time for ASV?

[quiescence at last]

when you have EPR on, that is when your machine may seem to be filling your lungs.  it will await your inhale, and raise the pressure and "bellows" you.  you already have done that, there is nothing you can set your machine on that will cause a greater feeling of being inflated.

I hope someone gave you this advice earlier, but most of us were told, "if you feel hesitant, just wear the thing a while as you read a magazine, or watch a TV show."

If you want to start slow, then do it.  You are the boss.  For example, we may say 6 cm to 6 cm, or 6 cm to 8 cm, but HECK just pick the lowest setting: 4 cm to 4cm.  The machine will sit there and ignore you.  If you feel starved at 4/4, then move it to 4.5 and 4.5, up it until you feel extra comfortable - most of us don't feel comfortable under 6.  Take a break, and come on back when you are ready to sleep.  The machine will just stay there all night.  It will be better sleep than you had before you started, and way better than having all those CA events. [and you will have more snores and OAs]

Once you have success behind you, the next steps of faith will be easier for you to do without the extra anxiety.

we will hang on as long as you need us.  period.

QAL

[TexasTiger]

Thanks. I have read the manual on how to enter "clinical mode" and change EPR, etc. but I'm a little reluctant since the dr office and equipment provider never even told me about this mode. Can I get in trouble or lose insurance benefit if I'm making changes not approved by the dr?

Also, I really don't think I could tolerate an entire night of EPR off and constant pressure. I turned EPR off, ramp off, and started at my min pressure of 6. With these settings, I felt like even the slightest initial inspiratory effort would trigger a bellows inflating my lungs and I felt I hade to forcefully exhale every breath. I started getting light headed. I think I began hyperventilating.

If get up the courage to try, When you say a "moderate" cpap pressure, what would you suggest I try?

PS: I picked up  my initial sleep study result today -- zero centrals! So I think sleeprider is spot on.

Hi lionel197 - I'm on the same PAP as you and have similar problems - only 3 CA events on the sleep study and way too many later.  Now have a very "mixed bag" of event types and very happy that the wonderful people on this forum have helped me to get much better sleep.

Was running AHI = 9+ for 2 years on old PAP with CAs 50%+ and multiple PBs every day as well.  Started checking results when I switched to Airsense 10 Autoset and with the help of this forum now running well under AHI 4.0 with CAs less than 30%.  In my case turning EPR off and working the max./min. pressures plus getting rid of leaks with FFM + soft collar made all start to come together.  Give it a try as I'm sure you will find good results when you get the settings adjusted to your specific needs.  I personally do not want to invest and have the higher pressures with an ASV machine - sleep is good with the APAP and hope to stay with it.

Good luck and hope this all works out well for you.

[lionel197]

Here's an update on my progress [?] I'm concentrating on overcoming my anxiety with the machine more than dialing in the settings right now. (think complex apnea is pretty well established) GP gave me trazadone and it was making me groggy and affecting my memory. I found some good meditation music for going to sleep. I have been off trazadone 2 nights- I feel good about accomplishing that but Centrals have gone way up. Last night I had many wake-ups, some feeling short of breath, but I was able to leave the mask on and breath through them with my meditation music. I guess that's progress but now I'm at a point where centrals are so frequent that I don't think I'm any better off than when I had untreated obstructives.

I live at sea level and I'm going to Santa Fe (8000 ft) for a week.  My first major occurrence was 9 weeks ago in Denver (5,000 ft) when I woke at 4:30 short of breath, sweating, chest pain- went to ER thinking I was having heart attack. Looks now like it was a panic attack from sleep apnea (possibly aggravated by altitude?) GP gave me Diamox to take for 3 days prior to going to Santa Fe.

1) any comments/thoughts on my (progress)?
2) any comments/ thoughts on Diamox?

Thanks!
http://imgur.com/a/MDWFT

[TASmart]

You are convinced that you have complex apnea. You have not followed the advice you have been offered, but that of course, is your option. But asking for advice and then not following makes giving further advice fruitless for both the giver and the receiver. Best of luck with your treatment and I hope you find the answers you seek.

[DeepBreathing]

I've been following this thread with interest. Based on what I've seen, and especially that last chart you posted, I say you have a severe case of complex apnea. I don't believe playing around with EPR etc will overcome this - you need an ASV machine. These are expensive and the insurance company will make you jump through hoops to get hold of one, but I think it needs to be done. The sooner you start, the sooner you will get proper treatment.

Some people do have difficulty adjusting to ASV, but for most of us it's a godsend. ASVs work really well - my untreated AHI was 62, but wit the machine I'm down to under 1.0 just about every night. The general consensus seems to be that the Resmed is much easier to adjust to than the Philips - I know it was for me.

