VAuto Central Apnea Very Frustrated(long post)

[lbl82]

   
   


Sorry if this is long.  I'm very frustrated! I'm tired of being tired!  I don't know what to do! When looking back at my data when using ResMed AutoSense 10 for 2 plus years I noticed something interesting.  From Jan. 13th 2019 to Thur Mar. 12 2020 my AHI averaged below 4 AHI (most of the events were centrals).  For some reason on Mar. 13 I decided to change my pressure.  I decided to change my pressure because even though my events were below 5 I was still somewhat tired.  Once I started messing with my pressure I could never get it back to have more than 3 days of consistent AHI under 5 for some reason.  Anybody know why?

Anyway, so I called my Doctor who prescribed me the VAuto after looking at my data.  I then came on this message board after attaching screenshots of my sleep using OSCAR.  You all noticed that most of my events where centrals.  I was told from this board that I needed an ASV.  I noticed on the ResMed website that the ASV was the only one to treat Central Apnea. 

Therefore, I called the sleep tech. at my sleep facility.  She told me my Centrals over the last 30 days were mild and that she has successfully treated patients with the VAuto for Centrals. She told me that ASV is for more moderate to severe centrals and with patients who have certain conditions.  I then called and talked to a respiratory therapist with lofta and she basically told me the same thing, that she was started my on a VAuto.

So last night was my first night and of course I'm over 5 AHI with most of my events being Centrals!! I don't know what I should do to be honest.  Do I need to get another sleep study at another facility?  Is there a way I can send my OSCAR data to a sleep technician/respiratory therapist/Doctor?  Should I adjust my settings? Do any of you all have any suggestions on a good sleep doctor in the Atlanta area?

[Crimson Nape]

What was your PS setting during the Jan. 13th 2019 to Thur Mar. 12 2020 time frame? I see your total time in apnea was 26.5 minutes. Try a PS of 3 for a starting pint and see where this leads.

[lbl82]

" What was your PS setting during the Jan. 13th 2019 to Thur Mar. 12 2020 time frame?"

I was using the ResMed AirSense 10 Auto CPAP during that time.  I don't remember seeing a PS setting.

[SarcasticDave94]

I think it is common knowledge from Apnea Board and with ResMed's own machine usage that ASV is in fact the only machine that can specifically treat CA. This sleep specialist is wrong in that she can manage CA with other machines, and as is this statement likely will only be partly true. A regular CPAP can be set to minimize the CA, probably not as well with a BPAP due to pressure swings, as per my own experience. Whether minimizing CA is effective or comfortable or not will be an individual experience.

You need evidence from the sleep study to show CA. You also will need OSCAR data. Finally you need a list of complaints. And you need to convey that even if the VAuto is reducing the CA, it is not comfortable nor tolerated well. I suspect you will need lots of complaints to help you get an ASV. Start building the case with your PCP and pulmonary/sleep doctors.

Some details about the sleep study will be required as mentioned above. Your sleep study needs to show a high count of CA to OA ratio. Secondly, proof of lesser machine failures to treat the CA would be required. Note that all of this info is assuming that you want to run this with insurance. If you want to buy one without insurance, get one of your doctors to write a script naming ResMed AirCurve 10 ASV, default pressures, and Dispense As Written. DAW needed in either case to prevent the DME from substituting brands, etc.

[SarcasticDave94]

" What was your PS setting during the Jan. 13th 2019 to Thur Mar. 12 2020 time frame?"

I was using the ResMed AirSense 10 Auto CPAP during that time.  I don't remember seeing a PS setting.

Correct, PS would not be listed. EPR is on this however, which is actually a reverse operating PS. EPR subtracts from the pressure setting, while PS adds to the EPAP on BPAP machines.

[Crimson Nape]

" What was your PS setting during the Jan. 13th 2019 to Thur Mar. 12 2020 time frame?"

I was using the ResMed AirSense 10 Auto CPAP during that time.  I don't remember seeing a PS setting.

OK, what was your pressure setting(s) and EPR then?

[Gideon]

Welcome but sorry for your troubles.
Read this Wiki article  http://www.apneaboard.com/wiki/index.php...P_Machines

You are currently on "Path 1" failing on CPAP, the failing on VAuto, BiLevel without backup, at this time.

With a VAuto, Central Apneas are not treated, they are avoided. This is accomplished by lowering your pressure support, possibly all the way to zero, then possibly lowering your EPAP pressure as well.  This is a balancing act between Central Apnea and Obstructive Apnea.  What tends to 'avoid' central apneas tends to increase obstructive events.  

Read the Wiki and let us know what path you would like to take and we will help you along your journey.

Your Central Apnea is likely idiopathic  (don't know the cause) since it hasn't gone away in the past 3 months.  This implies that time, which frequently helps Treatment-Emergent Central Apnea is not helping you.
Central Apnea is inconsistent. so much so that we call it consistently inconsistent, so expect to see your central apnea jump all over the place.  This IS important to note.  It IS a symptom.

Flow Limits are very important to ResMed in that they are a primary driver of pressure increases. You should adjust your charts to display the Standard charts, Click "View / Reset Charts / Standard " and vertically adjust them so Events, Flow Rate, Pressure, Flow Limits, Leaks show on your screenprint.

[Gideon]

Path 1: Reduce your PS by 1, use overnight, Post your charts.  This will likely be repeated.

Path 2: Call your doctor and complain/state your symptoms.  State that these settings are NOT working. Ask what can be changed?
This step is repeated daily.  Note the symptoms in the wiki http://www.apneaboard.com/wiki/index.php...P_Machines 
Write down ALL that you are having.  Be critical, Your medical team has no idea of how you are feeling, neither do we for that matter.  This is relaying your symptoms, not complaining, and many of our suggestions are at least shaped by your symptoms especially as your treatment improves.  NOTE: I did not recommend any changes here, even though I know I could make you more comfortable.  The goal here is to justify and get an ASV.  An ASV Titration is a good result.

Do get full copies of all your sleep studies and prescriptions.  They will be beneficial in the future.

Do post redacted copies of your sleep studies here.  They will help to flesh out your history.

[lbl82]

EPR 3 14 start, 45 min. ramp, min. 18 and max. 20

[lbl82]

" What was your PS setting during the Jan. 13th 2019 to Thur Mar. 12 2020 time frame?"

I was using the ResMed AirSense 10 Auto CPAP during that time.  I don't remember seeing a PS setting.

OK, what was your pressure setting(s) and EPR then?

EPR 3 Start 14, Ramp 45 min., 18 min and 20 max