*UPDATE* 1.5 years on ASV with NO RELIEF

[Coolsideofthepillow]

OAI = 91.4
CAI = 2.6
HI = 38.1

[robysue]

OAI = 91.4
CAI = 2.6
HI = 38.1

So the original diagnosis was severe OSA with an AHI = 132.1

Now can you fill us in on how you wound up on the ASV? The usual path to that machine involves some serious problems with CAs showing up---either before CPAP (not your case) or after CPAP was started. And the path usually looks something like this:

• Initiate CPAP; if the pressure gets as high as 15cm OR if serious numbers of CAs start to happen once CPAP is started, consider switching to a bi-level titration.
  
  Continue to titrate for a bi-level (BiPAP) and most likely start the person on a BiPAP that does NOT have the ST mode.
  
  If CAs continue on treatment OR if symptoms are not resolved in spite of good compliance, move on to a BiPAP ST or a BIPAP ASV titration in order to determine all the settings.

So---can you remember how you wound up with the ASV machine?

And---are you using the ASV in ASV mode or straight BiPAP mode?

It's critical to get this answered because you stated: "My pressure is set for the max the machine can take per the scrip, any lower apparently causes centrals."

And we need to understand just how many central apneas you are talking about when you were on lower pressures. Because the particular difficulties of dealing with high pressure AND significant pressure swings in ASV mode when the machine is triggering inhalations is a particularly difficult set of problems to deal with. But as JohnBFisher indicates, there are a number of experienced ASV users who will be able to help you conquer that problem.

[Coolsideofthepillow]

I remember during treatment that when the cpap was applied the pressure went too high and caused centrals. I believe the centrals got worse until they got up to the max pressure which I believe reduced them. I am going to have to sit down with my report and analyze it. It's been so long I need a refresher.

Also I believe it is in auto. I will have to read up on how to check.

[Therapist]

OAI = 91.4
CAI = 2.6
HI = 38.1

I suspected from the first page that you do not have central sleep apnea. ASV machine was throwing me.

What is the manufacturer name and the exact model number of your machine?

While you are figuring that out you need to be making an appointment with an ENT to get an opinion on those "huge" tonsils. It seems so obvious.

[JohnBFisher]

... OAI = 91.4, CAI = 2.6, HI = 38.1 ...

I suspected from the first page that you do not have central sleep apnea. ASV machine was throwing me. ...

While technically correct, this patient may indeed need an ASV unit. He also notes:

... I remember during treatment that when the cpap was applied the pressure went too high and caused centrals. I believe the centrals got worse until they got up to the max pressure which I believe reduced them. ...

This would indicate Complex Sleep Apnea which includes a reaction of increased central sleep apnea in response to the increasing pressure.

... What is the manufacturer name and the exact model number of your machine? ...

Coolsideofthepillow, I have to agree. You need to register your equipment so we can be certain we are providing appropriate responses. To learn more about how to register your equipment, see the following link:

wiki/index.php/Registering_Equipment_in_User_Profile

[Coolsideofthepillow]

Just took a glance at my machine. Model # 1040716 respironics. What is this in Lyman's terms??? I looked under equipment but cannot find anything that matches this.

[Pugsy]

Just took a glance at my machine. Model # 1040716 respironics. What is this in Lyman's terms??? I looked under equipment but cannot find anything that matches this.

Is this it?
http://1800cpap.com/respironics-bipap-a ... ifier.aspx

If so..look in the equipment drop down list for Remstar BiPap AutoSV machine.
Its in the grouping that begins with Remstar.
The humidifier would be Remstar Heated Humidifier (assuming yours is heated but there is a choice for Passover which is water in tank but no heat)

[Coolsideofthepillow]

So far the best night has been 3 hours. I fitted the mask at max pressure while lying down. Then I set ramp and fell asleep. 3 hours later I awoke and took the mask off,for no apparent reason.

[JohnBFisher]

Good for you!! That's the way to get going with it.

It's not unusual for people to remove their mask during the night .. and be totally unaware of it. Some people use things like a chin strap .. or the Pad-A-Cheek anti-leak strap. They help reduce leaks and make it a little harder to remove the mask.

Perhaps others have some ideas on how to handle removal of the mask while asleep ??

[robysue]

So far the best night has been 3 hours. I fitted the mask at max pressure while lying down. Then I set ramp and fell asleep. 3 hours later I awoke and took the mask off,for no apparent reason.

Coolsideofthepillow,

Just keep putting that mask on every night at the beginning of the night.

And if you wake up in the middle of the night and you find you've taken the mask off, just put it back on and then try to get back to sleep.

Perseverance is the name of the game: The more you sleep with the mask on the easier it will become to sleep with the mask on. With a bit of luck, eventually you'll get to where you're keeping it on all night.

[JohnBFisher]

Let's face it, having a mask strapped to your face each and every night is NOT normal. But you will get used to it. I've been doing this for the past 22 or 23 years. I hardly notice it .. unless I'm having a bad leak night.

Here's hoping you stick with it. You will feel ever so much better by getting the rest you need.

[NachtWürger]

Let's face it, having a mask strapped to your face each and every night is NOT normal.

"The New Normal"

[archangle]

Let's face it, having a mask strapped to your face each and every night is NOT normal.

The mask keeps mother nature from solving apnea the natural way. i.e. early death.

[DavidCarolina]

to cool side, do you have the help and support you need to find the right path to healthy weight loss? You cant do it alone, you need a system of some kind without feeling like youre on some rigid system that doesnt work for you.

Also, have you considered supplemental oxygen? I have a concentrator that I use when i awaken agitated. Better than pills, but have those too, Klonapin as needed.

You sound as if you have the same things working against you--former athlete, got heavier, narrow airway, large tongue?, heredity, and possibly deviated septum and positional sleeeping issues. Its a complicated web, but thats why were' all here, to help each other.

[Coolsideofthepillow]

I'm back. Since the last reply I have switched over to a Whisp. I tape my mouth shut ms wear a breath right and while not perfect it's much much better.

A few questions:

Pugsy,

The machine you linked above is the machine I have. As far as data collection I guess I am stuck with the respironics software and a card reader?

Is it possible that this machines pressure could be going to high????