Switching to ResMed Aircurve 10 ASV

[Howie51]

[attachment=8801]I'm shopping around for an ASV unit (New or refurbished) following along with the excellent recommendations received on this board. With no health insurance I try to be as frugal as possible, but even if the unit doesn't better my sleep quality, it will act as a backup for my existing non-ASV Cpap.
My prescription has been updated, so I'm all set.

Would one last look at my current charts be possible since it's been a few months from the last peek - - Just want to be as cautious as possible before biting the financial bullet. Any suggestions or comments gratefully acknowledged.

Cheers and many thanks!
Howie

[Sleeprider]

I almost think it would have been better to post this as a part of your earlier thread http://www.apneaboard.com/forums/Thread-...Airsense10  In that thread the history of your initial problems with variable pressure and EPR were documented.  Your summary information and most recent charts do not show a central apnea problem and it would be easy to miss why ASV is being considered for someone with very low or acceptable AHI and generally low CAI. The detailed chart for October 13 is good, and is not an argument in favor of ASV, but what it does no show is that when you deviate from low fixed pressure, something like this happens,



You seem to be getting good, but inconsistent results with AHI of 8 to 16, but a recent improvement at less than 3 for the last week.  Your sleep and therapy has been fragmented and sometimes of short duration.  You don't match the profile of users that benefit the most from ASV, but you will never know without trying it.  ASV will allow you to use bilevel pressure, and higher pressure without the complication of CA.  This can resolve the flow limits and hypopnea, and should allow enough EPAP to prevent OA.  Bottom line is there appears to be a basis for you to benefit from ASV, but it's not quite a sure thing, mostly because you have optimized CPAP to get acceptable results. It is still unclear to me how you arrived at the conclusion you have predominately CA and require ASV. Do you have sleep test results?

[Howie51]

I suspected from your post that CA was the issue.

06-21-2018, 06:34 AM (This post was last modified: 06-21-2018, 06:37 AM by Sleeprider.)
Seriously, you don't have obstructive sleep apnea. The problem here is all central. Set your maximum pressure to 8.0 and you're going to be amazed. It would really help if you replaced mask pressure with flow limitation, because that is what is causing your uncontrolled pressure increases. You may eventually need a different approach to therapy, but setting a limit to pressure, or using fixed pressure at 8.0 is going to significantly reduce events.
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2 sleep studies .. One (over a decade ago), and another in 2015 both suggested OSA, however my sleep continues to be (as you noticed) somewhat fragmented. I have nights where I simply don't feel as though I'm getting sufficient air - hence the short duration occasionally. But I admit that the longer I stick with the therapy the more consistent the outcome. My issues are no doubt clouded by sinus problems & while I haven't been diagnoses with anything as yet, I do share some bad genes when it comes to sinus congestion, and find that a pill or two at night can drastically affect my results.

[Sleeprider]

True that your early results appeared fully central in nature, but you have significantly improved b y limiting maximum pressure. I suspect that flow limitations are the reason your pressure moves quickly to the maximum setting, and it might be interesting to see what happens if you introduce a higher pressure or some EPR. My original post was not intended as a diagnosis, bu as an observation of the apparent problem at that time. I suspect you may have complex or mixed apnea, but we should work through the issues first,and focus on your needs and comfort. Your therapy results are trending in the right direction, and I think we should explore the potential of your current machine, before concluding CPAP will not work.

[Howie51]

I'll start with EPR and notch it up to 3 this evening! I'm all for exhausting the potential in the existing machine.

TX

[Sleeprider]

I would tag oke it gradually. We will be able to tell what is going on pretty quickly. Please include flow limitations in future charts.

[Howie51]

Agreed. It was already set to 2, so this is the most gradual I can do. I am also restraining myself from adjusting pressures until I've lived with the increase for a while .

Cheers & Thanks
Howie

[Howie51]

By the way, I am squarely to blame for any confusion - I should have (as you suggested) posted this along with the previous thread. My thoughtlessness was unintentional and I do apologize to all.

Cheers
Howie

[Howie51]

Having experienced CPAP therapy for a few months now, I'm beginning to believe there are 4 key factors in successful treatment (If you have more on your personal list that's fine by me).

1) Getting sound advice from ApneaBoard.com
2) Having determination & never giving up
3) Getting A little lucky now and then
4) Thinking outside the box

In tracking by better nights, I sleep quite well after ensuring that I shave just before bedtime, and ensure the nasal mask is clean and well adjusted. In my case, I have discovered that taping my mouth is not optional. There's no big issues here if you get past the first few nights of panic, and I have learned a few tricks from the board, such as pursing your lips and blowing out your cheeks before adding the tape. Position the tape such that there is more contact on the lower lip also works well for me. I also curl the end of one end to ensure I can quickly remove the tape - and the "panic" attacks have completely stopped.

Next in importance are my sinuses as I've discovered a direct correlation to nights when I don't address my sinus problem and a seriously increased AHI reading. Personally, I use Reactin allergy tablets (Which may not be available in your area) and Nasacort nasal spray, and thus far these have been helpful in getting consistent results with a minimum of arousal events. 

It seems that when I first started using the machine, my pressure was set far too high, and following excellent advice received here, the lowering to 8 resulted in an immediate improvement. Looks as though I do not have CA, and will be content to live with OA. The CA no doubt came from the events being triggered due to very poorly set pressure, and lowering the pressure ended that discussion. I have played with various pressures, and anything over 8.2 brings my AHI upwards. Also setting the relief pressure to 3 appears to have been beneficial. The addition of the mouth tape and a neck pillow also contributed vastly, since it was wisely pointed out that part of the problem was OA caused by the chin lowering.

I'm attaching the charts for reference, and as always am extremely interested in any suggestions that might make the numbers even better.

[attachment=8978][attachment=8979][attachment=8980][attachment=8981][attachment=8982]

[Howie51]

A  chart that would not add to the previous post.[attachment=8983]