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

[Jay51]

Thank you very much again Sleeprider, Dave, and Gideon. (And Supersleeper sent me the manual for the ASV). 

I want to amend something in my last post.  Instead of, "will the RT be insulted when I show her this," should have been, "the RT will be thrilled to see this from Sleeprider."  I forgot that this current RT who has given me the ST-A and AStral was not the RT who did my polysomnogram.  She won't become defensive (trying to protect her job and keep from being reprimanded for making this error) because she didn't do my overnight sleep study.  But this current RT stopped returning my calls when I first got the ST-A I called her so much.  She came by my home twice last week.  I have texted her a lot the past week.  She has not returned my last 2 texts.  I wanted to text her today with the attachment of Sleeprider's interpretation of my polysomnogram, but I am going to wait until she contacts me again.  She wants to meet with me sometime to go over data from the AStral.  I may even wait until then to show her this.  But many thanks again, Sleeprider.  
I will follow your instructions when I see my PCP in 10 days Dave.  Many thanks again for nudging me to get a Cardiologist consult.  The ENT Dr. instructed me to get the consult in November, but I have just kept putting it off.  You convinced me to get it.  
I will copy your above post Sleeprider about possible contraindications and give that to my Cardiologist along with a copy of my sleep study with important details highlighted.  Everyone will be covered.  I also found online when I was reading the specs for the ASV (REsmed) that it has a 45 minute (zero pressure - no pressure at all) ramp that should help me fall asleep better.  AS of today I am 2 for about 75 (0.266 - or about 2.5%) in my attempts to even fall asleep with either the ST-A or Astral.  Very very bad odds, but this ramp should help.  
Many thanks and much appreciation again for everything.  I feel like I have made as much progress in one week here as I have made in about 6 months without apneaboard.com

[SarcasticDave94]

Keep us updated and if questions arise, post here and we'll help out. Once you get ASV, you'll see how easy it is to program. I've had to run my own numbers from day one for the 2 years I had mine. Humidity aside, mode choice and up to 4 pressures. Done fini. Self titrate: Sleep and tell us how it felt, look at and post OSCAR. Maybe an edit or 2. Voila better therapy.

[Jay51]

Thank you Dave.  I will keep everyone updated here.  I am rereading all of the posts so I better understand everything when I see Docs again.  

5.0 is going to be the EPAP I will need (EPAP is the "air stent" to stop OA).  PS = 3.  And ASV with pressure support (this will prevent CA).  We can figure out the back up rate and IPAP then (or if I get the ASV titration study, they can figure it out that night).

I am using the AStral more during the day and attempts to fall asleep with it at night.  It should make my transition to the ASV easier.  My ongoing attitude adjustment (Thanks Sleeprider).  I realize the pops are to help me. 

The major thing I am noticing is that the AStral pops me about every minute or so as I am trying to drift off to sleep.  From my ST-A data, I saw about 20+ apnea events on it's charting system during each time I used it for about 30 minutes or so trying to fall sleep for a nap.  I am having multiple CA's as I am trying to fall asleep, Correct?  RT said she has setting as low as possible now on Astral.  EPAP would still be high enough now on Astral to air stent right?  

I have tried blowing back at it, but I still get another pop in a minute or 2.  At times, trying to fall asleep (but rarely), I can sense the A-fib beginning to happen (I guess from the multiple CA's).  Over the years I have somehow learned to ignore these multiple CA's (OA also here?) and even A-fib and fall aleep no problem.  

At this point I think I am better off sleeping with the Astral on all night.  Then I would not get any A-fib (O2 sats would not drop significantly).  Even though I might be awake all night.  

Any errors in my thinking here let me know.  Any other technique than blowing back at it?  Would a ramp help or hurt me?

[SarcasticDave94]

Sounds like you have a decent handle.

Preliminary but on ASV, I'll suggest ASV Auto Mode which makes EPAP a Min/Max range opposed to ASV Mode static EPAP. PS is pressure support you have now. It's a range on ASV always. IPAP is therefore a range but not manually set, it goes by EPAP and PS.

