[CPAP] Can you help me understand how ASV works for TECSA?

[trulyunspoken]

Hello,

Can someone explain to me how [auto ASV] can treat central apneas caused by TECSA? If I understand correctly, TECSA is caused by excessive CO2 flushing caused by the hyperventilation that some users experience with CPAP.

But there are aspects of ASV that seem counterintuitive to me.

For example, ResMed suggests a minimum pressure support of 3 in the titration protocol. This would already be enough to cause hyperventilation in most users who suffer from TECSA, wouldn't it? Imagine if ASV raises the EPAP to 6; with the pressure support, you would be inhaling quite a bit of air.

Wouldn't this cause hyperventilation? If you set a PS min of 3 the asv machine would always maintain this, flushing out co2. And you would stop breathing due to said hyperventilation, but ASV itself, upon detecting that you weren't breathing, would force you to breathe with a very high pressure support. Wouldn't this also worsen the problem?

What settings would you recommend for someone with moderate obstructive sleep apnea, who doesn't have central apneas when not using CPAP but suspects has TECSA? When I use a plain cpap or a bipap, even while awake, I experience palpitations and shortness of breath. If i manage to fall sleep i wake up not breathing. I also suffer from hypothyroidism, which I believe can cause impaired oxygen regulation and respiratory control center dysfunction.

What settings should i try??

Thanks!!

[SarcasticDave94]

From my use of an ASV, EPAP was mainly going to act as your minimum to keep the airway open from Obstructive Apnea.

PS here in the ASV shouldn't cause more CO2 flushing. The variable PS is how the ASV tackles the CA by a sharp PS spike blow to remind the body to breathe.

Normally the ASV would be the last step in attempting to help with treatment emergent Central Apnea. Typically these will diminish within a few months as the body gets used to CPAP and standard bilevel therapy.

When I used ASV, I ran mine in ASV Auto mode, EPAP 7-12, PS 3-15, with calculated IPAP 10-27. However the ASV will Max IPAP at 25.

What settings are you using, and how successful are they? We'll need a current OSCAR chart too.

By the way, if you have no Central Apnea but only suspect treatment emergent CA, you might find ASV to be more than you need. Its CPAP mode is a static single pressure that's likely less capable than the CPAP you've had.

[trulyunspoken]

From my use of an ASV, EPAP was mainly going to act as your minimum to keep the airway open from Obstructive Apnea.

PS here in the ASV shouldn't cause more CO2 flushing. The variable PS is how the ASV tackles the CA by a sharp PS spike blow to remind the body to breathe.

Normally the ASV would be the last step in attempting to help with treatment emergent Central Apnea. Typically these will diminish within a few months as the body gets used to CPAP and standard bilevel therapy.

When I used ASV, I ran mine in ASV Auto mode, EPAP 7-12, PS 3-15, with calculated IPAP 10-27. However the ASV will Max IPAP at 25.

What settings are you using, and how successful are they? We'll need a current OSCAR chart too.

By the way, if you have no Central Apnea but only suspect treatment emergent CA, you might find ASV to be more than you need. Its CPAP mode is a static single pressure that's likely less capable than the CPAP you've had.

Hi, thanks for expalining. im not using any particular setting sadly. Something as low as 5 cm H20 with plain cpap makes me wake up gaspering for air when falling asleep. I maybe slept like 10 min with the CPAP so I don't have reliable data.

Tried every kind of configuration and mask (cpap, apap, bipap mode s,  full face mask, hybrid mask, pillow mask, nasal mask, etc etc). Wondering if I have something like epiglottis collapse or TECSA, which are totally different things..But chatgpt says that something as low as 5 cmH20 shouldn't be causing the epiglottis to collapse (I know its not reliable info though).

Im thinking on buying VCOM it should be safer to try than ASV (which i already have). I have fear of trying things that i dont understand because i have had serious episodes choking with cpap (8 cm2ho) where i almost faint

[SarcasticDave94]

You can post an OSCAR chart anyway. Any info would be useful to help guide setup, and it would be helpful to know what settings were best vs worst. There needs to be a method to CPAP tuning, it can't be just random if you're going to get it set well.

[trulyunspoken]

Hi, you're right, i also feel that i need data but most of the data is really bad since i never managed to fall asleep for big chunks of time

these are some sessions:

-
Fixed cpap (bmc p2 and 9 fixed pressure without EPR)

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[SarcasticDave94]

I'm getting Moderator to clean up the code, whatever action you did failed to show the chart.

Please use the New Attachment button below the post textbox to attach OSCAR charts.

[trulyunspoken]

Hi, sorry! It wasnt my intention, tried to delete it myself but i couldnt.

So here there are some screenshots!

I want to clarify that I don't think I've ever been able to get completely asleep with the CPAP. The closest I get is transitioning to sleep and then just waking up. That's when I wake up feeling like I've been holding my breath and need to catch my breath. I often take off the mask. The bad thing is I've never written it down, so I don't know exactly when they happen. I'll try to do it from now on.

There are also many nights where none of those events happen, but I throw in the towel and turn off the CPAP because I've been an hour without falling asleep.

But the sensation is that I can't breathe, even when I'm "awake" or while I'm transitioning into that zombie state.

Here some sessions

1st Session Bilevel S IPAP 8 EPAP 9

   

2nd Session Bipap vauto PS 4 over 7.0-12.00 

   

   


And i have a third session that i cant post because of the limit, if you're interested just remove the space from .com https://imgur. com/a/1QnK2sA and scroll down

THanks in advance and  sorry for the massive message