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How many CA for ASV
#1
How many CA for ASV
My Apnea APAP treatment for close 5 year 's,  my daily CA average around a 2-3 AHI, more recent times, jumped up above AHI 5 at times, high single numbers, occasional low teen's ? 

Given that , should I be concerned with my APAP machine CA treatment ? or possibly other trigger, I haven't identified as ? to being root cause? and it may not be the APAP machine treatment capability?  But question then also the intermittently treatment response/readings, could it be other such as health, environment, seasonal, such as Hay fever, Asthma, Paroxysmal arrhythmia ? or other? 

Now also while saying that, with then presently now in last week my Air Sense 10, is back around CA 2-3ish AHI, and other apneas "O & H" Both under 1 AHI each ? and this is on quite low pressures, I have presently settings Pressure 5.6-7.4 , No EPR or Ramp  and 95% pressure is @  7.3 

I have intentionally been reducing pressure Both Min & Max, focusing on the CA's, as lower pressure not being detriment to O or H's AHI's and those No's at low best Numbers since start APAP?  

My question or thoughts of my thinking my machine is under 12 mths old, is it ok to with just my APAP treatment with concern of detrimental APAP treatment? of if need to consider looking to upgrade ?  from  readings in forum look as if recommend the  Resmed ASV ?  

Any suggestion / advice stay with what already have or particular alternative machine would be best or better and if any urgency to action ?


       
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#2
RE: How many CA for ASV
Your results from June 16 would merit consideration for ASV if these results were reasonably consistent, however, your AHI is generally below 5.0 and while therapy is not ideal, it will be difficult to persuade a doctor that an advanced PAP is the preferred answer. You are using no EPR and this keeps your AHI considerably lower than if you were using EPR or pressure support of any kind which tends to lower CO2 and increase CA events in sensitive individuals. You have obviously works on using CPAP pressure in a fairly low range to manage your obstructive apnea without triggering higher CA. I can think of two additional strategies that you might want to consider. The more conventional one is to use fixed CPAP pressure. You appear to do pretty well at a pressure of 7.0, but could try bracketing that to see what works best. Using fixed CPAP pressure rather than variable Autoset pressure often helps people to stabilize the airway and avoid some of the CA events.

A more experimental approach is to use Enhanced Expiratory Rebreathing Space (EERS) to maintain a slightly higher CO2 and improve respiratory drive. This is done by blocking the expiration vent at your mask or connector, and moving it a short distance toward the CPAP machine. This results in a small volume of air in the mask and tube that can be breathed with the next inhale. This often solves CA that is not related to neurological or other idiopathic conditions, especially where a low incidence of CA is the norm. Here is a link to our wiki on the subject http://www.apneaboard.com/wiki/index.php...ace_(EERS)
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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#3
RE: How many CA for ASV
First, you have done an excellent job of managing your settings and controlling your apnea, both obstructive and entral events, well done.

Please provide a 10 minute zoomed view of your centrals on both good and bad nights. That is to determine the character of your centrals. Is the character that of CO2 driven centrals or not.

ASV is formally called for when CA events are over 5 CAI and Obstructive events are managed (<5, AHI - CAI<5).
,How often does the above occur?!

The real question, other than the numbers being high, does any of this 'bother' you? Please be critical with your answer. If you say "I feel fine" or "it doesn't bother me" and I'm sleeping well,.
Regular AHIs going into double digits, or even regularly going over 5 need to be managed, but if it only happens once per month, does it?
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#4
RE: How many CA for ASV
Not much to add, basically if your CA are in the train wreck territory consistently, say 4 of 7 days, then ASV is maybe. Even a CA heavy person like me has to fight like mad to get ASV. By the numbers I'd say you're not there. You would have to make a very strong case by stressing how you feel is incredibly terrible and be able to link it to CA.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#5
RE: How many CA for ASV
Sleeprider, Thank you very much also appreciate in detail and time effort, I will certainly look to absorb that information. I actually previously had micro thoughts on fixed pressure, but hadn't  gone with it,  just playing closing gap on pressure settings, held back on fixed, thinking Auto on lower settings also Low max, with min ranges may minimize amount O2 ? to not contributing low Co2 ? was my thinking,  may be wrong and also or may misunderstood my learning's of trolling other more knowledgeable, Experienced posters, such as yourself, Gideon, Dave Scar also just others general post readings. Dave did explaining in other thread, on CA's from Low Co2.  But my thinking's give purpose to reducing both Min & Max pressures, in hope preventing Low Co2?  Also happy have go set to Fixed 7 Pressure, see result ? If change, up, down or same? also if "CA's  reduce/Increase or negative on O or H ?  I think my O & H especially on Resmed minimal pressure and Resmed, appears responds much quicker than RemStar ?be magical to have some control on CA's ?  

So 1st off, tonight  will  action to set 7 fixed pressure, will monitor few days, and only the 1 change till result known, in between also follow up understandings on the info gave me  re "Enhanced Expiratory Rebreathing Space (EERS)" see if I can get my head around it.

I do have a ResMed AirFit N30i mask" 2 x (air relief valve) 1 at top head and 1 on Nasal cushion? will that be concern ? then also hands on Valve / Hose set up etc? or is it know practice to cover up the on head air relief valve or frowned on ?? 


