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I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
Carry duct tape to keep doc's head from exploding when you mention all these things. It may be too much responsibility for their probable side job.

And Happy New Year.
Dave

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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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RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
Update:  I saw my PCP about a Cardiologist consult today (and I took a roll of duct tape - Thanks Dave).  I come here every day and at least read all threads/posts on central apnea and asv on the 1st page.  

This past Monday:  The manufacturer of the Astral called me to check on how I was doing.  They call me every 2 weeks.  This time, instead of saying that the machine's rate is much too fast for me and the pressure much too high (which always got the response, "Just use it more during the day to get used to it.); I said I was "hyperventilating" and also talked about hypocapnia and my 2:1 ratio of CSA to OSA.  It got a better response this time.  The manufacturer contacted the RT at my local DME.  

The next day (yesterday, Tuesday) I got a call from the RT saying she was about 30 minutes from my home and wanted to check on me.  She changed the settings for about the 4th time.  I talked to her about hyperventilating and hypocapnia (Thanks Sleeprider), about my 2:1 ratio of CSA to OSA and showed her the interpretation of my polysomnography posted by Sleeprider on this thread.  She read it and agreed.  What she said next though, and I quote, "The Astral is ASV," surprised me.  I thought to myself, that is wrong.  Not correct.  But I didn't feel educated enough to argue about it.  Is she technically correct (the Astral is ASV therapy?)  I have only heard of 2 ASV machines here I think (Resmed and DS).  I may be wrong though.  I then showed her a brochure for the Resmed ASV.  She read it and said, "There are different kinds of ASV."  I felt confused by her statement and not educated enough yet to talk more with her.  But she did say a great thing as she was leaving, "we can probably try the Resmed ASV next if the Astral does not work out."  She would like a few nights of me sleeping with the Astral for data though.  I agreed to that.  I will put on the mask and not take it off all night if I have to stay awake all night to produce some data for her to move things along. 

She mentions my "shallow breathing" a lot I think in an attempt to justify the Astral, too.  Is she correct here?  

I looked on my Astral and it says iVAPS/autoEPAP mode on the front touchscreen.  I guess it is in iVAPS mode.  I have done some research about iVAPS.  But this is not the same as ASV is it?  I know the Resmed ASV is much quicker and flexible with it's algorithm.  Correct?  

I have tried to "throw the Astral fail flag" like you recommended, Dave.  The Manufacturer and the RT from the local DME picked up the flag and handed it back to me.  I will keep throwing it though.  When the manufacturer calls me back in about a week, what should I say this time to get an even better response?  The Astral feels much too slow in changing it's pressures and rates, but the Resmed ASV is supposed to be much quicker responding?  Or something along these lines?  

Today, I saw PCP.  She is consulting her personal Cardiologist for me.  Says will want to probably do EKG or echo (I forgot which one she said) and have me wear a 24 hour monitor for a few days to catch the A-fib or arrhythmia or tachycardia I only seem to experience at night when I wake up (and it goes away in a few minutes after I start breathing again.)  PCP said the "buzzing" I felt in the back of my head and neck was my carotid arteries.  I do not want a blood clot from A-FIB to form and be thrown and go up my carotid arteries and cause a stroke (all from sleep apnea).  Kind of scared me, but gives me motivation to do my pap therapy.

Comments welcome.  Much appreciation for all of the help that has gotten me this far.
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RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
The ResMed Astral and ASV are completely different. One isn't a mode within the other, or anything else incorrect they may try to tell you. ASV should be a quicker response because it's programmed to be that way, quicker than even the Astral I'm pretty sure.

Both are ventilators, but with very different missions.

ASV is Adaptive Servo Ventilator to combat Central Apnea.

iVAPS is a true ventilator mode, the ASV will not have this mode. ResMed ST-A, Stellar, and Astral do. These are respiratory support machines for those with respiratory disease.

I'm guessing the RT and DME will not really get it. But at least the RT mentioned ASV. Keep throwing flags. But give yourself a time limit. If they expires, for them, return the Astral, and hire some other quacks.
Dave

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Standard OSCAR Chart Order
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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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RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
Update:  I had a Cardiologist appointment yesterday.  It was rescheduled twice in January and I had to change it last week because of the weather in the US.   They did 5 tests that lasted 3 hours.  I thought I was just going in for a basic check-up, get an echocardiogram to be cleared for the ASV, and be fitted with a 24 hour (Holter) heart monitor to wear for a few days and nights to see what is happening at night during sleep (A-fib or arrythmia of some sort).  

Doc showed me a 3D (doppler - moving image) 360 degree moving image of my heart.  He saw 2 small areas not functioning due to lack of blood flow.  One small area was about the size of a pencil eraser in diameter.  The other was the size of a nickel or quarter.  Looked like about 95% of my heart normal though.  I was stunned and had zero clue about this.  Caught in very early stages, but could have led to heart attack untreated later down the road. 1.  Family history (genetics) 2. sleep apnea and 3.  lifestyle factors - diet, exercise, and stress most likely cause.  % of each though is unknown.  Doc said my heart rhythm is good.  But he has not seen it at night with desaturation from sleep apnea yet.

This Friday they want to do one more test and possibly place a stent (or multiple stents) based on the test to open up a carotid artery (or arteries).  Doc said stents are low risk/high reward procedures most of the time.  Results are usually immediate. 

ENT Dr. was first to recommend I see Cardiologist back in late Nov.  It went in one ear and out the other.  Dave here kept encouraging me to see a Cardiologist just to get checked out.  I am glad he did.  Thanks Dave (Sarcastic).  

On the ASV front:  my 90 day trial period of the Astral ends in March.  I have tried producing some data for RT, but multiple alarms continue to go off on the Astral.  "High MVE",  "Low VTE," "low pressure", just to name a few.  

