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Newbe with Complex Apnea - Best ASV to get?
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racprops Offline

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Post: #31
RE: BEST ASV_CPAP machine for self setup??
I just learned that:

OK Called Phillips Resanonics and asked about central apneas...reporting.

AS they are NOT reading brain waves they cannot accurately report on centrals BUT As the machine will sense a non-breathing event and send a pulse of air into the air pipe and react to this test: If there is back pressure it is a obstruction apnea and react and record it as obstruction and if there is no back pressure it will again push air in and record it as a "Open airway" Event..

So open airways can be reasonable be read as centrals.

You learn something every day.

And had posted it on the other thread...I was considering weather to pull this thread BUT I may learn more with as well:

Like what people think of their ASV.

Rich
03-21-2013 05:42 PM
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racprops Offline

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Machine: Respironics DS960HS
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Post: #32
RE: BEST ASV_CPAP machine for self setup??
And your second post does raise a question as what is considered acceptable levels of any apneas??

During my sleep study they recorder I had 73 OB. Centrals of 35 with Hypopneas of 71 and the avg. lenght was 24.4 seconds this was under CPAP and a short trial of BiPAP.

I kind of wonder when do I really breath between all of that...

So I now can guess I cannot expect these numbers to be zeros?

Rich
(This post was last modified: 03-21-2013 05:50 PM by racprops.)
03-21-2013 05:46 PM
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SuperSleeper Offline

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Post: #33
RE: BEST ASV_CPAP machine for self setup??
Unless you're extremely lucky, those numbers will seldom be zero. The goal for CPAP treatment is to get all apnea events (combination including obstructives & centrals) plus hypopneas under 5.0 AHI. See this Wiki page on AHI.

As Archangle stated in another thread, it's likely that obstructives and centrals are equally damaging to your body. If you can get the combined total below that 5.0 AHI level, that's considered as acceptable AHI levels by most. However, you'll find that on this forum, a lot of folks are after that "elusive" AHI of 0.0... :grin:

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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.

03-21-2013 05:52 PM
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SuperSleeper Offline

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Machine: PR System One REMstar Auto (DS560)
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Post: #34
RE: BEST ASV_CPAP machine for self setup??
(03-21-2013 05:16 PM)SuperSleeper Wrote:  We've had several discussions on whether higher pressures induce centrals in most patients or not... but I think the more important discussion should be "do a few pressure-induced centrals really matter a whole lot?" (as long as they are not extensive in number)?

Let me further illustrate what I'm talking about above. Let's say that you're on CPAP and during the night, roughly 62% of your events are centrals, 20% of your events are obstructive and 18% are hypopneas.

Ordinarily, given the above stats, one might think "Oh my, you need to get those centrals down - the majority of them are centrals - you need an ASV pronto"

However, you have to look at the overall AHI levels. Those percentages could be perfectible acceptable. You have to look deeper into how many events we're talking about that make up that percentage. For instance, assume while on standard CPAP, the underlying events reveal numbers like this:

During 8 hours of sleep: 24 central events (62% of the total), 8 obstructive events (20% of the total) and 7 hypopnea events (18% of the total).

That's a total of 39 events during the night. Divide that 39 by the number of hours of sleep (8) and you get 4.88 events per hour (an AHI of 4.88). That 4.88 AHI level is perfectly acceptable, even though 62% of all events are centrals.

Given the above fictional scenario, I'm not sure that prescribing an expensive ASV would be the best route, especially if standard CPAP or APAP could get the AHI below 5.0.

Hope that made sense!


Smile

SuperSleeper
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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.

03-21-2013 06:20 PM
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racprops Offline

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Post: #35
RE: BEST ASV_CPAP machine for self setup??
It does.

Now with my record of:

AHI: 68.1 HR
RDI:68/hr
A Obstructive index of 27.5/HR and a Mixed apnea index of 0.8/HR

How does that look?

Rich
03-21-2013 06:28 PM
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britincanada Offline

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Post: #36
RE: BEST ASV_CPAP machine for self setup??
Them Numbers seem real High

if i where you i would go to the docs

Do not mess with a machine yourself get the pros to do the ground work then when your readings are under 5

see how u feel about adjusting it yourself

give it 6 mth before you even touch the setup manual

mine are down to 2.5 and i feel great

if you get yours down to below 5 or 5 and feel great leave it alone
03-21-2013 06:53 PM
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SuperSleeper Offline

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Machine: PR System One REMstar Auto (DS560)
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Post: #37
RE: BEST ASV_CPAP machine for self setup??
(03-21-2013 06:28 PM)racprops Wrote:  Now with my record of:

AHI: 68.1 HR
RDI:68/hr
A Obstructive index of 27.5/HR and a Mixed apnea index of 0.8/HR

How does that look?


