[Diagnosis] Would I benefit from an ASV?

[Sleepy Willy]

Now that I have my SPO import working   , with many thanks to the Crimson Nape!

I currently have an AirCurve V10 VAuto set to 9-15. I was recently prescribed O2, as my O2 was spending 90 minutes under 90% with Min SPO in the low 80s. The O2 has improved this, but I'm still hugging 90% with some CA and HA events. My AHI seems to vary, not sure why it was higher last night. I seemed to sleep OK, but I still don't feel rested.

I'm wondering if I would benefit from an ASV machine and if my pressures are appropriate?

[Crimson Nape]

Have you tried setting your Trigger setting to High or Very High?

[Sleepy Willy]

No, I played with TI Max, but I'm not sure it did much.

Adjusting the Trigger looks promising.

Thanks

[Sleeprider]

Trigger sensitivity on high seems to help with CA events. You are using PS 6 and OA is the majority of your problem. To me this looks like chin-tucking as discussed in our wiki on optimization. Your OA events are highly clustered, so I'll bet the majority of your apnea is positional, and would respond to reducing the number of pillows you use, or a soft cervical collar.
Positional Apnea: http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft Cervical Collar: http://www.apneaboard.com/wiki/index.php...cal_Collar

[Sleepy Willy]

Yeah, I noticed my events were clustered.

I do sleep with two pillows, as I suffer from Acid Reflux. Although my Reflux seems better using the machine.

The other oddity is that I fall asleep right away using the BIPAP, whereas I used to lay awake for hours. I think my dislike for the mask takes my mind off of the thousand other things I used to think about. ?

I'll try sleeping with one pillow.

Thanks

[pwnorris]

Are you diagnosed with Complex Sleep Apnea? I get repeated Clear Airway events with > 5 an hour and O2 levels below 90. I get dizzy and end up waking up even before my O2 sensor alarm is set off (at 88).

I can get as many as 12 clear airway events an hour and was wondering the same question? My events are also clustered and typically only after around 3 hours of sleep.

I found a couple of scientific studies on the topic for what it's worth:

1. The complex sleep apnea resolution study: a prospective randomized controlled trial of continuous positive airway pressure versus adaptive servoventilation therapy
2. Hindawi - Complex Sleep Apnea Syndrome

(I don't get to post links for another 3 posts).

That latter study surprised me. I was under the impression my problem was too much CO2 in my blood stream (and sometimes it can be), but evidently the brain triggers breathing based on the level of CO2 in the blood, and so Central Apnea can occur when the CO2 levels are too low (which is true in my case). My tidal volume drops really low when the pressure is high.

I'd be happy to hear what you decide. Apparently there are constraints for ASV if you have various health conditions.

Seems my problem is my pressure is too high. The ASV machines work hard to make sure they only use pressure necessary to stop 90% of obstructive apnea so you don't get too much pressure. But they're pretty expensive!

[Sleepy Willy]

I haven't had a sleep study in quite a while. I'm trying to get another one now.

My last sleep study was at least 5 years ago, and I only had 11 events per hour, but the Respirologist prescribed a CPAP machine, as he thought it might make me feel more rested. I hated the mask and did not use the CPAP much, as my Apnea was not bad at that time.

I developed some breathing issues, which they really can't explain. I have two Respirologists and a Rheumatologist (Ankylosing Spondylitis), and they all disagree on the cause of my breathing issues. The Sleep Respirologist prescribed a BIPAP as he thought it might prevent me from losing more lung volume. 

I was sleeping for 12 hours and still feeling exhausted, so I wore my sleep monitor one night without the BIPAP. I spent about 90 minutes under 90% O2 and had several O2 events < 88%. My O2 average was 91% without the BIPAP and 92% with the BIPAP. The BIPAP smoothed out my SPO2 swings, but I still spent a bit of time below 90% and still had several O2 events.

My waking O2 readings are also around 90%, so I went on a quest to add O2 to my BIPAP. The O2 has reduced my time under 90% and reduced some of the valleys, but I still hit a low of 85% last night. I have some work to do with my BIPAP settings/sleep habits.

Thanks for the info, I'll have a look. Until I get my sleep study, I don't know what's happening with me. I talked to a DME today and they wanted 5K CDN for an ASV machine, which they don't have in stock. Our healthcare won't cover an ASV machine either; not sure about the AirCurve 10 ST. Although I was reading that people with Complex Apnea are much happier with the ASV.

[pwnorris]

The Ankylosing Spondylitis may be a relevant factor. I too have the dread AS and have little movement in my rib cage. I stopped doing physio for the ribs due to Covid, but I wonder whether I should start again to try and get more movement. Maybe this is why my breathing is so depressed.

That second study I referenced recommended ASV for people with Complex Sleep Apnea (mix of OA and CA?) but warned that it may not be right for all people - especially if you have heart damage or other medical conditions.

I'm a newbie here and no expert, but it sounds like you may have the low CO2 problem that Gideon has referred to elsewhere. 

On the waking tired question, I find that most of my events occur in the final few hours of sleep. I'm often less exhausted waking up after 4 or 5 hours than after 8. Although my psychologist suggested that might be because I'm waking at the right moment "sleep cycle" wise. (If I recall correctly we go though several roughly 90 minute cycles). Wake up to an alarm in the middle of a cycle and I feel like crap. His advice on napping was dead on. Either nap for 20 minutes or for 90 minutes. I find I wake refreshed either way. Sleep less or longer and I have a stuffed up head.

I think Ontario pays 75% of the cost of CPAP - though I'm not sure how often they'd pay. Several other provinces cover part of the cost also. Or have you checked that the ASV machines are not covered?

What frustrates me is that I would probably be fine with ASV but I'll have to wait a year to find out. The alternative is to head abroad and try and get a sleep study.

[Sleepy Willy]

I'm losing lung volume from the bottom of the lungs and the last time my Rheumatologist measured my chest expansion it was still OK. Just don't ask me to lie flat or touch my toes  . 

I considered deep breathing Physio, but that's what my BIPAP is for.  [Sarcasm]

Not sure about the CO2 theory. I originally read that IPAP decreased CO2 and EPAP increased O2, but ....?

I do notice my breathing is worse near wakeup on some days, probably because the poorer breathing is waking me up.

Before I got used to the machine, I would wake up early, watch some TV and go back to sleep once the annoyance passed. There were some nights where I got one or two hours sleep and felt OK. I don't think I was rested though, just running on fumes.

The provider today said that ASV was not covered in Ontario, but I will ask the Sleep Doctor.

Patience is not one of my virtues, so I don't plan to wait a year for a sleep test.

Thanks

[pwnorris]

I'm losing lung volume from the bottom of the lungs and the last time my Rheumatologist measured my chest expansion it was still OK. Just don't ask me to lie flat or touch my toes ?. 

I considered deep breathing Physio, but that's what my BIPAP is for. ? [Sarcasm]

Lie flat? I hear yah! My head is 4 inches of the ground, and you can use me as a human teeter totter. I remember my toes but I have to be a contortionist to get anywhere near them. 

I think they said I have 25% mobility. I look ok from a distance though. Apart from the curved neck. I learned about 30 years after I was diagnosed that the secret was to exercise constantly to prevent the cartilage from turning to bone but they forgot to tell me.