Are these CA events real, or misdiagnosed OAs?

[Dormeo]

I wish I could advise you about what machine you might try. But I can give you some information that might be of use.

You would need a prescription specifically for a bilevel or ASV machine. The prescription could be written by any MD, dentist, or nurse practitioner.

ASVs are quite expensive, and they can be hard to adapt to. But they do take care of CAs.

As Sleeprider said, there's some possibility you could benefit from a bilevel machine, due to its specialized settings, especially trigger.

One reason I wonder whether you'd feel better with a different kind of machine is that your CAs come after arousals, and a different machine is unlikely to reduce the frequency of your arousals.

Here's a suggestion: scroll through your flow rates for a night with fewer CAs that left you feeling rested and a night with more CAs that left you feeling unrested. If you had roughly the same number of arousals both nights, then maybe the CAs themselves are causing you trouble. Then it might be worth trying a bilevel machine. On the other hand, if you had fewer arousals on the good night, then addressing the CAs may not give you the consistent relief you're looking for.

[SarcasticDave94]

Bilevel of any sort will require a new script.

You sleep specialist analysis is pretty much cookie cutter anyone else that uses them. They specialize in something else and moonlight as a sleep "specialist".

How about your primary care? Would they issue a script for bilevel?

[CLCCW]

Is there anyone out there who had a similar profile to me - youngish, 'normal' BMI, obstructive apneas cleared by CPAP but resistant treatment-emergent central apneas? And if you are one of these folks, what steps and instrument worked for you?

I can't say I am "young-ish" but do have a normal BMI and CPAP did well for my OAs but I had clusters of CAs that persisted, usually around 2-4am. I was using an AirSense 11 in APAP mode, but seemed to do better in CPAP mode, with slightly increased pressure. However, my AHIs were all over the map. And still those clusters of CAs.

I was diagnosed with both Obstructive and Central apneas (severe) but had to go thru the CPAP trial, I suppose. I had to fight for a few months to get an AirCurve11 ASV, which seems to have nulled out any apneas starting on night #1. I am just over a week, and am getting used to the new "sensation" of an ASV and working on some setting tweaks, but coming along. If you are a light sleeper or experience easy arousal, the ASV can be a little surprising.

I can't believe your sleep doctor thinks Oscar is BS! That is shocking. I have a kind pulmonologist but don't have 100% confidence in his understanding of stuff, but I was encouraged by this tribe (sarcastic dave and sleeprider) to be a squeaky wheel and get the device I needed. The doc listened to me and agreed with hints and requests. It was a helluva journey.

I'd drop your sleep doctor and see if your MD can prescribe Bilevel or Bipap (like the ASV) if you can't get your CPAP/APAP working for you. The data show ASV can kick CA butt.

[JonathanBravo]

I wish I could advise you about what machine you might try.  But I can give you some information that might be of use.

You would need a prescription specifically for a bilevel or ASV machine.  The prescription could be written by any MD, dentist, or nurse practitioner.  

ASVs are quite expensive, and they can be hard to adapt to.  But they do take care of CAs.

As Sleeprider said, there's some possibility you could benefit from a bilevel machine, due to its specialized settings, especially trigger.

One reason I wonder whether you'd feel better with a different kind of machine is that your CAs come after arousals, and a different machine is unlikely to reduce the frequency of your arousals.  

Here's a suggestion:  scroll through your flow rates for a night with fewer CAs that left you feeling rested and a night with more CAs that left you feeling unrested.  If you had roughly the same number of arousals both nights, then maybe the CAs themselves are causing you trouble.  Then it might be worth trying a bilevel machine.  On the other hand, if you had fewer arousals on the good night, then addressing the CAs may not give you the consistent relief you're looking for.

I'm going to stick with the plan for a month and just keep an eye on things. A good idea to cross reference arousals and CAs. How do you spot arousals? What should I be looking for on OSCAR? 

Bilevel of any sort will require a new script.

You sleep specialist analysis is pretty much cookie cutter anyone else that uses them. They specialize in something else and moonlight as a sleep "specialist".

How about your primary care? Would they issue a script for bilevel?

I will put pressure on both my PCP and sleep doctor and try to get a script from one of them. Sometimes you have to hold their hand and walk them through it. I'll bring printouts.

I can't say I am "young-ish" but do have a normal BMI and CPAP did well for my OAs but I had clusters of CAs that persisted, usually around 2-4am. I was using an AirSense 11 in APAP mode, but seemed to do better in CPAP mode, with slightly increased pressure. However, my AHIs were all over the map. And still those clusters of CAs.

I was diagnosed with both Obstructive and Central apneas (severe) but had to go thru the CPAP trial, I suppose. I had to fight for a few months to get an AirCurve11 ASV, which seems to have nulled out any apneas starting on night #1. I am just over a week, and am getting used to the new "sensation" of an ASV and working on some setting tweaks, but coming along. If you are a light sleeper or experience easy arousal, the ASV can be a little surprising.

I can't believe your sleep doctor thinks Oscar is BS! That is shocking. I have a kind pulmonologist but don't have 100% confidence in his understanding of stuff, but I was encouraged by this tribe (sarcastic dave and sleeprider) to be a squeaky wheel and get the device I needed. The doc listened to me and agreed with hints and requests. It was a helluva journey.

I'd drop your sleep doctor and see if your MD can prescribe Bilevel or Bipap (like the ASV) if you can't get your CPAP/APAP working for you. The data show ASV can kick CA butt.

Thank you for your story! It's encouraging that you've had a lot of relief already. What is the new sensation of the ASV?

[CLCCW]

Thank you for your story! It's encouraging that you've had a lot of relief already. What is the new sensation of the ASV?


There is not one constant pressure/flow. It is reactive to the breath, and felt surprising to feel it really pushing air as I was dozing off, making me wig out. There are many threads on this board about tips for getting used to ASV. Sarcastic Dave has some and others. I am getting used to it. I had to keep PS lower to help me, but I don't think that is common.

[Dormeo]

JB, I'm attaching some images of arousals.  In general, the breathing is deeper and messier-looking than normal asleep breathing.  Arousals -- even multiple arousals per hour -- are normal, but they can spell trouble if they leave you lying awake for more than a minute or two, or if they happen so often that your sleep architecture is damaged.