Complex sleep apnea, but can't tolerate ASV

[needzzzzs]

I have previously mentioned having a VPAP titration study (a few months ago), but completely failing to tolerate the therapy. I had so much aerophagia (air swallowing) and resultant gas that I barely slept and was not comfortable the entire night.

So, I've had another meeting with my sleep doc, and his feeling is that I have to settle for an average AHI of a little over 6. He pointed out to me that if I showed that AHI on a new, diagnostic sleep study, I wouldn't even be diagnosed with sleep apnea, nor offered treatment (my original diagnostic study showed an AHI of 16). And he pointed out that my ability to be totally compliant with BIPAP is a lot better than being noncompliant and getting poor sleep with VPAP.

Part of me recognizes the wisdom in what he says. The other part is disappointed that I can't get things better than they are.

Has anyone else out there been in my situation?

Debbie

[palerider]

be totally compliant with BIPAP is a lot better than being noncompliant and getting poor sleep with VPAP.

not quite sure what you're saying here, becuase bipap=vpap, they're just different manufacturers names for the same thing.

resmed: vpap
respironics: bipap.

both mean 'bi-level positive airway pressure"

[JDS74]

Is the problem with the auto function changing pressures and that you do better with a fixed bi-level machine?
If that's the case, your machine can be set to straight bi-level leaving the possibility that at some future time you may be able to tolerate the pressure changes and you machine will be ready to go.

[needzzzzs]

I must have still be asleep when I wrote my post. Palerider, you are 100% correct. I meant ASV, not VPAP.

be totally compliant with BIPAP is a lot better than being noncompliant and getting poor sleep with VPAP.

not quite sure what you're saying here, becuase bipap=vpap, they're just different manufacturers names for the same thing.

resmed: vpap
respironics: bipap.

both mean 'bi-level positive airway pressure"

[needzzzzs]

I goofed when I said VPAP...I meant ASV.

But, I've tried both auto BIPAP and fixed BIPAP. I tolerate both very well.

Debbie

Is the problem with the auto function changing pressures and that you do better with a fixed bi-level machine?
If that's the case, your machine can be set to straight bi-level leaving the possibility that at some future time you may be able to tolerate the pressure changes and you machine will be ready to go.

[JDS74]

OK, you just made an incorrect choice on the equipment list. No big deal.
It is still possible to configure your ASV device to work like a BiPap device and still keep the functionality in the background for possible future use.

That should be the way to go rather than giving up on the ASV machine.
Do you know what pressures on BiPap are working for you?
From there it will be possible to configure your machine to work the same way.
Then, later, you might be able to transition to full ASV mode.

Aerophagia is a difficult problem for CPAP patients and sometimes a compromise has to be made between optimal treatment and acceptable treatment (one that will be followed.)

[palerider]

I must have still be asleep when I wrote my post. Palerider, you are 100% correct. I meant ASV, not VPAP.

yeah, asv is a whole different beast

got one of those here in the house for another housemember (who has congestive heart failure)

[Sir NoddinOff]

It is still possible to configure your ASV device to work like a BiPap device and still keep the functionality in the background for possible future use.

Some fine tuning of this statement: This concept works according to reports I've gotten from JDS and others using PR ASV machines experimenting with BiLevel mode. Full disclosure: I haven't tried this technique myself with my PR ASV machine, but see no reason why it won't work since you can set just about any EPAP-IPAP (PS support) you want.

On the other hand, Resmed Adapt ASV users can not use their machines in a pseudo-bilevel mode... I have recently tried and it was not possible due to the way ResMed sets limits on the adjustable EPAP and IPAP parameters. In the clinicians menu it won't even let you attempt it, unlike PR ASV devices. Granted, I don't have the very latest ResMed ASV, but I have no reason to believe they changed the setup menu that much in the last year or two. Newer users with newer machines, correct me if I'm wrong.

[archangle]

I have previously mentioned having a VPAP titration study (a few months ago), but completely failing to tolerate the therapy. I had so much aerophagia (air swallowing) and resultant gas that I barely slept and was not comfortable the entire night.
Debbie

OK, there's too many plot twists here.

Are you using bilevel or ASV? What machine in particular are you using now?

There's a youtube video in my links in my signature line about aerophagia. Some people have had success with it.

