications, the cardiomyopathy are something still related to the apnea.

Is there anything more I can do to see if my apnea treatment can be improved?

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RE: Can I optimize my treatment?
@Shifty (great screen name BTW) - 

I am NOT an expert but was curious because the Aircurve 10 is purpose-built to handle Centrals. As I understand it, your machine should be able to eliminate virtually ALL centrals. September 3rd was a much better night; did you make any changes that would account for that? An expert should come along soon to help you with this.
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RE: Can I optimize my treatment?
The AirCurve vAuto is NOT designed to handle Central Apneas. It is targeted at UARS, flow limitations, and hyponeas.

The machine for treating Centrals is the AirCurve ASV - Auto Servo Ventilator, and there is some controversy about using it for people with low ejection fraction.

There are ways the vAuto can minimise CA events, and somebody else will have to discuss that.
Apnea Board Monitors are members who help oversee the smooth functioning of the Board. They are also members of the Advisory Committee which helps shape Apnea Board's rules & policies. Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.
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RE: Can I optimize my treatment?
As you mentioned I have a low EF so the ASV was not recommended to me at this point in time. Hopefully my EF will continue to increase, but for now I am stuck with the VAUTO.
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RE: Can I optimize my treatment?
You are "stuck" with a very good machine. And no, it is not meant to treat CA's but we can try to minimize them by using the Trigger setting. The default setting is Medium.
Set the Trigger setting to High.
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RE: Can I optimize my treatment?
What is your trigger set at?
Ask your doctor if there is a problem that conflicts with your heart failure with setting Trigger higher to attempt to trigger a breath easier and thus reduce your central apnea. I have no expertise with your combination of conditions so I'm not recommending this for you. Only to have you talk about it with your doctor.
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RE: Can I optimize my treatment?
I had already changed that setting a month or so back from reading on this forum.
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RE: Can I optimize my treatment?
Please add your trigger setting and your current settings to your profile
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RE: Can I optimize my treatment?
I have updated my profile as requested.

I'm attaching last night's sleep data as well, which was with the settings I have posted.

Most of the CAs happened before I awoke, which for last night was earlier than usual.


The previous night my AHI was 0.80, but I didn't have the SD card in, it was in my PC :-(

I seem to flucate between nights where I am less than 1 AHI and and some where < 3 AHI. I hardly ever go above 3AHI.
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