Is ASV useful for AHI around 6, of which 4 are Centrals?

[Pugsy]

what was your AHI originally?

AHI 20.4 diagnosed per this thread.
viewtopic.php?f=1&t=78447&p=713492#p713492

[49er]

Meds?

Do you have a lot of fragmented sleep? Wake up often? Tossing and turning?

Current meds for high blood pressure & cholesterol, and a nasal spray for allergies (antihistimine plus steriod). Maybe once a week I wake up in the middle of the night and have a 50/50 chance of getting back to sleep; otherwise don't wake much (that I remember).

Hi Yarrow,

Steroid Nasal sprays can cause insomnia as an FYI. When I experienced this with nasonex, I couldn't understand why. An RN I knew explained that the steroid part of the solution was causing the insomnia. Unfortunately, I can't remember all the technical details.

There was also a thread on this forum about flonase causing insomnia. Unfortunately, I tried to find it it but couldn't. You may have better luck.

Anyway, this may not be applicable in your situation but I thought I would throw it out there.

49er

[yarrow]

Your FL graphs would be right up there with the coyote ugly ones.

Particularly last night's! AHI up too. Not sure why. It was a short night because I had to get up early to do a system upgrade at work, but my events are not generally front-loaded. I did wake up on my back (from a dream). Interesting that it was mostly hypopneas. Next appointment with the sleep doc is in a week.

[Tom W]

Your FL graphs would be right up there with the coyote ugly ones.

Particularly last night's! AHI up too. Not sure why. It was a short night because I had to get up early to do a system upgrade at work, but my events are not generally front-loaded. I did wake up on my back (from a dream). Interesting that it was mostly hypopneas. Next appointment with the sleep doc is in a week.

A lot of your events took place while the pressure was maxed out at 12....seems you need more pressure. Of course if this increases the number of centrals then you might need an ASV to handle those. See what your doctor thinks when you see him/her.

It looks like you're taking some very large breaths during your events but it's difficult to see.

Can you zoom in (like a 2 minute period) during a group of clustered events? I'd be curious to see what the flow chart looks like during those times.

[yarrow]

Can you zoom in (like a 2 minute period) during a group of clustered events? I'd be curious to see what the flow chart looks like during those times.

Here's a hypopnea:


Two obstructives:


And an obstructive and a central:

[Mary Z]

I find ASV to be the most comfortable and beneficial therapy. I had drug resistant depression, continued excessive sleepiness, no libido, and chronic leg and back pain requiring heavy meds. My AHI on BiLevel or AUTO was 18.6 for a solid year. The previous three years it was worse. Hard to believe, I know, but true none the less. I had pressures prescribed from 4/8 to 27/30.I One doctor gave up on me. I had never had an AHI under five with numerous sleep tests and titrations- it ran an average of 18.6 for the last year of conventional therapy. I was feeling barely "OK", but jumped at the chance of a sleep study with ASV. It worked. After 14 months of therapy, in fact in the first six months my depression lifted and I had improved wakefulness. My AHI is now 4-8, so I have many days five or below. I did not have to decrease or stop any of my meds.
With conventional therapies (CPAP, BiPAP, and AUTO) some people begin having clear airway episodes as the pressures rise. On AUTO the higher the IPAP went the higher the AHI, I ended up chasing my tail. I was using an S8 so had no breakdown of A,H,C. I think (not confirmed by any research, but anecdotal reports) that anyone who can swing an ASV should do so. For the first time I am getting good therapy. Good luck,
Mary
By the way I am using the Wisp nasal mask with 0 leaks.

[yarrow]

what was your AHI originally?

AHI 20.4 diagnosed per this thread.
viewtopic.php?f=1&t=78447&p=713492#p713492

You got it! Though looking back at the study, I didn't, quite. The diagnostic study RDI was 20.5, with an AHI of 14.1 and the rest RERAs.

