I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?

[quiescence at last]

It is the pressure that causes aerophagia. And it is sometimes the surprise pressure bump. In general, I usually hear that complaint with pressure above 12 cm. But, people generally get used to the pressure and have less swallowed air over time.

QAL

[SarcasticDave94]

If any PAP could be set to zero, that's the same as no PAP. The way I handle the air splint is to use the exhale/EPAP to splint or it'll collapse upon going from inhale IPAP to exhale/EPAP.

The need for BPAP needs to be more defined then just BPAP. There's ones without backup rate and with. If you have Centrals, you need to have backup rate like on the ASV. A BPAP without backup rate will likely make Centrals either worse or just not treated.

It appears you will enter clinical menu by holding the lock button for 3 seconds from your patient "home" screen.

[S. Manz]

Hypoglossal nerve stimulation operation for the treatment of OSA which you tend to want to gravitate towards, is a very expensive and relatively new FDA approved procedure with a >80% average success rate...which means if you are in the 20% segment, you'd be way out of luck...and your insurance company may refuse coverage after.
I have Central apnea (CA) and seriously considering  transvenous phrenic nerve stimulation operation , however I am sticking with my machine for now and want to wait for a greater number of success stories before I make up my mind.

[Jay51]

Thank you QAL, Dave, and S. Manz.  QAL - I forgot to mention about the buzzing.  I had an xray and MRI of neck.  No pinching of nerve.  No tingling sensation or decreased strength or motor control ever.  MRI and xray showed no pinched nerve.  That would be great to have an 8 hour ramp time.  That would solve my problem.  Not.  I am the point where I am thinking:  if I can't use it at night, why even have it.  Hopefully that changes with the ASV.  
Dave, does the Astral 100 have a back up rate?  What exactly is back up rate?  
S. Manz, thank you very much for your post.  I am seriously leaning towards trying to avoid getting the Inspire hypoglossal nerve stimulator.  One post I read said that when it went off every night it was like an alarm clock in his mouth.  It would most likely wake me up and possibly keep me up.  *Also, with my central sleep apnea and cheyne stokes breathing (faster, slower, medium, erratic, etc.), is there any way the Inspire would be able to sync with me enough to be effective?  I read  were it has a sensor on the diaphragm and around the heart.  Would I still need the ASV also?  I learned a lot the past 2 days here about central sleep apnea and cheyne stokes.  I am wondering if it would even work with my combination of severe obstructive sleep apnea and mild central with cheyne stokes?  I definitely don't want to pay that huge a bill if the implants does not work in my case.  
I saw 2 other things on the internet.  One is a suction c-ring shaped device that suctions to the lower jaw and keeps it forward during sleep.  The other one was called a Hyoid (bone) suspension.  Rubber bands and a surgery to keep the airway open at night.  Can remove bands during the day.

[S. Manz]

I am somewhat surprised to find that you are already on ventilator Astral-100. Dave will update you with more detail on that.
FYI, a "backup rate" is used by a ventilator (or Dreamstation ASV) as backup number of breaths per minute that the machine uses to provide you with breaths, when you stop breathing. In the case of my dreamstation SV, when I stop breathing, it will start providing breaths (not just a continuous pressure, but real timed breaths just like my own natural inhalation cycles) at the backup rate that I have pre-programmed it for (you can also set it to auto) and it progressively raises the pressure each time, until I start breathing again. (You can also set an alarm in Dreamstation to alerts a caretaker, if after a preset number of tries, I'm still not breathing).
An ASV machine should solve your issues but depending on the model it will also take some getting used to. Patience is key here.
Also when it comes to relatively new surgical procedures, it is best to wait for at least 3 to 5 years until all the bugs are taken out, before commiting to one, otherwise you run the risk of wasting an enormous amounts of time and energy on it.

[SarcasticDave94]

Yes your Astral 100 has a backup breath rate while in iVAPS mode and possibly PAC, maybe others but not while in CPAP. ST-A and ASV has backup rate as well. The ST-A is a different form factor and less powerful than Astral but are otherwise similar, including an iVAPS mode.