 
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#6
RE: How many CA for ASV
(07-15-2021, 08:36 AM)Gideon Wrote: First, you have done an excellent job of managing your settings and controlling your apnea, both obstructive and  central events, well done.

Please provide a 10 minute zoomed view of your centrals on both good and bad nights.  That is to determine the character of your centrals.  Is the character that of CO2 driven centrals or not.

ASV is formally called for when CA events are over 5 CAI and Obstructive events are managed (<5, AHI - CAI<5).
,How often does the above occur?!        

The real question, other than the numbers being high, does any of this 'bother' you?  Please be critical with your answer.  If you say "I feel fine" or "it doesn't bother me" and I'm sleeping well,.
Regular AHIs going into double digits, or even regularly going over 5 need to be managed, but if it only happens once per month, does it?
Hi Gideon, thanks for input and time, and the comment as being managed, then that give some confident that I am  the right path, Gideon I have actioned then as requested, in dot points and hope I have correctly zoomed in ref to 10 Minute zoomed ?  
  • How often does the above occur?!         **  Random intermittently **  days now then, but then again may last a week or more then good again ?? but also think if go for extra big walk couple hour's usually helps most often then back to low CA's / AHI's  ??  May be more tired so Sleep more dead no movement ?
  • does any of this 'bother' you?   As Probably more just reading the Numbers, tells me, I should be horrified especially I often see others with much low Numbers, while mine are much higher, oh should I be worried to in comparison to those numbers.  Do need be concerned ? acting on My Health, am I neglecting from blissful, unawareness ? while  health slip's away, I don't even know! day time sleep very rarely, these days for a afternoons, nanny naps, or had big night before maybe! If do feel bit tired, may go for a nap but most often then toss turn back up 1/2 hr, and cant sleep, come on get up have cold shower and quick bite, eat an look get body moving , which does then mostly feel good.  My Night time sleep is generally these days mostly pretty good sleep, except occasional times if stay up too late, planning go away, like that or coincide with things on my mind, then going bed, may not get to sleep, from brain, turning, turning , same over and over, eventually force get up out bed go watch TV 1hr ? and little snack, to relax try break the Brain cycle, but only ? maybe 3-4 times over year at most. Then prompted randomly type anxiety get me the CA AHI Numbers especially seeing the "Green" Cheyne Stokes Respiration?  For some reason gets me worried, even thou previously told not to worry about that! then I don't understand why they say yes Resmed does that ? but dont worry about it, is bit Dumbfounded as it to do with Resmed Company while make appears as mostly sought out CAPA Machines, yet and cant get correctly diagnose Cheyne Stokes Respiration,  just disregard ? don't worry about it ? and while confidence is said with 1st off ease's my thinking, but still traces of  until pop up again get the old grey matter going around incircles again.
  •  provide a 10 minute zoomed view of your centrals on both good and bad nights.

BAD 
   

GOOD 
   
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#7
RE: How many CA for ASV
(07-15-2021, 03:20 PM)SarcasticDave94 Wrote: Not much to add, basically if your CA are in the train wreck territory consistently, say 4 of 7 days, then ASV is maybe. Even a CA heavy person like me has to fight like mad to get ASV. By the numbers I'd say you're not there. You would have to make a very strong case by stressing how you feel is incredibly terrible and be able to link it to CA.

SarcasticDave 94 , So yes thanks also for Reply, and yes what saying does make sense, I was sorta hoping, that would be the case, just more to ensure I wasn't being to casual or blissfully unaware of something of urgent attention, will then just keep eye if stays all good, will stay as same status, just look look to give consideration closer next due renewal ?
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#8
RE: How many CA for ASV
I'm going to reiterate that this is not CSR, it is significant periodic breathing. OSCAR reports it as CSR only because that is what ResMed calls it and OSCAR is a reporting tool. You are not the only one. Nearly everyone who sees the green highlighted CSR panics to some degree and says OMG am I going to die? The truth is that yes, we are all going to die, just not from this and not in the near future. This is such a big problem that the OSCAR team is talking about how we can relabel this to learn this impact.

Having that significant of periodic breathing for a week or more, and have it repeat often should be adequate to justify an ASV. Your homework is to compile daily charts week or longer event occuring several times. Put together a 3, 4, or 6 month history. Combine this with an OSCAR summary page to give to your doc.

The zoom views, both the good and bad show CO2 induced breathing pattern, and not ideopathic central Apneas. That's good because we know the cause.

As Sleeprider indicated there are 2 treatments. ASV and EERS
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#9
RE: How many CA for ASV
Just to eliminate other causes, any history of brain injuries or stroke or seizures, any use of meds that affect the CNS, this does include pain meds.
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#10
RE: How many CA for ASV
Hi Gideon, yes over years had few decent hits to the head, playing football head hitting ground and times in confided areas by lifting up head to fast so as to have arguments with timber Joist's but that mostly at least over 20 year ago but more recent did have a stroke, that kept in hospital for 3 days, but virtually now close enough to fully recovered, and was identified Paroxysmal Arrhythmia, Atrial Fib, which then suspected but not certain for the cause of  stroke, and now taking Flecainide, Metoprolol & Eliquis (Apiaxban)
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