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Stubborn Centrals
#21
RE: Stubborn Centrals
EPR feels good, and it's not necessarly a bad choice to choose comfort over events (AHI).
Sleeprider
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#22
RE: Stubborn Centrals
I think that I have noticed that I feel better if my o2 sat stay higher and they seem to stay higher with EPR 2 regardless of the events.  I feel a lot more awake during the next day.  I probably need to do some more testing though.  I have also experimented with the "soft" response and I think my events are lower with the standard response.
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#23
RE: Stubborn Centrals
I was able to to a full night at a continuous pressure of 9.  Clear airways were up. but I am wondering if they aren't just arousals.  I often toss and turn a lot.  I do remember that they told me in my titration study that I kept waking up when they got to a pressure of 10, so I wonder if the higher pressures wake me up some.  I highlighted some of the centrals and most look like arousals to me.  Maybe I should ignore the centrals for the most part.  Would using EPR allow me to get a higher IPAP to reduce hypopneas while allowing the EPAP to stay a little lower and maybe cause me less tossing and turning or waking up?  In my sleep studies, I had more hypopneas than anything.

       

Thank you,

Kevin
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#24
RE: Stubborn Centrals
All, I am excited that I have been able to procure an aircurve 10 avs machine. Would anyone be able to recommend some initial settings for me? I would kind of like to be conservative with the pressure support settings at first. Also, does anyone know what I need to do to continue receiving supplies through my insurance since I have a different machine now? I am still in the rental phase of my current machine and the 10 months will be up in September.

I appreciate any feedback!
Kevin
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#25
RE: Stubborn Centrals
If your last machine and the current ASV are both ResMed 10, they take the same supplies. I suppose you could call insurance and ask them if the ASV needs listed, but if supplies are via a DME, they should have things in order for proper billing to the insurance.

On the ASV, what you can do is standard titration protocol. I can post that page below. What settings from the old machine were you on? Some can be placed on the ASV as it could be acceptable, and may save a bit of time.

I'd suggest going with ASVAuto Mode and see below:

   
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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#26
RE: Stubborn Centrals
Hi Dave,  thanks for the info.

My best settings on my current machine have been apap 8.4-13 no EPR and cpap 10.4 with EPR 1.  I was thinking of running the asv as auto with Epap min 8/max 13 and PS min 1/max 6 to start with.  Would this be crippling the machine too much by limiting pressure support max to 6?  Would I start with a lower Epap min with an ASV?  I was titrated on cpap at 8, but now I am taking clonazepam which I think increased my pressure needs for epap.

Thank you,

Kevin
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#27
RE: Stubborn Centrals
You're welcome.

The EPAP of 8-13 and PS 1-6 may be OK. I think the EPAP aspect should go in as is and it'll help shorten your self-titration time. Just note the PS range can't be any tighter/closer than 5, as in what you have here starting at PS Min 1, PS Max cannot be lower than the 6 you stated. This is info only on PS for reference for now. And it may turn out more PS is needed overall, either in more PS Min, Max or even both.

I think the aspect to adjust then would most likely be to try it and post results. As is, I think PS would be the one to consider tweaking if it becomes necessary according to the data. Then there's the aspect of how you feel. Adjustments should be made for events flags and comfort/how you feel. I suggest if you do an adjustment and don't like the feel and/or data result, go back to the prior. Reminder 2 is adjustments do not need to be whole numbers, there's the fractions/decimal steps to consider also. Whole number steps are coarse tuning to get you in the ballpark, and the fraction steps to fine tune as needed.

Be aware that the ASV sometimes blows hard to jolt one awake just as you're drifting off. Remember the blow back method, which is to literally blow back through the mask to get the ASV to back off.

Best to your success.
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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#28
RE: Stubborn Centrals
BTW Note on the Modes: ASV vs ASVAuto is in the EPAP, ASV gives static EPAP while ASVAuto has EPAP as a range of EPAP Min and Max.
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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#29
RE: Stubborn Centrals
Kevrx, I am going to suggest the following settings:
Mode ASVauto
EPAP min 6.0
PS min 2.0
PS max 12.0


Normally I would put you on the default  EPAP min 5.0, PS min 3.0, PS max 15.0, but I'm deferring a bit to your inclinations, and we know you need an EPAP of about 8.0 to fully resolve OA. The Resmed recommendations for initial settings are below.  If you do not set PS max high enough, you will not control central events.   As far as supplies, let's get you titrated and demonstrating efficacy, then you should inform your doctor that you are using ASV, provide some charts, and he can then track your usage of the ASV and your benefits from it to justify continuing insurance coverage for supplies.

[Image: attachment.php?aid=4210]
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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#30
RE: Stubborn Centrals
Thank you Sleeprider.  The machine is still enroute but as soon as I get it, I will try the settings you suggested and post a chart.

Kevin
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