[Jay51]

Thank you S. Manz and Dave for explaining back up rates to me.  Makes sense. I called my PCP and got an appointment (earliest is in 2 weeks) to get a Cardiologist consult (Thanks Dave.).   
Last night I got the courage up to try to fall asleep with the Astral 100.  Same results though.  Just as I am about to drift off into unconscious sleep, the Astral 100 delivered 3 consecutive full strength inhalation pressures that woke me up.  About half as bad as the ST-A did at a higher pressure though.  
This week the RT came to my home and observed me using the Astral.  She said as I relax my breathing becomes very swallow.  The RT who did my overnight sleep study said that just as I am about to fall asleep, I completely stop breathing.  
I am going to write what I believe is happening, but please jump in and correct me here if I am wrong.  I relax.  My breaths get swallow and eventually stop breathing.  ST-A and Astral both sensed this.  Their response was exactly the same every time:  deliver 3 quick full strength inhalation pressures.  This always wakes me up.  Both machines immediately back off after the 3 blasts and start delivering much slower and lower pressure inhalation pressures to me.  Is there a way even try to correct this with the current Astral I am using?  If I understand Sleeprider, the ASV can be set to use one instead of 3 consecutive inhalation pressures and even at a lower strength than full blast to try to get me to spontaneously breathe.  Would simply using the standard 2 liters of oxygen from a bottle (and delivered by nasal canula) all night long solve my problem?  
I actually always feel worse after using the ST-A or Astral than if I did not use it at all.  Last night the "buzzing" was really bad.  It felt like a live bumble bee somehow entered the middle of my physical heart and was buzzing.  Or even this.  I have a gas heater in the house here.  At night when I am up the house is quiet (like my physical body from head to toe) except my heart.  Body still and quiet and relaxed.  My heart is like the heater in the middle of the house - I can sense it "rumbling" while everthing else is quiet.  My guess is that my blood oxygen saturation gets too low with the apneas (lowest recorded on me was 79) and that this decrease in oxygen is causing my heart to not function 100% correctly.  When I wake up the rumbling is like shaking almost like my heart is in an earthquake, but the rest of my body is not.  AFter a few minutes of consciously breathig in some oxygen, my heart returns to normal funtioning (I don't sense it rumbling or buzzing and the earthquake stops).

[Jay51]

The only reason I attempted the Astral last night (which I knew would not work) is because I think insurance and Dr.'s and RT may want to see multiple repeated unsuccessful attempts to use the Astral 100.  I have one more from last night.  I think I have 4 now with each one unsuccessfully trying to fall asleep with the AStral at current settings.  I think it will move me quicker from the Astral to the ASV.  The Astral is a very expensive machine. 
On my home sleep study that I uploaded here I read the recommendation to, "discontinue bipap if central apneas worsen."  I would like to understand this completely as it will arm me with a huge reason to move from the Astral to the ASV.  I think this is what is happening to me.  I always feel worse after I use the ST-A or Astral.  Is it simply the fact that when it produces three straight high pressure inhalations and wakes me up.  Is this what it means that central apneas are worsening.  Or is there an even better, more technical explanation of how the ST-A and Astral are worsening central apneas.  
I was very tired today and took an hour and 1/2 nap this afternoon and feel better.  I really don't want to even try the Astral at its current settings again at night.  I hope they don't want any more attempts.  I don't feel any better using it during the day.  Thank you everyone.

[SarcasticDave94]

Jay51, you can force the issue forward if you feel it's necessary. After diagnostic sleep study: To get ASV, normally you progress from CPAP to BPAP without backup rate, ST, then ASV. In '15 I tried straight REMStar CPAP and hated it. Straight 18 pressure and no doc support I'm thinking it's probably why.

Early '17 on DreamStation BPAP Auto and just using it I felt TERRIBLE due to Centrals. How long did I stay on terrible therapy? 5 days. I called doc daily and told his staff for bad it was. The Monday after issuing BPAP, I had a 7 AM urgent pulmonary visit there with my diagnosic in hand. 124 Centrals, 24 Obstructive events highlighted. Asked I "With high CA like this, wouldn't ASV be better?" Nurse, yes, why aren't you on that? Cue starting ASV path.

The moral is, call call call call call call. Make ASV happen.

[Jay51]

Thank you for that DAve.  More documented centrals can move a person to the asv faster.  I had a thought.  I am thinking about maybe trying to get the cheapest used/refurbished cpap I can find online, download OSCAR on it, sleep with it a few nights, and upload the data here and let you and Sleeprider (QAL, S. Manz., and anyone else who feels like it) to analyze it and make sure I am on the right path.   I believe I am headed in the right direction, but after looking over OSCAR, you might find some other important things from data also.  Loaner cpap from a DME or hospital?