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UARS Suggestions (CPAP triggers centrals) Need help with ASV settings
#1
UARS Suggestions (CPAP triggers centrals) Need help with ASV settings
I had a sleep test done after much arguing with insurance and ended up getting diagnosed with mild sleep apnea with an AHI of 5 and an RDI of 30. Ended up getting a CPAP that raised my AHI into the 10+ range (mostly centrals) but at that point my provider gave up on me and told me to go to stimulants or modafinil since "my apnea is mild and RDI doesn't significantly affect your sleep."

I know I need to find a new doctor...

I got ahold of an Airsense 10 and a SystemOne AutoSV (found it on a good deal) which I've been experimenting with, but haven't had a ton of success since I either have centrals on the CPAP or just bad quality sleep/snoring on the ASV with the OSCAR data just being a mess.

Still calling and messaging around for sleep doctors near me, but it's slow going finding one that will help AND is covered by my insurance.
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#2
RE: Mild apnea/UARS Suggestions (CPAP triggers centrals)
(05-27-2022, 03:22 PM)ophiuchus Wrote: ........ with the OSCAR data just being a mess.

We can help, but need to see some data.
Post a couple screenshots from OSCAR, one from the AirSense 10 and one from the System One ASV. Follow the links in my signature line to guide you.
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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.
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#3
RE: Mild apnea/UARS Suggestions (CPAP triggers centrals)
These are my 'best' nights after attempting titration based off of other posts I had found scouring various forums and sites. Many have been worse, primarily on the CPAP when I was fiddling with 'auto' and EPR as those really did a number on my centrals. Other thing I had planned but have yet to try are setting my BPM to a low number as opposed to 'auto' to prevent the excess of timed breaths...Might be wrong on how that works exactly.


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#4
RE: Mild apnea/UARS Suggestions (CPAP triggers centrals)
Self-bumping for an ASV expert  Blink
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#5
RE: Mild apnea/UARS Suggestions (CPAP triggers centrals)
Trying to learn a bit about flow rate myself as I know it comes in handy, here's a couple of middle of the night spots.


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#6
RE: UARS Suggestions (CPAP triggers centrals) Need help with ASV settings
When showing graphs of the Auto SV it would help if you would use the Mask Pressure graph rather than pressure. It shows the breath by breath pressure support and how it is responding to the events. You have very pronounced flow limitations, sometimes bordering on obstruction. It's possible some of this comes from chin-tucking, or what we call positional apnea. We have see this problem severely affect members on CPAP BPAP and ASV. Clusters of obstructive events and flow limits with severely decapitated inspiratory curves are often and indicator of this problem. The Positional Apnea wiki covers this in more detail http://www.apneaboard.com/wiki/index.php...onal_Apnea and the Soft Cervical Collar wiki expands on some of the cases we have dealt with. http://www.apneaboard.com/wiki/index.php...cal_Collar

Your graph on the Airsense 10 is unusual in that there is a mix of central and obstructive apnea, however both appear in clusters, and I don't see the variable breathing that seems to accompany most CPAP or bilevel onset central apnea. I think this is obstructive and perhaps positional. On the AutoSV it is normally pretty uncommon to see this many events in someone with CA sleep disorders. Snoring, flow limits and hypopnea are normally effectively mitigated by the adaptive pressure support. We're going to have to look closer at the respiration and mask pressure charts to see how these events evolve and what they are. I also want you to consider that something in your sleep position is promoting chin-tucking.
Sleeprider
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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.
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#7
RE: UARS Suggestions (CPAP triggers centrals) Need help with ASV settings
I've seen and kinda tested myself with positional apnea, but this is the first I've really considered chin tucking as an issue and tested my breathing with it -big difference with being able to snore. Definitely need to try sleeping without my pillow for a night or get the collar.

I've attached the nights of me testing EPR vs no EPR that led me to believe that CPAP was triggering centrals. The ASV was a lucky find so I'm not really out anything, but this is what led me to look for one in the first place.

(06-03-2022, 12:20 PM)ophiuchus Wrote: I've seen and kinda tested myself with positional apnea, but this is the first I've really considered chin tucking as an issue and tested my breathing with it -big difference with being able to snore. Definitely need to try sleeping without my pillow for a night or get the collar.

I've attached the nights of me testing EPR vs no EPR that led me to believe that CPAP was triggering centrals. The ASV was a lucky find so I'm not really out anything, but this is what led me to look for one in the first place.

Also what I think might be notable ASV portions, only time it ever told me I had central apneas.


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#8
RE: UARS Suggestions (CPAP triggers centrals) Need help with ASV settings
The CPAP results, with and without EPR show the kinds of apneic threshold breathing I didn't see before. Lots of centrals and it makes sense you would go to ASV. It would be interesting to see your results on an Aircurve 10 ASV. I rarely see such a high rate of events when that is in use. The relatively high hypopnea event rate seems fairly common with the Philips Auto SV.
Sleeprider
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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.
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#9
RE: UARS Suggestions (CPAP triggers centrals) Need help with ASV settings
To me, the breathing patterns look at lot like Cheyne-Stokes respiration (however I am not really that familiar with OSCAR data presentation having only seen it for the last day in various screenshots on this site), so the ASV would be the ideal machine considering it monitors and reacts to changes in breathing like those of CSR in real time, designed to ‘fill in the gaps’ with support designed around patient breathing (the times when patients breathe sufficiently spontaneously)…if I put it in these terms, the machine monitors your spontaneous breaths, and when that changes, it replicates your previous breaths (the good thing is that it reacts almost instantly, the down side is that if it goes on too long, it is basing its breaths on the previous breaths, so if you aren’t spontaneously breathing deeply enough for too long, the breaths are continuously diminishing - this is where ventilator support would be needed eg: AVAPS, or VPAP ST/A, as these are based on a more independent premise of function which is backing up breath rates and volumes/pressure supports indefinitely, independent of patient effort or timing/timeframes). 
My suggestion would be to increase the ipap min by a couple of cm to reduce the incidence of hypopnoea and level out the dynamism of the difference between ipap min and max in real time experience. This may make it a little more user friendly and comfortable/easier to get used to. I use Philips AVAPS and I’ve set up many machines over the years (albeit some years ago now), and I do recall Philips algorithms having a very softly softly approach to pressure changes resulting in higher hypopnoeas in the earlier software versions (when machines are sent off for servicing is usually when I’ve seen an upgrade in algorithms done - costs money). If you have a list of your other settings, I would be interested to see, if you’re comfortable in sharing Smile

Of course, it all depends on how you feel after use: if you feel refreshed, then it’s working - no matter what machine and what settings Wink

INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE EVEN WHEN COMING FROM A MEDICAL PROFESSIONAL. ALWAYS SEEK THE ADVICE OF YOUR OWN 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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#10
RE: UARS Suggestions (CPAP triggers centrals) Need help with ASV settings
Peach25 that is an interesting analysis and I look forward to hearing more ideas like this. My thought was that PS min needs to be increased. As the respiration clearly needs more than OS 1.0, the Philips SV algorithm just gets too far behind the changes in respiration. I think the faster response of the Resmed ASV is the best answer, but PS min needs to be brought up to at least 3.0 to to avoid the extent of hypoventilation we see in the graphs. I agree that respiration swings in a classic rhythm between hyperventilating and hypopnea, and the Philips is just not fast enough to even out the volume.

We don’t have much personal experience with AVAPs on the forum, and I hope you will help as those issues come up.
Sleeprider
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Download OSCAR Software
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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.
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