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Please help! 4+ years fragmented sleep and insomnia – Extremely Desperate
Overall, this seems like a good night. Most of it at PS=6 with the exception of ten minutes 13:35-13:45 at max PS=12 and few earlier, which means a bilevel with PS=6 would have worked pretty much the same as the ASV. Going forward, you can try slightly higher EPAP=6 and opening up PSmax, letting the machine do its job in the short time you really need the pressure thus avoiding some possible awakening.


While there is always room for improvement, objectively your SDB is handled very well by the ASV machine. You had bad years without treatment, but now your breathing is probably better than 90% the people you know. Try to believe this and sleep well.
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Thanks, yrnkrn. I don't know why the pressure initially went up as my breathing got narrower starting at 10:36 but instead of sustaining higher pressures, the machine decided to drop off instead as my breathing continued to get more shallow. I'll try again with your (and vsheline's) suggestion of increasing EPAP to 6 and higher PSmax. I hope I don't get any aerophagia as my cervical collar is starting to get way too hot to wear now, ugh.
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Update - Waiting on a bilevel in the mail, but getting worrying centrals with EPR 3?


So given a few terrible nights with the ASV, I'd decided to get a AirCurve 10 VAuto bilevel thinking my centrals aren't too big of a deal since half of them happen after disturbed breaths. I'm still waiting for the bilevel to arrive in the mail.

However now I think I should have gone with the ASV (which I did initially but canceled my order.) I'm sorry to everyone who suggested to get an ASV over a bilevel.

Last night my central index in SH went up to 4.47. Most of the centrals aren't triggered by disturbed breathing and they've all gone up in duration on average with the longest being 43 seconds which is something that has never happened to me before. According to SH, time in apnea was over 10 min with just over 6h30m of sleep.

I've also just realized that my centrals go over 5.0 index in SH twice a week for the past few weeks.

On the bright side, the awakenings are shorter. The fatigue is still very painful and disabling with the CPAP.

I turned up my min pressure because I was getting these disturbingly long OSAs lasting 60s+. Going to turn it down tonight.


[Image: yn6GdLf.png]

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So if this central trend continues with EPR 3 alone, maybe getting a bilevel was a bad idea?
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The Vauto is not capable of treating central apnea and may make it worse. I think you made a mistake if you were approved for ASV and quit during the adjustment period.
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In my own experience, using a ResMed 10 AirSense AutoSet (APAP) machine was resulting in too many apneas (including CAs), but I was only a "marginal case" for ASV.

When I did a trial on Bi-level (ResMed AirCurve) my numbers were very bad and I felt horrible.

ASV required an adjustment period, but it was the ticket for me.

Bill
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(08-01-2018, 10:23 AM)Spy Car Wrote: In my own experience, using a ResMed 10 AirSense AutoSet (APAP) machine was resulting in too many apneas (including CAs), but I was only a "marginal case" for ASV.

When I did a trial on Bi-level (ResMed AirCurve) my numbers were very bad and I felt horrible.

ASV required an adjustment period, but it was the ticket for me.

Bill

Your ASV thread was really inspiring, Spy Car. I actually started my thread after reading yours. It's always heartening to read that you're doing well. I almost got an ASV initially a few times, but I kept trying to convince myself that maybe a bilevel would suffice. I guess I could be a marginal case as well.

(08-01-2018, 09:16 AM)Sleeprider Wrote: The Vauto is not capable of treating central apnea and may make it worse.  I think you made a mistake if you were approved for ASV and quit during the adjustment period.


Yeah, it doesn't look like the VAuto would play nicely with me. To my luck, the centrals started getting worse only after buying the VAuto online. I wish the medical community were helping me all along through this cursed journey where I live in Ontario, Canada, but that's not the case.
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Update - VAuto Day 1 and Longest OSA ever

So I had my first night with the VAuto and I didn't get to sleep much since I have somewhere to go today. I had some really massive OSAs for some reason. One lasting up to 112 seconds! Never seen such a long obstructive apnea in my life with xPAP! How could I get longer OSAs with bilevel over CPAP? My settings were 6/13/4 with TiMax 4s, TiMin 0.9s, Trigger High, Cycle High.

Maybe I should try a different pillow and try changing cycle to medium? More EPAP min? I couldn't wear the Caldera Releaf collar as it's much too warm. Any advice?

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Try setting trigger to high or very high. EPAP min may need to be raised, but if so, you also need to increase IPAP max.
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During this apnea, you were at pressure 8 or so and there were no breathing attempts in the flow.
If this is an OA, the only thing that would matter is to raise EPAPmin beyond the pressure-during-apnea to preempt the next apnea. EPAPmin, cycle or other BiLevel parameters were not relevant.
If this is a CA then you need an ASV ASAP.
Your results are inconsistent between nights. Please consider a titration at a competent sleep lab to clarify what's going on.
Not waking up from such a long apnea is rare. Have you used any sleep medication this night?
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Thanks, guys.

My trigger was set to high and my cycle was set to medium.

Nice deduction, yrnkrn. I did in fact take sleep medication for this night. Maybe taking an extra Ambien when the first one didn't put me out (total of 2 x 10 mg) wasn't a very good idea and had something to do with it.

I don't think it was a central, hopefully. Here is the start of that colossal 112s apnea: 

[Image: MAVOrxk.png]

Compared to below, which was flagged as a central:

[Image: vySuF3c.png]

Also, I just realized that my EPAP min to max was only 6-9cm per above, as compared to my CPAP settings below, which should be EPAP range of 6-12cm here, am I correct?

[Image: G2byYPm.png]

The night before VAuto: Without medication and the obstructives were low even with the same exact 95% EPAP. 
Yeah, not terribly consistent and I'm going to see a different sleep physician about getting a sleep study done, thanks.

Why won't changing trigger to very high be relevant for obstructive apnea?

So if an apnea like that giant one of 112s happened at high 7cm to high 8cm EPAP, the only thing that would help is to have EPAPmin at 9? Maybe I'm slow, but shouldn't the machine in theory intervene with a setting of EPAP min/max of 6/11cm or 7/11cm if I change the settings to 6/15/4 or 7/15/4 on the VAuto to approximate my CPAP settings?

I guess I just wish it wasn't the case of increasing EPAPmin because for fear of aerophagia.

Yrnkrn, I think you also made a typo here: "EPAPmin, cycle or other bilevel parameters were not relevant." Did you mean EPAPmax?

I'm going to try 7/15/4 tonight and not take any medication to see how it goes. Hopefully I won't run into a different problem (centrals).

Thanks again, folks.
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