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New ASV User Looking For Advice
#1
Hello. I've been using CPAP for about 7 years and was on a Respironics System One APAP set from 6 to 15 and my 90% Pressure stayed around 9 - 10 for years with well controlled AHI. I loved my PAP and used it every night.

I was living at high altitude (7000 ft) for 3 years and began to exhibit Periodic Breathing about almost two years ago. I went for a new sleep study and was then prescribed a Respironics BiPAP autoSV Advanced set at EPAP 11, PS MIN 3 and PS MAX 8. I hated it from the first night and it would wake me up several times per night and I gave up on it after a few months and went back to my APAP.

Strangely enough, my Periodoc Breathing seemed to stop and everything went back to normal and I had no problems for well over a year. I'm living at a lower elevation now (~1000 ft) and my PB started to come back again. My AHI has remained at < 5 through all of this, BTW. I took the ASV out of the closet this weekend and started to use it again. PB is back down to 0% but I'm still waking up several times a night and having a hard time adjusting to the pressure.

Are the new ResMed Aircurve 10 ASVs really that much more sophisticated in "working with" one's breathing? I don't feel like my System One is adapting to me.

Does anyone have some suggestions for me on how to more easily adjust to the ASV? Also, am I making to much out of 5% PB per night? Maybe I should just go back to my APAP.

My insurance won't pay for a new machine yet but if the Aircurve 10 ASV is really as good as I've been hearing, maybe I will attempt to pay for one out of pocket.

Sorry for the long winded post. Thank you in advance for any/all suggestions you may have.
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#2
Hi GrandGuignol,
Welcome to Apnea Board!

It may be that your pressure settings need tweeked a bit. There are several ASV users here, so hang in there, I'm sure they will be able to advise.

OpalRose
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#3
Hi GrandGuignol,

Another welcome to the Apnea Board. I am an Aircurve 10 ASV user and I love the machine. Please install the Sleepyhead software and begin downloading your data so that we and you can get a better handle on what is going on. We would also like to know more about your original diagnosis. Specifically, your OA, hypopnea and periodic breathing events that may have been observed in your sleep study and the recommended pressures. Other things that we might look at are your response to different settings. In particular the differential between EPAP and IPAP as well as Pressure relief settings. That said, the higher the altitude the more chance for periodic breathing, and Central Apnea. CPAP users in CO have a higher incidence of Periodic Breathing than those at sea level. An original assumption is that you were being treated primarily for Obstructive Apnea. The goal would be to first control the OA and then tweak your settings to minimise the Periodic Breathing. An ASV machine might be overkill unless adjusting your traditional machine doesn't work. Keep us posted.

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

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#4
Hi GrandGuignol,
WELCOME! to the forum.!
Hang in there for more answers to your ASV questions and good luck to you with getting your machine adjusted to meet your needs.
trish6hundred
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#5
Thank you for the replies. I need to buy an SD card reader and then I will upload Sleepyhead data for you all to look at.

Since my last post I did some digging around and I changed two settings on my ASV which may make for a more comfortable night. I increased Biflex to 3 (from 2) and I also set Mask Resistance to 0 (from x1) since I am not using a Respironics mask.

RichD - My original sleep study was in 2009 or 2010 and I don't have a copy of it. It's from a previous doctor in a previous state, so you know how getting old data can be... Smile

We just moved into a new house and I will have to dig up my ASV Titration study but I know that's here somewhere.

I appreciate the welcome messages and I look forward to contributing here.
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#6
(08-31-2016, 11:11 PM)GrandGuignol Wrote: Strangely enough, my Periodoc Breathing seemed to stop and everything went back to normal and I had no problems for well over a year. I'm living at a lower elevation now (~1000 ft) and my PB started to come back again. My AHI has remained at < 5 through all of this, BTW. I took the ASV out of the closet this weekend and started to use it again. PB is back down to 0% but I'm still waking up several times a night and having a hard time adjusting to the pressure.

Have you discussed the PB issue with your physician as it can be linked to cardiac issues (arrhythmias and fluids - chf)?

"Half of heart failure patients experience either OSA or central sleep apnea (CSA) with central nervous system–mediated periodic breathing, commonly referred to as Cheyne-Stokes respiration. Such cardiorespiratory disturbances profoundly alter autonomic nervous system activity and increase risk of arrhythmia, hypertension, and myocardial infarction. " http://circep.ahajournals.org/content/2/4/450.full

I noticed a new onset of Periodic Breathing, saw the cardiologist, and a simple blood test BNP (Brain natriuretic peptide) showed I was carrying extra fluid. An relatively easy fix with a mild diuretic.

Best of luck trying to get it all up and working again.
"The object in life is not to be on the side of the majority, but to escape finding oneself in the ranks of the insane." -- Marcus Aurelius
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#7
(09-02-2016, 03:00 AM)srlevine1 Wrote: Have you discussed the PB issue with your physician as it can be linked to cardiac issues (arrhythmias and fluids - chf)?

"Half of heart failure patients experience either OSA or central sleep apnea (CSA) with central nervous system–mediated periodic breathing, commonly referred to as Cheyne-Stokes respiration. Such cardiorespiratory disturbances profoundly alter autonomic nervous system activity and increase risk of arrhythmia, hypertension, and myocardial infarction. " http://circep.ahajournals.org/content/2/4/450.full

I noticed a new onset of Periodic Breathing, saw the cardiologist, and a simple blood test BNP (Brain natriuretic peptide) showed I was carrying extra fluid. An relatively easy fix with a mild diuretic.

srlevine1 makes a very good point in suggesting that you coordinate treatment with your cardiologist to be sure you are on the right track. The onset of Periodic Breathing and even worse Cheyne Stokes Respiration can be diagnostic when it comes to Chronic Heart Failure. There was a time when ASV was prescribed to treat these breathing anomalies with CPAP and ASV. Thinking is changing today when it comes to using ASV for Cheyne Stokes Respiration. Recent studies have shown that when ASV is used for patients with a low ejection fraction ( <35% ) mortality increases. It seems to me that a change in ones breathing pattern, especially the onset of Periodic Breathing, should trigger a visit to a cardiologist. An annual visit to a Sleep Dr probably wouldn't be sufficient to find subtle changes in breathing. Therefore I think it is very important to monitor your own breathing patterns using Sleepyhead or other high definition software.

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

Download Sleepyhead
Organize your Sleepyhead Charts
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