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Do I need an ASV machine?
#1
Do I need an ASV machine?
Hi everyone,

I was so happy I found this forum. Reading all the posts here has educated me about sleep apnea more than my sleep doctor. Anyway, last month I got 2 at-home sleep studies from 2 different hospitals (just to compare the results). Both results came back positive for severe sleep apnea (AHI 30.9/hr), and they both show all of the events were Obstructive Apneas + Hupopneas, 0 Central Apneas. So I got the BiPAP ResMed AirSense 10 and have been sleeping with it for almost a month now. The treated AHI I got from OSCAR has been around 2-3, sometime 4. So I guess the treatment is working. However, in the event flags panel, 90% of the events were flagged as Central Apnea on pretty much all nights over the past 30 days.

Do I have CA? Should I get an ASV machine instead (cost is not an issue)? Why didn't the two at-home sleep studies detect CA? Should I go check for any heart condition to be safe to use ASV? I'm a 29-year-old healthy and fit male. Thanks a lot in advance!
           
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#2
RE: Do I need an ASV machine?
Without seeing your sleep tests (full copy), I can't comment on them.

Looking at your charts, let's try an experiment.  Set your PS to 1 (PS = 1) and let's see what happens.    I'm expecting the numbers of your centrals to significantly drop.

What I THINK is happening:

I take this is a sign that your machine is acting very efficiently.  So much so that it is washing the CO2 out of your bloodstream, sound good?  I did too, unfortunately it is a 'high' amount of CO2 in the blood that triggers a breath, not a low amount of oxygen.  By changing your PS from 4 to 1 as above should demonstrate that this is happening, then we can look at a solution.  I just wrote a Wiki article about it here.   http://www.apneaboard.com/wiki/index.php...tral_Apnea
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

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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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#3
RE: Do I need an ASV machine?
(11-15-2019, 02:25 PM)bonjour Wrote: Without seeing your sleep tests (full copy), I can't comment on them.

Looking at your charts, let's try an experiment.  Set your PS to 1 (PS = 1) and let's see what happens.    I'm expecting the numbers of your centrals to significantly drop.

What I THINK is happening:

I take this is a sign that your machine is acting very efficiently.  So much so that it is washing the CO2 out of your bloodstream, sound good?  I did too, unfortunately it is a 'high' amount of CO2 in the blood that triggers a breath, not a low amount of oxygen.  By changing your PS from 4 to 1 as above should demonstrate that this is happening, then we can look at a solution.  I just wrote a Wiki article about it here.   http://www.apneaboard.com/wiki/index.php...tral_Apnea

Hi bonjour,

Thanks for the reply and the awesome wiki. I attached the sleep study result here. Please take a look if you can.

I'll try changing PS to 1 to see how it goes. My current machine is Auto BiPAP, which means EPAP and IPAP are auto-adjusted during the night, but PS is constant. Can I use an ASV machine as an Auto BiPAP with Auto PS? I read in the ASV manual that this machine can auto-adjust PS throughout the night. Is there an option to turn off ASV feature if I don't need it. That way I don't have to worry about adjusting PS and let the machine handle it. To be honest, I could get this ASV machine for cheap through my insurance, so I need to make the decision before the year ends.

       
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#4
RE: Do I need an ASV machine?
(11-15-2019, 05:41 PM)masonmiller407 Wrote:
(11-15-2019, 02:25 PM)bonjour Wrote: Without seeing your sleep tests (full copy), I can't comment on them.

Looking at your charts, let's try an experiment.  Set your PS to 1 (PS = 1) and let's see what happens.    I'm expecting the numbers of your centrals to significantly drop.

What I THINK is happening:

I take this is a sign that your machine is acting very efficiently.  So much so that it is washing the CO2 out of your bloodstream, sound good?  I did too, unfortunately it is a 'high' amount of CO2 in the blood that triggers a breath, not a low amount of oxygen.  By changing your PS from 4 to 1 as above should demonstrate that this is happening, then we can look at a solution.  I just wrote a Wiki article about it here.   http://www.apneaboard.com/wiki/index.php...tral_Apnea

Hi bonjour,

Thanks for the reply and the awesome wiki. I attached the sleep study result here. Please take a look if you can.

I'll try changing PS to 1 to see how it goes. My current machine is Auto BiPAP, which means EPAP and IPAP are auto-adjusted during the night, but PS is constant. Can I use an ASV machine as an Auto BiPAP with Auto PS? I read in the ASV manual that this machine can auto-adjust PS throughout the night. Is there an option to turn off ASV feature if I don't need it. That way I don't have to worry about adjusting PS and let the machine handle it. To be honest, I could get this ASV machine for cheap through my insurance, so I need to make the decision before the year ends.
You cannot use an ASV as an auto BiLevel because the algorithm is different.  You could use it somewhat as a fixed biLevel but that IMHO would be for 'emergency' use, not regular use.

Sleep study, a diagnostic study,  shows no Centrals and is missing the summary.  No centrals means that any centrals later are likely Treatment-Emergent Centrals.   Your Obstructive events are over 30 seconds average duration.  This is longer than normal even though your oxygen didn't dip real low.
Fred Bonjour - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter 
OSCAR

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Attaching Charts

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: Do I need an ASV machine?
In my opinion, as I didn't see any central apnea present, 1) ASV is not needed nor justified and 2) you'd probably need at the most a ResMed VAuto.
Dave

I'm not a doctor in real or fictional life. My posts include opinions based upon user experience and researched info regarding CPAP therapy and should not be considered medically professional directions or advice.


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#6
RE: Do I need an ASV machine?
Your Aircurve 10 Vauto is an amazing machine, and I'm surprised that it was prescribed with straight obstructive apnea. I agree with the suggestions you have received so far, and we usually see a significant reduction of CA events with less pressure support. I have also found that if there is pressure support being used, that a trigger sensitivity of "high" rather than medium, can by itself reduce CA events. Just though I'd put it out there in case you need something beyond the suggestions above.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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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#7
RE: Do I need an ASV machine?
(11-15-2019, 10:25 PM)Sleeprider Wrote: Your Aircurve 10 Vauto is an amazing machine, and I'm surprised that it was prescribed with straight obstructive apnea. I agree with the suggestions you have received so far, and we usually see a significant reduction of CA events with less pressure support.  I have also found that if there is pressure support being used, that a trigger sensitivity of "high" rather than medium, can by itself reduce CA events.  Just though I'd put it out there in case you need something beyond the suggestions above.

I think the VAuto was bought out of pocket. I agree that all that is needed here is to reduce the Pressure Support. There is no need of an ASV.
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