CPAP and biPAP don't work, trying ASV?

[rosevader]

I haven't posted in a while as I have been moving on to a new more competent sleep clinic (my previous doc seemed to have no clue what to do next. (When I complained that my AHI was still in the teens in spite of cranking up pressure on my auto CPAP and using it 7 hours every night, he told me that I should try to sleep for at least 8 hours every night for a week to see if that made me feel better?????????) Long story short, the new clinic had me do an in house sleep study/titration with a BiPAP. According to this study, my OA was taken care of by the BiPAP but now I am having CA instead. I didn't see CA using my auto CPAP results (maybe the machine saw them as OA???) Anyway, now the clinic wants to do a sleep study/titration with an ASV. Anyone have any experience with this machine??

[Julie]

What are your pressure settings - particularly the low one? Setting them unecessarily high could potentially account for some CAs and there may be other reasons for them. Sleeping 8 (or 6 or 9 hrs a night is nonsense advice). They may be trying to get you to pay for a more expensive machine but you need to be sure you need it before agreeing and I wouldn't necessarily trust them without seeing a copy of my study - get hold the results (yours by law) and present them here. Also, it's important to know that very many people do get a few CAs on falling asleep and then on awakening - they're not normally considered to be problems though... only if you get a lot throughout the night.

[Pugsy]

It doesn't surprise me. I remember you. Unable to use the higher pressures needed to adequately prevent obstructive apnea events due to gastric issues when using apap.
In the sleep lab they were able to use the higher pressure by utilizing bipap but with the higher pressures came the centrals. It's called complex sleep apnea and the cpap pressure causes the centrals. Happens in about 15 % of the people who start cpap and didn't have any centrals prior to starting cpap.

This video might help you understand.
https://www.youtube.com/watch?v=CU-XTcf ... e=youtu.be

You need a machine that will do both...treat the obstructive apnea as well as the central sleep apnea.
I was really hoping you wouldn't need to go down this road because treating the centrals may cause some gi distress...it all depends on how often it has to treat the centrals. At least this doctor doesn't have his head up his ass like the first one.
I was hoping that all you needed was a bipap machine but it doesn't surprise me that the centrals reared their ugly head.

[klv329]

Even on Craigslist those machines aren't cheap, but usually negotiable. This s9 adapt has an asking price of $500:

https://columbia.craigslist.org/for/5681560711.html

https://phoenix.craigslist.org/cph/hab/5696107795.html

[rs500]

Just checking, I believe the s9 pap adapt is an auto bi-level machine, not an ASV.

[Pugsy]

Just checking, I believe the s9 pap adapt is an auto bi-level machine, not an ASV.

Incorrect.
The Adapt is indeed an ASV

The S9 VPAP Adapt is an adaptive servo-ventilator (ASV) specifically designed to treat obstructive sleep apnea (OSA), central and/or mixed apneas, or periodic breathing. The device continuously monitors and adapts to the patient’s breathing pattern throughout the night to ensure they’re receiving the right pressure at the right time.

from http://www.resmed.com/us/en/commercial- ... adapt.html

[Bons]

I have obstructive sleep apnea and idiopathic central sleep apnea. My pressures are low (minimum pressure is 5.5 and a minimum pressure support of 0; a weave pressures are 7 and a pressure support of 4). But I need that patterning of the ASV to stimulate my breathing. Unlike cpap or bipap which change pressure in response to your spontaneous breathing the ASV changes at a set rate to coax your body to breathe along with it.

It can be annoying to get used to because it can feel like the machine is forcing your breathing. But you get used to it.

And yes, if the doc just keeps trying to up the pressure to lower your AHI it could cause centrals. My first doc did that to me. Had me at minimum pressure of 12 and minimum pressure support of 5 so I was well over what I needed. My centrals shot up more than they had been.

[palerider]

Just checking, I believe the s9 pap adapt is an auto bi-level machine, not an ASV.

an ASV is a type of auto bilevel machine..

but I think you're mistakenly thinking of the VPAP Auto.

[rosevader]

Thankfully, this new doc seems more on top of the situation.
The results of this in lab sleep study really surprised me. At the lower pressures on the sleep lab bipap (IPAP 8 EPAP 4), the AHI= 22.4, all of which was CA. The original (at home) sleep study showed CA and OA, with mostly OA. My autoCPAP downloads showed close to zero CA every night I checked it. Maybe the autoCPAP results were not a reliable measure of CA versus OA, so it looked like OA was staying high no matter the pressure, when in fact the OAs were being eliminated and the CAs being mislabeled as OA???
At any rate, as I have begun to read up on this, its definitely a low probability situation.
Thanks to everyone for replying, especially Bons ( so I know someone else out there also has this going on).
Bons, how long did it take your sleep doc to figure this out? Was the ASV hard to tolerate?

[Pugsy]

You know it wouldn't be totally impossible for the machine to have been flagging centrals as OAs.
I have seen it a handful of other times. There was a guy a while back where Sludge/aka whoever he was at the time got involved with actually reading the breaths and he said that the events flagged as OAs/hyponeas by the machine were most likely centrals. This was a guy with high PB/CSR flagged flow but not many centrals but upon looking at the wave form it just stood up and slapped you in the face that it was Cheyne Stokes Respiration.

These machines are good but they aren't without their limitations.
I just the other day cleaned out all the files I had from your data...darn it. Or I would go back and look a little closer at the air flow but to be honest...I know that I can't do what Sludge could do. He did it for a living and for years...my skills for breath by breath analyzing at that level is next to none.

If they say you need ASV for centrals....you need ASV for centrals despite the apap mainly flagging OAs.
It could have made a mistake. Someone once told me that if a machine calls it a central then it likely is a central in the true sense of the airway being open but that sometimes what the machine calls as obstructive could be central.