[TASmart]

Here is a link on the prevalence of CSA in CPAP treated patients.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699163/

The prevalence of persistent CSA which emerges with CPAP treatment is 1.7 % so it is pretty uncommon for this to actually be an issue. The authors did not that it may take up to 8 weeks to iron out the therapy and determine of the patient actual has treatment onset CSA.

Just information for discussion.

[lionel197]

TASmart,
I think your criticism is unfounded. I am in an initial 30 day cpap (apap) trial, where my doctor has not authorized any patient- initiated changes. I must request changes from the dr. I have been informed that if I make changes on my own I will lose my insurance coverage for this treatment. I'm just trying to learn and for the most part (with the exception of your comment) this forum has been incredibly supportive and information providing.

[jerrydaw]

Lionel


Deep Breathing is correct.  It takes a lot of time to get insurance to pay for the ASV machine.  My first machine was the ResMed AirSense.  When that didn't work, I was given an AirCurveAuto.  When that didn't work, I had to take another sleep test with an ASV machine to prove that this therapy worked on my centrals.  The therapy worked like a charm, and I was finally given what I knew I needed from the start-an ASV machine.

I agree with Deep Breathing that the ResMed ASV is the best.  The Auto feature takes a lot of the guess work out of achieving the best settings for your condition.
I had my sleep test using the Phillips ASV and found that it had an ever so slight delay in responding to the inhale breath pressure increase.  It was nothing big, but was noticeable to me after having used the ResMed AirCurve bilevel machine where the inhale breath was smooth and seamless.

[TASmart]

If it is the case that any changes you make will result in loss of insurance coverage, then why ask for opinions on what you can do to increase your therapy? I am not trying to be unsupportive, but what it really seems you are asking for in not doable under the conditions of your insurance. I don't necessarily agree that you have complex or central apnea, that is for a Dr to determine. I am pointing out that there are other possibilities to complex apnea and that unless you are able to make adjustments no one here can have much of a chance to help you other than a jumping onto the complex apnea bandwagon. SO be it.

I really hope you get your apnea issues solved, good sleep is a wonderful thing. I will bow out from this discussion, I have stated what I think, other agree/disagree but it's of no help to you.

[Sleeprider]

Here's an update on my progress [?] I'm concentrating on overcoming my anxiety with the machine more than dialing in the settings right now. (think complex apnea is pretty well established) GP gave me trazadone and it was making me groggy and affecting my memory. I found some good meditation music for going to sleep. I have been off trazadone 2 nights- I feel good about accomplishing that but Centrals have gone way up. Last night I had many wake-ups, some feeling short of breath, but I was able to leave the mask on and breath through them with my meditation music. I guess that's progress but now I'm at a point where centrals are so frequent that I don't think I'm any better off than when I had untreated obstructives.

I live at sea level and I'm going to Santa Fe (8000 ft) for a week.  My first major occurrence was 9 weeks ago in Denver (5,000 ft) when I woke at 4:30 short of breath, sweating, chest pain- went to ER thinking I was having heart attack. Looks now like it was a panic attack from sleep apnea (possibly aggravated by altitude?) GP gave me Diamox to take for 3 days prior to going to Santa Fe.

1) any comments/thoughts on my (progress)?
2) any comments/ thoughts on Diamox?

Thanks!
http://imgur.com/a/MDWFT

With regard to a trip to Santa Fe, if you know that you have problems adapting to high altitude, Diamox can be very helpful in reducing that effect, however it needs to be started a week prior to your exposure to altitude.  Since you may need a prescription for this, it might be an opportunity for you to discuss the high level of central events you are observing in your CPAP therapy with your doctor.  Altitude can also significantly increase CA events, and considering your problems already, I would expect you to have a noticeably higher rate of CA when at altitude.  This may not be well-advised if you can avoid the travel while on the CPAP trial.  Santa Fe is mostly under 7200 feet MSL, but Taos is higher.  If you can stay in ABQ, the altitude is about 5200 feet. Diamox will not likely reduce or help with your apnea, but is for the edema that can cause the headaches and discomfort with altitude.

I think the end of your 30 day trial with this CPAP machine is already predictable.  You will report the high level of events and related sleep disruption and feeling of fatigue and being unable to breathe on CPAP, and should not proceed with the purchase.  You need to be evaluated for something that can reduce the number of apnea events, and that is most likely ASV, although you may first be subjected to BiPAP or ST (spontaneous/times bilevel).  I think the sooner you have a discussion with your doctor of your concerns at this point the better.