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[Treatment] ASV settings for treatment of complex sleep apnea
RE: ASV settings for treatment of complex sleep apnea
(05-13-2021, 03:29 PM)MrSpeed Wrote: Thanks for this Geer1. Very insightful. I guess technically an ASV device could detect such heavy breathing and limit that to control the hyperventilation. Ever heard of a device that can do that? ASV really helps me a lot but it is far from perfect.

There is no device that I know of that will treat hyperventilation. If it was a PAP type device it would have to act in the opposite way and create a vacuum to try and counteract spontaneous respiratory effort, such a process would be counter intuitive/productive to the underlying reason for using PAP to begin with.

How I believe ASV helps this situation is by forcing you to breath when your body doesn't want to(via backup rate and maintaining ventilation). It removes the central apnea and associated hypercapnia which avoids triggering the hyperventilation process. This doesn't treat the hyperpnea/hyperventilation but rather helps to try and avoid it. 

Joey, regarding oral anatomy all I can recommend is trying to get an appointment with a knowledgeable and experience ENT that specializes in this stuff. I wouldn't try to convince him that your anatomy is an issue, I would ask his opinion as to whether it may or may not be affecting your sleep breathing/quality and if there is anything that could be done to help (and of course the risks associated with such a surgery).
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RE: ASV settings for treatment of complex sleep apnea
I've seen one ENT and he wasn't very helpful, didn't appear to have much training in airway-related disorders. With surgeries, I think ENTs mainly do soft-tissue surgeries which has very low effectiveness in treating OSA/UARS. I'm thinking of seeing an orthodontist.

Sleep endoscopy would be interesting.

Didn't use CPAP last night and dreamt of cracking my teeth and spitting them out...
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RE: ASV settings for treatment of complex sleep apnea
I used to have the crumbling teeth dream ALL the time. rarely since I retired though so I attribute it to stress.
  Shy   I have no particular qualifications or expertise with respect to the apnea/cpap/sleep related content of my posts beyond my own user experiences and what I've learned from others on this site. Each of us bears the burden of evaluating the validity and applicability of what we read here before acting on it.  
 
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RE: ASV settings for treatment of complex sleep apnea
Whether it is an ENT, Orthodontist or whatever the key is that it needs to be a specialist in this field. Not all ENT's or Orthodontists will have the knowledge or experience about this because there are a wide range of issues these doctors treat. If you see and ENT that specializes in apnea he will know a lot more than one that specializes in hearing issues.

Edit: Was that actually a dream or is your bruxism worse without PAP? SDB is a cause of arousal, more arousal's mean more bruxism in a lot of people that have both.
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RE: ASV settings for treatment of complex sleep apnea
Bruxism is worse without CPAP, not just dreams.

Doctor appointment booked. Will be asking for sleep study and gastroscopy.

Don’t think any ENTs here are specialised in airways. I’ll ask my doctor and search online later.

If I was to get a surgery, it wouldn’t be a soft tissue surgery. If clinically indicated, I’d get palate expansion with a MSE device. Side-effects and complications are usually minimal, biggest issue is the cost and time. You sometimes have to get braces beforehand, and always need braces afterwards.

Biggest benefit for airways is increased oral space and nasal space. Because the palate is the base of the airways, expanding the palate then increases airway space.
Nothing I post is medical advice and should not be taken as such, always consult a medical professional for guidance.
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RE: ASV settings for treatment of complex sleep apnea
I used to have that dream too - the teeth thing? Also about grinding my teeth so hard one pops out and then all the others would come with like they were unzipping almost, like the roots were linked to something... Horrible dreams. It's very disturbing to see myself clenching my jaw in my sleep and equally frustrating that I had dentists arguing with me about it. Insisting I would wake up before I broke a tooth. Yeah. No. That happened at least four times.

Stress definitely made it worse but so did having a godawful crossbite and, no doubt, the sleep apnea (considering I haven't had one of those dreams OR woken myself up clenching my jaw, making my teeth hurt, biting my lip/cheek or the cracking/grinding of teeth since I started PAP).

Good luck.


See my comparison of Viatom/Wellue and CMS50F oximeters here.

Not a doctor, definitely not your doctor, all advice is given as-is and represents simply my own understanding as a fellow patient and OSCAR user.
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RE: ASV settings for treatment of complex sleep apnea
Joey,

I just had a 2nd sleep study (clinic agreed to one at a reduced cost because of couple issues and lack of data in the first one). I went in a bit more prepared knowing what to expect and even got a sleeping pill from doctor in case I needed it (and did end up taking it).

Started the first bit out like my first study. I didn't even think I was falling asleep, I kept having the hypnic jerk type thing going on when trying to fall asleep. I called sleep tech in to say I would like to use the sleeping pill and when she came in she said that I was having bruxism arousals again and the off RERA and that I was drifting in and out of sleep but barely. Soon as she said RERA I made up my mind and told her I want to use CPAP. We put it on and I was able to get a bit more sleep but I woke up a bit later and had some issues with some aerophagia and was having trouble falling back to sleep because of noisy venting of mask (they only had N20 with old style elbows). I am pretty sure this is because she was running straight pressure (confirmed this morning that didn't use flex or PS, it was a PR machine). I did end up getting back to sleep after I believe she dropped pressure back down and then I slept for a good chunk and was able to get the rem sleep data I was hoping for.

I believe she now thinks my bruxism is caused by very minor breathing disturbances and that she noticed definite improvement on the CPAP. It was a bit worse during REM during which she had to increase to 12 cm of pressure to avoid arousals. I guess I might be in the UARS club after all. My question now is if it is because of restricted airways or because of an overly sensitive nervous system.

Now the question is if my current settings treat this (I believe they do at least partially) and how much is remaining untreated. Unfortunately there is no way to easily know without further titration tests to be able to see the arousals. I can pick through my OSCAR data to see arousal breathing and can record sleep to see if there is obvious bruxism etc but still difficult to know if ideally treated without EEG data.

Anyways thought you might be interested. PSG is the holy grail because it gives all the data necessary to diagnose these sleep issues. Unfortunately sleep techs are a pain (I had mentioned I used EPR of 3, why was no pressure support used) and finding a good one/clinic to do tests and be willing to do ASV titration for you would be the hard part.

I've also confirmed some reactions on my tongue related to ingestion of both dairy and gluten (ingestion of either causes geographic tongue in my case). I am starting to wonder if my scalloped tongue is/was due to being swollen from some sort of allergy/autoimmune reaction. If so that would also explain why my breathing used to be much worse and why my original home sleep study indicated moderate level hypopneas. I still think a whole lot of this stuff is all intertwined (gut health, "nonallergic" rhinitis, lpr, bruxism, apnea/UARS), the question is what is the main driving force and how to treat/fix.
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