The titration study settled on 9cm, resulting in an AHI of 9.4, mostly centrals, and an RDI of 13.1. My first night at home I had an AHI of 14.93; setting it to vary, at settings like 5-9, 6-8, etc. got me through the first few days. I then set it at a straight 9cm for a couple of weeks, average AHI 12.10, on the theory that I should at least try my prescribed setting. Then did 6-11 (average AHI 5.19) for a couple of months, then 5-9 (AHI 5.48) for a month 5-14 and 8-14 (AHI 6.85) for a month, 8-12 (AHI 5.62) for two months and 11cm (AHI 5.69) for a month and a half.

After the sleep study at the new sleep center, tried low pressures (6, 7, 8, 9) (AHI 10.18, 9.84, 10.53, 7.40) for a night or two each, since that study titrated me at 6cm. (Subjectively, my allergies were hardly bothering me that night, even before I put the mask on -- so I'm curious as to whether that might have anything to do with it.) Then the doc set it to 6-12 with EPR 2 and I said I wouldn't mess with it until I saw him again.

Here's the SleepyHead overview for all that:


Subjectively, summer was pretty good, things started getting gradually worse in the Fall, and some time in January bad enough to hunt down a new doc. Which is a slightly different story than the overview graph is telling, no?

[yarrow]

Steroid Nasal sprays can cause insomnia as an FYI. When I experienced this with nasonex, I couldn't understand why. An RN I knew explained that the steroid part of the solution was causing the insomnia

Thanks, 49er! I started the Dymista (azelastine and fluticasone) around the time things started feeling gradually worse. Hmmm.... should be able to cut that out.

I'm also realizing that I stopped using my home-grown positional apnea rig because it seemed to have stopped making any difference to my AHI -- but I wasn't paying attention to the flow limitation. I'm going to try that again with a more educated eye. (Thanks, Pugsy!)

I find ASV to be the most comfortable and beneficial therapy. [...] jumped at the chance of a sleep study with ASV. It worked. [...] My AHI is now 4-8, so I have many days five or below. [...] For the first time I am getting good therapy. Good luck,
Mary

Thanks, Mary! Of course, here I am complaining that my AHI is in the 4 to 8 range! Ah well, it is what it is.

[Pugsy]

Sorry about the RDI vs AHI boo boo. I just quickly glanced at that old thread where you mentioned it.

You know if you ever get in a position to get a back up machine you might look at the PR S1 Auto. It shows FLs differently than the S9 and it also flags RERAs. Might be interesting to see what it wants to flag.

Maybe you have some sort of underlying issue along the lines of UARS also going on.

When you have satisfied your doctor's request to "not mess with the settings" I think cpap mode or apap with a tight range might be looked at but you need to give things more than a couple of nights before changing again.
With more attention to the Flow limitation graph and also your nasal congestion issues.
Maybe the FL is in the nasal passage and not at the usual airway where tongue and those tissues flop around.

I think that there is more of a sleep quality issue going on here than an AHI issue. Your AHI isn't horrible but your sleep itself isn't so great and you know what I always say...sometimes the bad sleep has nothing to do with OSA and the machine can't fix bad sleep if OSA isn't the cause.

[yarrow]

Sorry about the RDI vs AHI boo boo. I just quickly glanced at that old thread where you mentioned it.

That was my boo-boo, not yours -- I said AHI in the old thread. (I think I hadn't actually seen the study at that point, just got a number over the phone and assumed it was AHI.)

You know if you ever get in a position to get a back up machine you might look at the PR S1 Auto. It shows FLs differently than the S9 and it also flags RERAs.

That makes sense.

When you have satisfied your doctor's request to "not mess with the settings" I think cpap mode or apap with a tight range might be looked at but you need to give things more than a couple of nights before changing again.
With more attention to the Flow limitation graph and also your nasal congestion issues.
Maybe the FL is in the nasal passage and not at the usual airway where tongue and those tissues flop around.

Makes sense. My allergist says my throat seems clear (allergy-wise) and the allergies are all in my nose.

I think that there is more of a sleep quality issue going on here than an AHI issue. Your AHI isn't horrible but your sleep itself isn't so great and you know what I always say...sometimes the bad sleep has nothing to do with OSA and the machine can't fix bad sleep if OSA isn't the cause.

True enough.