This week RT gave me a new Quattro (Resmed FFM) to try.  I told her to charge it to my debit card.  She said, it is free.  I am not charging you.  Nice of her to do that.   I have mentioned a lot of negatives here, but must give credit here to be fair.  The Quattro is very nice.  I have a PR Amara gel mask and a Resmed Dreamwear gel pillow mask.  The Quattro is much more comfortable for me than the PR.   1.  gel softer  2.  no irritating forehead bar with pad  3.  best and most comfortable back of head strap design I have used.  I have used about 10 chin straps and these other 2 masks for comparison.  I would eventually down the road like to use the nasal pillows, but higher pressure seems easier at this stage with a FFM. 

The RT is just about on board with the ASV.  She still thinks ST and Astral and all ventilators and ivaps are ASV (I guess that is the way they are trained to think), but that doesn't matter because I am failing Astral compliance.  Thank you Sleeprider for all the education about ASV.  "Educated" squeaking has been as twice as fast and productive for me than just increasing the frequency and intensity of my "squeaking" for ASV.  I can see the changes in the RT's thinking and attitude.  It also seems to me that central apnea is both unrepresented (from the posts I have read here a larger number of posters seem to have central issues than statistics seem to display) and less understood.  

The RT explained the insurance process to me though.  She said most of the time you need documentation that each level of treatment failed to work in a reasonable amount of time to be able to move to the next higher machine with full coverage.  Not a problem.  

I have been sleeping in a recliner for about a month with a soft cervical collar in the mean time.  Easier to breathe for me the higher the angle of the recliner, and I have bought into the soft cervical collar (keeps me from chin tucking and contorting airway).  Both are sustainable it seems.  I am willing to do just about anything to be able to lower my pressure a bit to better tolerate and comply with my pap therapy.  The recliner and collar are probably helping my severe OSA somewhat, but not doing anything for my centrals.  When I used to wake up from a nap sleeping on my back, I could hear myself snoring, my mouth wide open - jaw dropped, and choking and gagging.  Not so in the recliner with the cervical collar.  I can keep my mouth closed all the time - when I fall asleep and when I wake up.  Sleeping much longer periods of time without waking up also.  I even tried sleeping on my back, but my neck could not take it twisting (not sustainable for me).  I have a massage table here at home with a horseshoe shaped padded face support.  I tried sleeping on my stomach on the massage table, but my forehead hurt too much (not sustainable).  But the horseshoe neck rest locks my neck in place and prevents chin tucking. Much easier to breathe it was, but not sustainable for me personally.  

Thank you again for both the education and support on this forum.
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RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
That is a lot of progress to catch up on. I didn't expect cardiology to find anything, but it sounds like you got the full workup and may have benefitted your long-term health. Nothing appears to be a risk factor for ASV. The positional issues needed to be resolved regardless of therapy. Well done on taking initiative and experimenting with alternatives to see what works best.
Sleeprider
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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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RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
Congrats on the news of getting checked out. It seems like you've had some progress on the ASV front. Keep up the fight and best wishes the cardiac issue gets addressed.

Maybe if we can find an image of the ResMed AirCurve 10 ASV mode screen, it can be shown to your RT that there's only CPAP, ASV, and ASV Auto available. If I find a screenshot I'll post here.
Dave

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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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RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
See if this image helps. It looks like it's in downloadable form so you can grab a copy and print.

[Image: vldGvNd.jpeg]
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
Thank you Sleeprider.  And thank you Dave for the printout.  I am curious as to how she will respond when she sees this.  I will let you know.
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RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
Jay, I used an analogy in a post to another member, maybe it will help you. Here is what I posted in response to a member needing bilevel pressure support for UARS:
(02-09-2022, 10:56 AM)Sleeprider Wrote: The bilevel pressure support actually comes in behind your spontaneous effort to assist getting to your peak flow.  CPAP pressure can get uncomfortable at higher pressures, but bilevel pressure offers a contrast between inspiration and expiration.   CPAP pressure cannot change respiratory volume or cause people to take a deeper breath.  A more extreme example, people with central apnea need ASV which provides a lot of pressure during inspiration when spontaneous effort is weak or absent.  They would not get a breath at all with just CPAP pressure, but they can have normal respiration with the pressure support of ASV.  With UARS an analogy might be to think of a car trying to go over a hill using a fixed throttle. As the car climbs it reaches a maximum speed and may even slow down. Bilevel pressure is like using the throttle in that car to keep it climbing over the hill without losing speed, then letting up on the throttle to go down the other side.

Now, let's apply this to ASV. Suppose you are driving in your car on cruise control, but instead of responding to the terrain and accelerating as needed for a hill when needed and as needed, the car accelerates every 7-seconds to full throttle regardless of the need for more power. I'm sure you would turn off that uncomfortable and dangerous cruise control very quickly. ADAPTIVE cruise control only applies pressure when it is needed and only as much as is needed. It gets you over the hill of inspiration whether you have no spontaneous effort, weak spontaneous effort, or if you are breathing normally, it just gets out of the way and lets you do the work. ST is on or off, and it hits the throttle 12 times per minute at the same pressure. ASV reads the terrain and keeps you moving at the same speed, even when the hills are not evenly spaced.

Do you want a device that will make you crash into the car in front of you on flat ground, or one that can detect speed, effort and maintain a constant speed. On or off, or modulated assistance. The answer is obvious. The ST and ASV work very differently with different designed objectives. The ST is for a rusty car that needs constant pushing, the ASV is designed for the car that needs more power when it needs it.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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RE: I cannot fall asleep with my bipap/home ventilator. Hypoglossal nerve stimulator?
As one that's used ASV, it sounds exactly like the therapy I had.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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