[Pugsy]

I am totally confused....is the problem with the ASV machine aerophagia or something else causing the poor sleep.
How come you were even given the ASV machine? Too many centrals or what?
Which ASV model are you using...950 or 960? What are the current settings on whichever ASV model you are using? All of them...you need to go into the clinical setup menu to see them all.

[JDS74]

I goofed when I said VPAP...I meant ASV.
But, I've tried both auto BIPAP and fixed BIPAP. I tolerate both very well.
Debbie

Debbie, need a little help here.
Is the problem when using the ASV machine aerophagia?
Its possible that the IPAP value that is used when it detects a central apnea is too high and causing the aerophagia.
Do you have the BiPap pressure settings that you were comfortable with?
Do you have the ASV pressure settings that are causing the problems?
Have I got the problem described correctly?

[needzzzzs]

Thanks for asking these questions, JDS74.

Yes, the problem when using the ASV machine was extreme aerophagia. I was not given an ASV machine because I did not tolerate the therapy. I have never been so uncomfortable in my life. I have about twice as many central apneas as obstructive apneas with my current therapy (both APAP and both fixed and auto BIPAP).

I can try to extract the ASV pressure settings from the titration study, and I should be able to get the BIPAP pressure settings from my current machine. Can't do it right now, but I'll try to get the info tomorrow.

Debbie

I goofed when I said VPAP...I meant ASV.
But, I've tried both auto BIPAP and fixed BIPAP. I tolerate both very well.
Debbie

Debbie, need a little help here.
Is the problem when using the ASV machine aerophagia?
Its possible that the IPAP value that is used when it detects a central apnea is too high and causing the aerophagia.
Do you have the BiPap pressure settings that you were comfortable with?
Do you have the ASV pressure settings that are causing the problems?
Have I got the problem described correctly?

[needzzzzs]

I was not given an ASV device, and at my last doctor visit, he did not think I was a candidate for one, based on the sleep technician's opinion of my experience. I would note that she *was* able to get my AHI down near zero during the small amount of time I actually slept during the titration study.

As you said in the last sentence of your post, "Aerophagia is a difficult problem for CPAP patients, and sometimes a compromise has to be made between optimal treatment and acceptable treatment (one that will be followed)." I believe that I probably have to settle for the acceptable treatment, since some reduction in sleep apnea is certainly better than none. I generally feel pretty well, and do not have excessive sleepiness under the current regimen.

Debbie

OK, you just made an incorrect choice on the equipment list. No big deal.
It is still possible to configure your ASV device to work like a BiPap device and still keep the functionality in the background for possible future use.

That should be the way to go rather than giving up on the ASV machine.
Do you know what pressures on BiPap are working for you?
From there it will be possible to configure your machine to work the same way.
Then, later, you might be able to transition to full ASV mode.

Aerophagia is a difficult problem for CPAP patients and sometimes a compromise has to be made between optimal treatment and acceptable treatment (one that will be followed.)

[justinjustin]

Thanks for asking these questions, JDS74.

Yes, the problem when using the ASV machine was extreme aerophagia. I was not given an ASV machine because I did not tolerate the therapy. I have never been so uncomfortable in my life. I have about twice as many central apneas as obstructive apneas with my current therapy (both APAP and both fixed and auto BIPAP).

Just curious.. Is it a common occurrence with ASV to experience aerophagia?

Moreover, does this usually cause wake-ups? Or is it common for non-xPAP or CPAP users to wake up in the middle of the night once or twice?

[needzzzzs]

Pugsy, I had the aerophagia on the ASV titration to such an extent that I was NOT given an ASV machine. Still have my BIPAP.

I personally think the aerophagia was due to a couple of things. I have a really bad case of (treated) long-standing GERD, and my esophageal sphincter muscle is probably very weak. I also have a lot of post-nasal drip, and although I take medication to minimize this, some nights I have to swallow repeatedly because of it. Lying down makes it worse, unfortunately.

Debbie

I am totally confused....is the problem with the ASV machine aerophagia or something else causing the poor sleep.
How come you were even given the ASV machine? Too many centrals or what?
Which ASV model are you using...950 or 960? What are the current settings on whichever ASV model you are using? All of them...you need to go into the clinical setup menu to see them all.