Central & Obstructive - AHI always around 10 with ASV. Tweak Settings?

[My3rd3y3]

My AHI simply never seems to get below 5,   most of the time it is around 10.   I am wondering if this is simply something I need to live with or might it be possible to adjust some setting to help?  Sure I feel better then I did when I was using my Cpap and had an AHI of around 50-60,   and a ton better then untreated.   I guess I am wondering if its even possible to get my AHI below the "5" benchmark and feel even Better?  

Not sure if anyone might have some input or opinions,  ideas etc.  I am no expert at reading the data but it seem's to me that the pressure I need thru the night is high and the machine runs near the top of its limit?     Let me know too what info/screenshots you might need from my Sleeyhead data etc......


 I have had my Resmed Aircurve ASV since they come out with this model,  I am due for a new one and well not sure if I should get another Resmed Aircurve ASV or a different company?>   Does Phillips make an ASV or do they call it something else? 

Here is a summary of my Stat's 



Last Night's Data 

[SarcasticDave94]

I will let the chart reading and settings to the gurus. As for machines, yes Philips Respironics has an ASV. Me personally, I have ResMed's ASV 10 series, and it's a great machine. Since you're already on ResMed, and by my personal knowledge that it works well, I'd suggest staying with this brand. Both make very good products, but I hear better results for most users via a ResMed, especially when we're talking about the ASV. These 2 companies machines work on handling apnea differently, with ResMed users stating that it feels more comfortable and natural. And that feeling comes from myself as well.

[Sleeprider]

Your minimum EPAP is relatively high which suggests you have a stubborn obstructive apnea problem. UA is more often a reflection of obstruction, and CA events are mostly non-existent. We could take a closer look at the flow charts and hypopnea events, but I think even with the high EPAP pressure you are continuing to experience obstruction. A soft cervical collar might help maintain your airway and eliminate much of the obstruction through the night. We have seen individuals with up to 30 AHI and stubborn obstruction respond to a soft collar and achieve less than 1 AHI with its use. It may or may not be the answer, but is worth a try.

Collars may wrap around the neck or be a simple wedge that fits under the chin like the Doctor Dakota Snoring Stop. Either one will prevent the chin-tuck that puts pressure on the front of the throat and causes flow limitation, obstruction and hypopnea. Do you have any experience with positional aids like this?

As far as alternative machines, Philips Respironics Dreamstation BiPAP SV is the other one in wide use. I don't think a change in machines will make much of a difference. Let's explore the positional solution first, and go from there.

[My3rd3y3]

I'll grab one of those collars later today to use tonight.    This is what my charts looked like prior to getting the ASV,   it is an improvement but I think I can get it better

When on a Cpap,   Prior to my ASV
https://imgur.com/bJbXBiz

[Sleeprider]

I think I remember seeing this, throwing up may hands and telling you to get on ASV.

[My3rd3y3]

Yes you and Pugsy on a diff forum were pivotal with getting my to understand taking control of my own therapy and get an ASV as soon as possible.  I actually dropped my sleep dr that had me just on the cpap for years and found a new amazing one,  picked up a used S9 Adapt till I jumped thru all the insurance hoops to get my current machine the Resmed Aircurve ASV.   



I did get a collar yesterday,   was only able to keep it on about half the night......   its going to take some getting use too that is for sure just did not feel right lol.



i also raised the minEPAP from 12 to 13 and lowered the minPS from 4 to 3 

[Sleeprider]

Brenda (Pugsy) and I have similar thoughts on therapy on different channels as you note, but I'm not a big fan of the abuse her sidekick PR dishes out, so even though my membership on that forum dates to 2008, I don't generally hang there. The collar should help quite a bit. We have done a wiki on the positional apnea issue here http://www.apneaboard.com/wiki/index.php...onal_Apnea and you can see some examples of the success others have had. Fit needs to support the jaw and chin, without impinging on the throat or soft tissue between the chin and throat. Getting the right fit in terms of height, circumference and feel may take some persistence, but it might make it possible for you to control OA and H events at lower pressures, and that will leave more room for CA control. Your results have some room for improvement, but much better than they used to be. I think you were also using opioid medications back when that old screenshot was taken; have you kicked those?

[My3rd3y3]

Well I went to see my sleep dr yesterday , I think shes an amazing sleep dr I really do. So glad I switched years ago from the pulmonologist who had me on the cpap for 2 years and thought he knew it all and really would not listen to me. 

She thinks there might be an issue with my ASV (Resmed Aircurve ASV ) - I got it 3 years ago and she thinks it is covered under a 5 year warranty thru the dme supplier I got it from.... I think she might be wrong as I just looked up on Resmed's site and it says 2 year warranty... She wrote a script to have them look at the machine and repair/replace but I feel they may just tell me to pound rock salt. That dealer also does not deal with Remed anymore. 

I myself do not think anything is wrong with my current ASV. She thinks my AHI numbers should be below 5 and even lower since my weight loss surgery and it might be machine related vs pressure related. I told her I am maxed on the settings end of my machine - she said she can raise the lower numbers if the machine is ok ..... my numbers have always been in the 5-10 range since being on ASV.

She also wrote a new script for a New ASV as my insurance changed (currently have medicaid thru my state - blue cross blue shield) - they said they do not have any asv machine on record as I had a diff plan when I got my machine 3 years ago. I had my most recent sleep study done 3 years ago the ASV one so she thinks since its under the 5 years i wont have to retest foe the new insurance 

That being said, The new DME I deal with also does not deal with Resmed so It looks like I am going to be getting the - Philips DreamStation BiPAP autoSV

Anyone know if the Dreamstation ASV / Bipap AutoSV lol - works on sleepyhead now? wonder how this reports vs the resmed? Guess ill find out after I hear back from the DME place

[My3rd3y3]

.....  I think you were also using opioid medications back when that old screenshot was taken; have you kicked those?

Sort of....    Well I am no longer ( to be completely honest with myself and others) No longer sniffing Heroin and or taking 30mg Oxycodone  x 100 every 2 weeks and Time Release Morphine I am however attending out-patient treatment for addiction and taking Liquid Methadone 130mg once daily.   The lesser of the two evils -  I dunno.....   I am in a better place now vs then but still on an Opiate to fully answer your question,   it's just more regulated? 

I know some fokes have misconceptions Methadone bur for me it has helped,   it also controls pain better in my opinion.   But I am sure too might be the root cause of my central sleep apnea ?  I am surprised they do not make people who go to pain management or out patient addiction places get sleep studies etc.   Going to ween down eventually and go in a more Natural / Medical THC route as I do not want to be on the "liquid handcuff's" some call it,  all my life.....

[Sleeprider]

Hopefully any machine issues get sorted. The soft cervical collar is intended to prevent pressure on your throat and soft tissue between the jaw to prevent the obstruction that occurs with chin tucking. The ASV is an amazing machine, but it cannot open an obstructed airway. It's important to address positional apnea so the machine can do its part to maintain the airway and provide breathing assistance with pressure support as needed.