Biot's Breathing - ASV?

I finally had my titration study two weeks ago, and had my follow up appointment yesterday. When I went in, the recommendation was for BiPap, but mentioned that all the apneas seen were central apneas, but I had not tolerated ASV. Discussing this with my doctor, I questioned this, as I knew that I did not sleep well during the titration due to a migraine that kept me awake a good bit of the night. I was worried that my worst episodes didn't show up. I was on the wires for 257 minutes, with a 70% sleep efficiency. Seemed like I slept even less, but I know that can be hard to know.

Well, looking at the detailed data, I need not have worried about the worst not showing! I started showing centrals almost immediately, even though the first half of the sleep period was highly fractured. The tech mentioned that I showed something called Biot's breathing, which is the name I guess they call the raggedy flow chart that I always show for most of the night. During the appointment, I didn't know what it meant, or I would have fought even harder for ASV.

Turns out the tech only tried ASV for 30 minutes, found it disturbed my sleep, and instead of trying other settings, went back to BiPap. In talking with the doctor, I expressed my concern that BiPap would not treat the centrals that were still showing (20-40 per hour, depending on sleep stage and pressure), and I would have to go though this all over again. The doctor consulted with another, and came back agreeing to ASV. She figured that if I could not adapt to it, we could run it closer to BiPap mode. I am more concerned about knocking out some of the those centrals. My desats are not too bad, but I can tell it is damaging my sleep quality, as I NEVER feel rested, in fact feel worse when I sleep longer.

Just hoping for some feedback on the Biot's and ASV. I read a bit on Pubmed, but nothing beats hearing actual patients. From the studies, it sounds like I pushed for the right machine, as they are using ASV for Biot's as well as central apnea. I don't have the actual report yet, as they need to reprint it with the new recommendations (and take off the wrong GP!), but I will get that and all the detailed sleep study pages soon. I do know that my records from teh S9 Autoset show pretty raggedy flow lines almost all night, almost every night. Just curious, anybody with Biot's doing OK on BiPap? Or do I really need ASV?

Also, are they right that my nasal pillows won't work with ASV? I used them during the titration, and didn't have any problem with leaking at the higher pressures, but I know I wasn't on ASV long. I know it will be an ordeal finding a nasal or full face mask I can tolerate, as I have a lot of facial pain, and the pressure of the mask and headgear is an issue. The less I can wear, the better, but I want to give this a good shot.

Recommendations?

I know nothing about Biot's but you can indeed use a nasal pillow mask with an ASV machine.
Lots of people do....including myself and my S9 VPAP Adapt (which an ASV machine).

Thanks, Pugsy! I thought I remembered you used a nasal pillow. I wasn't sure if you were using BiPap or ASV. I intend to try the nasal pillow first, and only go to something else if I can't figure it out and have too much leaking.

I had to look up Biot's respiration. Here's a comparison graphic:

https://en.wikipedia.org/wiki/Biot%27s_ ... lities.svg

From the above, it looks to me like a span of regular breathing but pronounced amplitude with a hypopnea interspersed at semi-regular intervals. Somebody correct me if I'm wrong, but I would think once you get used to your ASV it will knock that pattern out of the ring. At least that's what ASV did for my stubborn periodic breathing (5% many nights).

BTW, I used Swift FX nasal pillows with my ASV for about six months. I now use an FFM but that had more to do with my long running ear problems than any nasal pillow issues.

Here is a little you tube video https://www.youtube.com/watch?v=P7zvzDUcCCQ

Hi Sir NoddinOff!

From Pubmed, it looks like Biot's is ataxic breathing, in other words, the flow chart looks like the path a drunk would walk, totally erratic, with periods of hyperventilation, hypoventilation, and central apneas. Sounds like difference from Cheyne's Stokes is the erratic nature, instead of the timed changes in Cheyne's Stokes. I always thought my flow chats looked raggedy, but though it was just due to flow limitations. This is another file showing Biot's, but it is actually a lot more even looking than mine. http://www.ncbi.nlm.nih.gov/pmc/article ... figure/F3/

Glad to hear from another who could use a nasal pillow!

Do you routinely take any medications, or have you had a brain injury from stroke or injury? I know nothing of this condition but what is on the article previously linked. BiPAP appears to be a less than optimal choice. ASV seems to be the treatment of choice for CSB and other periodic breathing disorders. A second opinion might be a good idea as well as an explanation why ASV was rejected.

Thanks for the video, squid13! They are much tidier than I am, that is for sure. My flow chart looks like a two year old tried to draw it. Extremely erratic. But they have the basic idea.

Sleeprider, yes, I take pain medication. Also very high doses of antihistamines. I have been on both for a long time, and have no noticeable sleepiness, but it looks like it may be causing more trouble than I knew. Previously also had a brain injury from car accident, and have ongoing chronic infections that sometimes affect the brain. So yes, lots of possible causes. Not too many I have a lot of control over, but I will be talking to my non sleep doctor about what we can do.

I don't think the sleep doctor has much experience with Biot's, as no mention was made other than noting it was there. She is usually good about explaining everything. I was worried about the fact that the report stated I only had centrals, and there was nothing that was addressing that issue. ASV was rejected because the tech put me on it for 30 minutes, at one setting, and decided I could not tolerate it, so took me off. Not good enough!! Fortunately the doctor agreed. BiPap did not address the centrals at any pressure.

I will get the ASV. Once I pushed a little, she acknowledged that was the best choice. The study summary has to be re-written to emphasize what is needed for insurance coverage. Didn't know what the Biot's was till I got home and looked it up.