New BIPAP user recommended to ASV

[Sleeprider]

It seems you have approval for ASV and this will get you on the path to adapting to the proactive pressure support of that device. A word of caution, that if we can mostly resolve CA with your Vauto, the ASV is a much more active and potentially disruptive device as it will much more aggressively use PS to maintain respiration. Your success also informs us you will continue to need a fairly high EPAP pressure for OA, and you won't need a great deal of pressure support to avoid centrals. Meanwhile, I think you will become more comfortable as you finally get therapy that is generally effective. There is still room for improvement, and if you want to get after some of the OA events, we can try using the auto-pressure (Vauto) algorithm to try to address that.

Now, I'm going to link you to the positional apnea article to consider if your obstructive events are perhaps related to your airway being positionally obstructed by tall, firm pillows, chin-tucking or other things you can control. We would be able to quickly spot this in an Oscar chart, but I'll just put it out there for your consideration. https://www.apneaboard.com/wiki/index.ph...onal_Apnea

[mpfields17]

Thank you, sleeprider!!!

I don’t think I have an issue with my chin because I use a small pillow under my chin to make sure I’m keeping my mouth shut
But it could be my pillows I will have to take a look, and I will read that article. Thank you.

It sounds like you think I should move ahead with the sleep study for the ASV.  Or were you saying that the ASV pressure changes might be uncomfortable for me?

I’m going to keep trying the very high trigger sensitivity setting for the next couple nights and see if I settle in and sleep better.   And I will address my pillow issue lol if that’s causing some obstructive issues.

Thank you so much for your guidance and wisdom!! I was about ready to just forget this whole thing and give this BiPAP machine back lol

[Sleeprider]

Another good question. Moving to ASV should not require further study. If you have failed CPAP and bilevel and your doctor thinks ASV is medically necessary, there is no requirement by insurance or Medicare to perform a titration study. The doctor can prescribe the device and your efficacy is determined based on use at home. Titration studies are an interesting invention of sleep clinics to help improve revenue, and there is a widespread belief, mostly among those that profit from the studies, that they are "required". They are not, and especially with the ASV, they are kind of pointless. The Resmed ASV is completely automated with only four settings; EPAP min, EPAP max, PS min and PS max. I already know exactly what you should be prescribed if you move to ASV based on our discussions here. Another wiki I wrote is Dealing With a DME https://www.apneaboard.com/wiki/index.ph...with_a_DME The last section of that wiki discussed the issue of dealing with a request to get a titration test and dealing with the DME, doctors and suppliers in getting devices.

Your settings on bilevel are S-mode at IPAP 13, EPAP 9.0 which yields a fixed pressure support of 4.0. I said, we could move to Vauto mode, and if we did that, I would suggest Vauto mode, EPAP min 9.0, Max pressure 16.0 and PS 4.0. That would yield the same therapy you get today, but allow pressure to move higher if needed for OA events. With the ASV, we would use ASVauto mode at EPAP min 8.0, EPAP max 11.0, PS min 3.0 and PS max 8.0. The ASV would provide EPAP pressure similar to what you need with bilevel to minimize OA, and would actively treat any variable breathing and pauses in breathing by using PS between 3.0 and 8.0. We would observe your therapy in the data and decide if any changes are needed, making titration a waste of time. The titration protocol for the Resmed ASV is in the figure below. We would start with the higher EPAP based on the fact you have some OA events and those seem to resolve at the pressures suggested above. Everything else is just common sense. I think if you were to share your results with very-high trigger with your doctor, he would agree with me, that there is very little incremental benefit at this point in moving to ASV. This is something we should give more time to see if the improvements are durable.

[mpfields17]

Had an even better night last night only two AHI’s an hour, and they were evenly split between central and obstructive.
And I had a more restful and longer sleep than I have probably had since starting this

I don’t wanna jinx myself, but I might be finally on the right track. Thank you so much for all your help. This has been fantastic advice.

Now I’m going to add the oximeter the rest of this weekend and see what that tells me Since the only thing that convinced me to try CPAP was that my oxygen was going to low at night

[Sleeprider]

Pretty cool, and we didn't use a single chart. Good job on your part describing your issues. If these results hold up you won't be needing ASV, and that's actually a good thing.

[mpfields17]

So I am very happy that my AHI’s are way down and under what is considered normal

However, I still really really struggle to get to sleep. I think all of the central apneas I’m having I’m having right as I try to go to sleep lol
It takes me more about two hours once I lay down to finally fully fall asleep and during that time, I am having multiple incidents where I start to drift off to sleep, and then I jump awake with what I assume is an apnea event. I realize no one can really help me until I figure out how to use the Oscar software to really look at what’s happening during those two hours, but just wondered if anybody else had suggestions for that whole falling asleep time period.

[Sleeprider]

You should search "Sleep onset central apnea":

https://www.e-jsm.org/journal/view.php?n...l%20apneas.

Sleep Onset Central Apnea
Sleep onset central apnea (SOCA) is a type of sleep-disordered breathing characterized by pauses in breathing that occur shortly after falling asleep.
Causes:
Reduced respiratory drive:
The brainstem, which controls breathing, may temporarily fail to send signals to the muscles that initiate breathing.
Instability in sleep:
SOCA can occur when there is a rapid transition from wakefulness to sleep, leading to an imbalance in the body's respiratory control.
Underlying medical conditions:
Certain medical conditions, such as heart failure, stroke, and opioid use, can increase the risk of developing SOCA.
Symptoms:
Snoring or gasping sounds during sleep, Frequent nighttime awakenings, Excessive daytime sleepiness, Difficulty concentrating, and Mood changes.
Diagnosis:
SOCA is diagnosed through a sleep study (polysomnography), which monitors breathing, oxygen levels, and sleep patterns.
Treatment:
Treatment for SOCA typically involves:
Positive airway pressure (PAP) therapy:
A machine delivers pressurized air through a mask to keep the airway open during sleep.
Adaptive servo-ventilation (ASV):
A more advanced form of PAP therapy that adjusts the pressure based on the patient's breathing patterns.
Treating underlying medical conditions:
If SOCA is caused by an underlying medical condition, treating that condition may improve breathing patterns.
Prevention:
Maintaining a healthy weight, Avoiding alcohol and sedatives before bed, Getting regular sleep-wake cycles, and Managing underlying medical conditions.
Note: SOCA can be a serious condition that can affect quality of life and overall health. If you experience symptoms of SOCA, it is important to consult a healthcare professional for proper diagnosis and treatment.

[mpfields17]

Thanks, yeah it’s looking more and more like I’m gonna have to transition to an ASV if I don’t give up on this completely lol

[rapwedinger]

try a VCOM (Google it) in the circuit.  It helped cut down the clear airway events for me.  Not perfect, but a big help.