Elderly back sleeping mom, new ASV

Sorry to hear your problems... sleeping with head raised appears to be the best solution... she's not a side-sleeper at all.

Recliner? Hospital-type bed with raised head? Angle cushion?

Here's another thought... is it her tongue? The iNAP is a new device that pulls a suction in the mouth to keep the tongue forward... would be able to work along side a nasal mask.

https://www.inapsleep.online/

Good luck, enjoy your mom while you have her... mine gone 13 years now.

As a person with complex apnea I can say that the machine they gave you will make things worse rather than better. The only thing that will effectively treat complex is an ASV.

Oh yes, I was thinking of replacing the bed with a sofa a lot when I first came down here. But I stopped thinking about it, clear that mom would flip out and balk and be angry. Much better when she’s calm and cooperative!

It’s so funny, at night she wants the bed. I try to encourage her to sleep on the sofa instead, but that never works at night. In the morning she wakes up, has coffee and a piece of toast, then conks out happily on the sofa and has her best stretch of sleep of the day.

I can’t remember her previous range for the APAP, but it went up to 20 max. And it was very often at 20, so she would have a constant jet engine in her face and annoying leaks and tear the mask off. The doc lowered the max to 15, and it does seem compliance has been better. I can’t remember the other tweaks, maybe my sister would know.

She started therapy with a Luna machine, which was %$#!!. And no data and no Oscar didn’t help. With the Luna, whatever the settings were, she was pretty uncomfortable and non compliant. There was also the sense that she was struggling to breathe against that machine. I think the same settings got moved to the new Resmed Airsense 10 we bought online for her, but that was much more comfortable. Then the settings got tweaked to what they are today.

I haven’t met her current sleep doc, but my sister says she thinks he’s very good. She ended up with him after the other sleep docs weren’t working out. This one is a neurologist who also does sleep, and who isn’t too busy.

She has also been taking Lyrica for restless legs, which we are in the process of titrating away from. It seems Trazodone is actually much more effective for the restless legs than the Lyrica, and will likely have less cognitive impact. I never heard of trazodone for RLS, but I tried giving her 25mg, and bam! No more restless legs. She had bad RLS even with the lyrica, and her cognition has been … well… that’s what we’re hoping to improve here….

To be clear, we only used the BIPAP they gave us by mistake for that one night. That OSCAR data was scary. We’ve fallen back to the old Airsense 10 APAP. We will scream bloody murder about the wrong machine and bad setup. Hopefully they have an ASV they can give us, and soon.

What's the minimum pressure?

Her min pressure on the APAP has been 11 for at least maybe 5 or 6 months now. I don’t remember what it was before that, or if it changed. But like I say, when they started her out on that Luna we had the sense that her poor compliance was linked to her trouble breathing out. Maybe she just couldn’t get used to it, but her complaint was, “I can’t breathe.”

Hopefully we get the ASV soon, and then we set it up ourselves or hopefully get a different DME rep out here than we got last time and get a good setup.

Currently with the Resmed APAP her AHI isn’t far from 5, seems to range like 3 to 7 in general over a night, but that is a mix of smooth sleeping, mask off altogether, and then chunks of OAs one after another, which often mean she’s rolled onto her back. After a stretch of clear sleeping, if she has it, she’ll start to show centrals. The centrals are usually clustered toward morning. On many nights without a lot of back sleeping she’ll have more centrals than OA. On a bad back sleeping night she might go into Cheyenne Stokes. Since I’ve been here and my sister and I are both sharing the night patrol, she hasn’t had so much Cheyenne Stokes, I think maybe one or two nights in the month I’ve been here.

I had been staying with my mom for a month and helping manage her care, but I left about 9 days ago. Right after I left my sister got the ASV (Aircurve 10 ASV) machine straightened out. It came set up, but I don’t know the settings. She had to argue with the DME rep, that the BIPAP was the wrong machine. DME rep: “But it’s an Aircurve, and Aircurves are ASV.” No!

My sister looks at Oscar every day. She says the ASV is working MUCH better than the old APAP and of course the mistake BIPAP. Also for some reason mom is tending to sleep less on her back and maybe even take the mask off less. Maybe it’s more comfortable, or maybe with it working better she has just enough more clarity that she can remember. So it’s all looking better on the PAP side of things, if not perfect.

Unfortunately mom’s mental clarity isn’t responding as much as we hoped. We’re also titrating her meds. She was on Lyrica/pregabalin for restless legs. It wasn’t even working for the restless legs, and surely Lyrica has taken a cognitive toll (it is known to do so). It was right around the time she started taking it regularly (instead of on and off as she had been) that we noticed her cognition going downhill. But that’s also when we noticed the apnea. It turns out that Trazodone (introduced a month ago) is helping the restless legs better than the Lyrica anyway. Though most studies don’t show negative cognitive effects from Trazodone, it seems like it might be a factor. Or in combination with the lyrica. But we’ve got to get her off the lyrica.

We’ll see.

Thanks for the help figuring out the ASV and all.

For me the ASV is MUCH less trouble than the standard machines or BiPaps. When I am breathing with it there is no sense of having to 'push' against it to exhale. Is basically like breathing with nothing on unless I start to shallow out or miss a breath. Then it pushes and I feel it. So it doesn't surprise me that your mother is much more comfortable with it and isn't taking it off so much.

If your sister posts an Oscar graph or just emails the graph to you the settings are on the left.