I'm assuming that's your untreated AHI level, correct? (when not on any type of CPAP machine at all)... a 68.1 AHI is considered severe sleep apnea definitely, although many here have a much higher untreated AHI level.

The numbers I gave in the above example were for AHI while under CPAP treatment, so if you could find out what your AHI was while under CPAP/BiPAP during the sleep lab night, that would be nice to know, along with the best titrated pressure the lab worker could get during the titration.

Alternatively it might be worth it to find someone with an extra data-capable Auto-CPAP machine to see if you could lower your overall AHI with that machine, rather than spending 3+ times the cost for an ASV.

Or, perhaps you could find a local DME who might rent one cheaply for a week or so as Paula suggested. Or actually purchase one that has some sort of 100% money back warranty for 10 days or so through the DME supplier, so that if after a week you find it doesn't reduce AHI to 5.0 or below, you can turn it back in for a complete refund, or at least a complete credit that you can use towards a more expensive ASV.

SuperSleeper
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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.

03-21-2013 07:03 PM
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jgjones1972 Offline

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Post: #38
RE: BEST ASV_CPAP machine for self setup??
I know I'm starting to sound like a broken record with this; but, I think a recording oximeter would give you some of the most important data needed for optimizing your therapy. Especially when dealing with clear airway events.

I know that's not really answering the question about what the best machine is for self setup - but it's something to think about.

We all know how to deal with obstructive events: Obstruction bad. Obstruction not supposed to happen. Try stop obstruction, <grunt>.

Clear airway events are a little different. I think its pretty justified to assume that having a lot of or long CA events is a bad thing - but I think it is really hard to properly evaluate without O2 saturation data.

JMHO

Sleep-well
03-21-2013 07:20 PM
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racprops Offline

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CPAP Software: SleepyHead EncoreBasic

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Sex: Male
Location: Phoenix AZ

Post: #39
RE: BEST ASV_CPAP machine for self setup??
Sorry that was ON A CPAP.

Off I was

AHI 104.1/hr

RDI: 104.1/hr

Obstruction index of 36.4

Also the AVG. SpO2: 90%
Low SpO2 was 79%

ON CPAP:

AVG. SpO2 was 92%
and Low was 84%

AHI at optimal pressure N/A
(This post was last modified: 03-21-2013 07:44 PM by racprops.)
03-21-2013 07:22 PM
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SuperSleeper Offline

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Posts: 9,967
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Machine: PR System One REMstar Auto (DS560)
Mask Type: Nasal pillows
Mask Make & Model: ResMed Mirage Swift II
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CPAP Pressure: 12.5 - 18.5 cmH20 (auto range)
CPAP Software: SleepyHead

Other Comments: Have diabetes Type II

Sex: Male
Location: Illinois, USA

Post: #40
RE: BEST ASV_CPAP machine for self setup??
I second jgjones1972's suggestion for an oximeter. Low cost piece of equipment that will tell you a lot of what's going on during the night. Happy Eyes

(03-21-2013 07:22 PM)racprops Wrote:  Sorry that was ON A CPAP.
Off I was
AHI 104.1/hr
RDI: 104.1/hr
Obstruction index of 36.4

Oh my... yeah, that's pretty high for AHI while on CPAP. ouch. Sad But then again, I don't know what pressure he had you at during the titration period.

But I think you said that the sleep tech really didn't get a chance to fully titrate you, correct? (ran out of time).. If so, could it be (for example) that he only got up to a titration pressure of around 12 cmH2O of pressure, but ran out of time to see if higher pressures would have solved the problem? If so, perhaps raising CPAP pressure to 16 might have lowered AHI to 5.0, but he ran out of time to check higher levels of pressure... (just using arbitrary numbers as an example here)

The problem here is that you were never properly titrated. I'm wondering what prompted the tech to switch from CPAP to Bi-level during the titration...

Was it 1) the increased central events, or 2) that he couldn't lower AHI even at a top level of 20 cmH2O (the highest level on most CPAPs)?

Bi-levels go to higher pressures (most of them go up to 25 cmH2O).

Thinking-about

SuperSleeper
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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.

03-21-2013 07:33 PM
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