We can start at bare minimum ResMed Titration or slightly modified, probably in EPAP Min.

EPAP Min should be used as the air splint, which prevents Obstructive Apnea and Obstructive based Hypopnea. PS will kick in to get the CA.

Ramp? I'd rather avoid it, it made my therapy worse. It adds complications IMO. Ramp holds off on therapy, locking it down then abruptly jumping into therapy pressures. Besides, Ramp and CA didn't seem to mix well.

[Jay51]

Got it.  Thanks Dave.

[Jay51]

Very quickly.  I have managed to desensitize myself to the frequent pops from the Astral as I am trying to fall asleep.  Happens after 15-25 times or so.  
New problem:  After this my mouth opens wide open (seems like I want to become a 100% mouth breather) and I hear very loud snoring.  This is with full face mask.  
I have a nasal pillow mask also.  Use tight chin strap and mouthguard in teeth with pillows.  Same problem.  I get relaxed, and try as I might, my mouth still opens and very loud snoring sounds.  
Significant?  Insignificant?  Which of these masks will work better for me in the long run?  Or another type of mask?  Thanks.

[BeMurda]

Very informative thread thanks

[SarcasticDave94]

I associate snoring with closing airway. Next stop is Hypopnea or Apnea. I've successfully used a Fisher and Paykel Vitera full face with ASV. The RT I'm working with said if the Vitera was doing well there, it can handle the Astral. Maybe it's back to mask basics.

Does this mask model work well for you specifically? Is the cushion your correct size? Are straps adjusted correct? Not too tight and causing pain or distorted cushion? Maybe a different mask is better for you than this one. Just food for thought.

[Jay51]

Brief update:  The Dr.'s office called and had to reschedule the appointment I had this upcoming Monday to see my PCP about getting a Cardiologist consultation.  Appointment is now Jan. 12th.  No problem. 

The company that manufactures the Astral I am currently using called yesterday.  Every 2 weeks they call to check on progress.  I told them the Astral did not seem to be working out, and the ASV seemed like a much better option for me with my 2:1 ratio of Central apneas to Obstructive apneas on my polysomnogram.  Their response, "Just keep trying to us the Astral more during the day to get used to it and keep trying it at night when you can, too.  If the Astral does not work out, then just get a script for the ASV to try."  She said my certification period on the current Astral started Dec. 2nd and goes until March 2nd.  No problem here either. 

One last thing also.  In the down time now while I still have the Astral, I have noticed that I am going to have to build up my endurance to using it (increased endurance should help me tolerate the ASV easier later also).  My breathing gets shallow (and slower paced).  It seems like I am getting at least twice the oxygen consumption using the Astral as I am when I am not using it.  It forces me to inhale much deeper and at a much faster rate.  I can tell my heart is beating faster and pumping more oxygenated blood through my system also.  If this is what is considered normal nightly breathing, then I will do my best to change and adapt to this.  8 hours of my 32.2 AHI nights without using any machine seem like about 3 or 4 hours while using the machine (oxygen consumption wise).  I feel like I just finished a workout after using the Astral for an hour or 2.  I feel a little tired. 

Thank you everyone (Thanks Dave and Sleeprider).  Thanks BeMurda for the comments.

[SarcasticDave94]

Just my opinion, but if the machine is making you adapt to it rather than it pacing your rate, it's not doing its job well or it needs a settings edit. I want to say maybe breath rate is too high, that comes to mind first.

Also keep in mind if you feel you're torturing yourself without ASV and stuck on Astral, keep complaining. DAILY. I would adamantly refuse torture till March. Just fail it with cause. When asked Why did you fail Astral? Because I have Central Apnea not respiratory disease.

What I did when I was issued the wrong therapy machine was try it a night to give data. Then call the DME's office, schedule a return of this machine please. It's not working for me. I will not use it further.

Sincere best wishes.