[Treatment] Nearly eliminated OAs, but getting tons of consecutive CAs?

[CactusCactus]

Thanks guys! I'll turn it off and get back to you when it seems right.

[SarcasticDave94]

You can post a single standard OSCAR shot tomorrow. This should show some change pretty quick IMO with CA. At the most two days data due to the CA variability thing.

[CactusCactus]

Thank you Dave! I’ll do that. 

So I’m guessing that if I continue getting CAs at anywhere near this rate, the prognosis would be that I ought to start looking into acquiring an ASV machine? And/or getting a real sleep study, but that’s a given 

I’ve heard some say that it can take quite a long time—maybe up to a few months—to acclimate to treatment-emergent Central Apnea, if that’s the case. Are these cases distinguishable different from mine (Fewer apneas?)? Meaning there’s no reason to expect it will change in a couple of months.

I haven’t been able to find any user anecdotes/references with data regarding cases where an individual with CSA/mixed used a CPAP and failed to treat CAs, and concluded by acquiring an ASV. Or data on cases of an individual who did not have issues with CAs/CSA, encountered them as a result of treatment, and which disappeared after the person became acclimated.

[Gideon]

Not necessarily a sleep study, a prescription. It has been done without a prescription but . . .

Let's see what the data says.

[SarcasticDave94]

Partly from my own experience and the rest from seeing others, treatment emergent CA should diminish some nearly immediately after therapy adjustments to minimize pressure swings. These swings can typically be from Ramp and/or EPR and sometimes other therapy settings like bilevel pressure support without backup rate. If the CA drop rather drastically a day or two right after EPR is cut down, we're likely headed right. It's a generality we go by that treatment emergent CA would diminish by 90 days, some PAP users see this drop off much sooner.

A definite fact on CA is CPAP/APAP treatment fares better than BPAP without backup rate. Any CA case can be dealt with on ASV, but it really is best to reserve that to the cases where CA of any type can't be treated with CPAP, in large part due to the expense.

[CactusCactus]

Hello everyone. It's taken longer than I expected to get consistent results. I've been having trouble getting used to sleeping without EPR, for very long at least. Also, increased problems with aerophagia and mask leaks.
























It's not looking good to me. I cannot figure out why I get such varying results with the same settings, on different night. 

Something worth of note is that I noticed some on this forum advising others to avoid sleeping with a "chin down" posture. on Jan 31st, I tried sleeping without a pillow and got my lowest AHI yet. I unfortunately could not replicate the results on February 1st.

[SarcasticDave94]

The variable up/down events is due to CA consistently inconsistent trait.

I'm seeing idiopathic CA in the tea leaves. This group was with the AutoSet for her, if you tried any BPAP without backup rate it's very likely to go a lot higher on the CA, without question likely double, triple this. I may be projecting myself in a bit, but if these are my charts, no I can't accept this as humane treatment or medically treated.

Was the AutoSet through insurance? I've lost track. If yes, get on your smartphone horn and blow phrases like too much interruptions in sleep, not well rested, and even so far as too many CA, and whatever else is stealing from your sleep. Blow that info into the doc's ear. Maybe mention idiopathic CA, medical for unknown cause CA. And mention the ResMed machine for CA is ASV. Stay with ResMed for this, it's the best there is.

[CactusCactus]

Wow. It is unnerving to realize that I was unknowingly suffering with this, for who-knows how long. But also vindicating, to realize that the constant fatigue and lack of comfortable mornings is not just due to being a lazy ***.

I didn't use any insurance for any of this. Bought the machine off of an online retailer which doesn't require prescriptions. They also have the ASV for a decent price. Tempted to order it right now, and Craigslist the current one.

From what I understand, the ASV is fairly foolproof when set/tuned properly, and will not allow CAs like this to occur?

[Sleeprider]

ASV is the appropriate therapy for the problems we see in these charts. I think your overall pressure will be much lower.  We can't blame the CA events on EPR, and you actually had better results using it.  I think the trick with your autoset is to find the lowest effective pressure that gives good results for OA, then dealing with any CA by avoiding excessive pressure increases with the maximum pressure set more aggressively low.  If you choose to move to ASV, that is a very easy device to optimize. The Resmed Aircurve 10 ASV is about as close to automatic with default settings as it gets.

[SarcasticDave94]

Definite it won't let much of anything through. Mine is the ResMed AirCurve 10 ASV. Settings are standard humidifier and heated hose and mask type like you've got now. Then there's Mode CPAP ASV & ASV Auto.

As a CPAP your current is better but it wasn't really meant to just be CPAP, ASV is static EPAP while ASV Auto is EPAP and PS ranges with auto IPAP. Mode plus 4 pressure settings.

It's entirely up to you but if you buy one, we can have you running in 5 minutes. Here's how I'd go on one: mode ASV Auto EPAP 5-15 PS 3-15, representing a slight EPAP edit from stock titration. You might edit EPAP a bit and maybe editing PS a little. Copy your humidifier and hose settings and you're done.

All current items will fit, hose, filter humidifier tub, same mask if you like it.