New Member and New to CPAP...new issue with ASV trial

[JCFlorida]

Thank you all for your observations and advice. I am getting more comfortable with my mask (F20). I have a follow-up appointment with the clinic to review my CPAP results in a couple of weeks. That will be 4 weeks of CPAP therapy. They had mentioned the possibility of a second sleep study if my results merit it. I will provide an update afterwards. Thanks again!

[zonker]

looking forward to that update!

[JCFlorida]

Hi All,
Just came back from 3-week follow-up with sleep tech. Still groggy most days. Will see doctor first week in January. Sleep tech said it looks like I may have treatment emergent central sleep apnea. They want a full 30 days of data, so they can determine next steps: another sleep study to determine Bilevel with backup rate or ASV. Attached is just a summary report from Oscar.

https://imgur.com/a/M02imRK

[JCFlorida]

Update:
60 days in. 90% of apneas are central in nature. Typically 5 to 6 CA's per hour for the last 30 days. All others apneas resolved effectively by airsense 10 apap. After about 40 days met with doctor and told him I was still feeling more tired than before I started cpap therapy. He said sounded like treatment emergent central sleep apnea. Suggested titration study. Had a titration study with bipap to bipap st last week with a bipap st machine (respironics I think). Completed that study but could not tolerate the pressures. It felt like powerful jets of air being pumped into me at set intervals of 3-4 seconds. Review finding with doctors, said I had what he thought now was complex sleep apnea. Scheduled me for another study for ASV titration that took place last night. Didn't see a resmed machine just another respironics.

Unfortunately, I couldn't fall asleep during asv titration. Went to bed and the machine, while I was awake, started to deliver a constant strong pulse of air at about every 4 seconds lasting  2- 3 seconds, stopping completely in between. So not continuous pressure. When it started I attempted to breathe in during the pulse  but then it would stop before I got a full inhale, leaving me with a sense of inhaling dead air.

The pulse would start again during part of my exhale. It felt like it was trying to breathe for me while I was awake. Tried change of mask. But the mask wasn't the issue for me it. It was the pressure pulses being out of sync with my awake breathing that kept me up to 230 am with no sleep recorded.

I let the tech know how I was feeling a few times. She said that is the way they worked. That I would need to fall asleep for it to adapt to me. So, I told her I wasn't going to able to fall asleep with it affecting my breathing that way. She said I should have taken a sleeping pill. So, it was clear that no benefit would be derived by staying longer.  

I guess I thought the asv would be more like my apap, but with a feature where a pulse or stream of pressure would be initiated during a central apnea. Then it would back down to my apap range. Is this what an ASV machine is supposed to feel like? The way ASV's are described online was very different from this jarring "ASV" study.

I had the same experience as this person who posted on the https://www.apneaboard.com/forums/Threa ... typical%3f

So, waiting to hear what next steps are from doctor.

[Pugsy]

I changed your original subject/topic title to reflect your new issues with ASV.
This was done to get the attention of people who actually use ASV and are familiar with it and little tricks they know of to make the adjustment easier.

[JCFlorida]

Thank you very much.

[ineedtosleepasap]

I changed your original subject/topic title to reflect your new issues with ASV.
This was done to get the attention of people who actually use ASV and are familiar with it and little tricks they know of to make the adjustment easier.

I tried posting my own post, but I can't find it. I also tried private messaging you, but don't see the option. Can I please get help?

[Pugsy]

I changed your original subject/topic title to reflect your new issues with ASV.
This was done to get the attention of people who actually use ASV and are familiar with it and little tricks they know of to make the adjustment easier.

I tried posting my own post, but I can't find it. I also tried private messaging you, but don't see the option. Can I please get help?

I see you figured out how to create a new topic of your own. Stick to that thread and not this one please.
You should also now be able send PMs.

[JCFlorida]

Will do. Thank you. This is pretty new to me. I am averaging over 5 AHI then sporadically under 5. Confusing. Anyway, look forward to getting any advice.

[Miss Emerita]

Your original sleep study showed both central and obstructive apneas. As Ozij noted, the study would not have counted pauses in your breathing that occurred while you were awake. You also showed significant periodic limb movement and some respiratory-effort-related arousals. Based on that study, I'd have thought your diagnosis would be mixed apnea and PLM.

Even with mixed apnea, patients are often started with a regular PAP machine, because sometimes that works to reduce central as well as obstructive apnea, for reasons that are unclear. Your regular PAP machine isn't having that effect; your CA index seems basically unchanged since your sleep study. It's good that your doctor tried to see how you'd respond to an ASV machine, but it's a shame you didn't get more help the night of the study in how to breathe more comfortably with an ASV. (Alternatively, they could have started you with regular PAP and then switched to ASV once you were asleep.)

I'm mystified why your doctor isn't paying attention to the PLM, which can mess with sleep quality. There are medications that might be able to help you. I strongly recommend that you follow up with the doctor about this.

I'm also mystified why your doctor hasn't had you try turning off EPR. For some people, using EPR can lead to CAs. Unless I missed something, that isn't an experiment you've tried yet. Do you want to give it a whirl?

[JCFlorida]

Posted response on other thread.