Switched to ASV

Oscar Sleep Report from Nov 26.

Step one, turn OFF the EPR.

palerider wrote: ↑

Thu Nov 28, 2019 4:01 pm

Step one, turn OFF the EPR.

Yes I know. But due to my lung issues, I just can't. I get too short of breath. I have tried EPR 2 and 1, several times, and get up in the middle of the night to change it back. That's why I am considering VAuto.

KatieW wrote: ↑

Thu Nov 28, 2019 4:07 pm

palerider wrote: ↑

Thu Nov 28, 2019 4:01 pm

Step one, turn OFF the EPR.

Yes I know. But due to my lung issues, I just can't. I get too short of breath. I have tried EPR 2 and 1, several times, and get up in the middle of the night to change it back. That's why I am considering VAuto.

A VAuto wont help. You need a a machine with a backup rate incereasing EPR or pressure support will sent your CA’s through the roof

KatieW wrote: ↑

Thu Nov 28, 2019 4:07 pm

palerider wrote: ↑

Thu Nov 28, 2019 4:01 pm

Step one, turn OFF the EPR.

Yes I know. But due to my lung issues, I just can't. I get too short of breath. I have tried EPR 2 and 1, several times, and get up in the middle of the night to change it back. That's why I am considering VAuto.

What lung issues, exactly?

more PS tends to cause more co2 blow off and that exacerbates central apnea.

Now, there may be some tweaking on a vauto that might help the lung issues, but that's probably not going to help with the centrals.

Palerider,

I no longer have fluid on my lungs, but as my Nurse Practitioner explained to me, it's like I've had an insult (acute pulmonary edema) to my lungs. So that, plus the long period of convalescence and inactivity have left me with shortness of breath on exertion and shallow breathing. I am working on those things, with breath work and qigong, and a daily walking program, but it will take time.

My cardiologist has gone from her original diagnosis of "heart failure" to diastolic disfunction, and atrial fibrillation to occasional atrial flutter. So that's good news.

Up until now, I have thought the Central Apneas would decrease as my lung capacity increased, but this has not happened yet. Obviously it's a concern to me, having so many Centrals, but there is also the uncomfortable breathing while using CPAP, and frequent awakenings, which has never been an issue for me before. So I am looking at available options. In addition to seeing a Pulmonologist.

Has anyone ever actually talked ASV use with you? Pros and cons?
Or did you come up with this idea on your own (and it's a very valid idea so I mean no disrespect.)

If you didn't have the history of some rather serious lung issues I wouldn't have a problem with saying go for ASV but I just don't know if it would be a contraindication or not.
Even people with heart failure have been put on ASV as long as the ejection rate is more than 45...so even if there is something to that crappy study that was done that start all the alarm bells about ASV and heart failure....
and now you don't even have that diagnosis but you do have something pretty serious going on.

Now if your doctor was to say it would be safe for you...after all it's really just a really glorified version of what you are using now that will breath for you when those centrals happen.
Then you would be able to use the pressure support you need for comfort right now and if the situation changes later you could always dumb the ASV down or just use it. If the centrals don't happen the machine won't breathe for you anyway.
It's not like you would later (once you are all healed up and back to normal) be stuck with a machine you couldn't use.
Its settings can be altered so it can function like a fixed cpap or apap or fixed bilevel or auto bilevel.
It's a very versatile machine with just a little tweaking here and there.

I just don't know if your health issues now would be a contraindication to using ASV now just to deal with the centrals which it would very effectively and at the same time do a bang up job with your OSA side of things.

So...have you actually brought all this up with your doctor?

KatieW wrote: ↑

Thu Nov 28, 2019 8:24 pm

Palerider,

I no longer have fluid on my lungs, but as my Nurse Practitioner explained to me, it's like I've had an insult (acute pulmonary edema) to my lungs. So that, plus the long period of convalescence and inactivity have left me with shortness of breath on exertion and shallow breathing. I am working on those things, with breath work and qigong, and a daily walking program, but it will take time.

I'm familiar with the fluid overload and gurgling that happens to people in heart failure when they're in fluid overload... it's happened to my brother when he didn't watch his fluids and take his diuretics properly. fortunately, he hasn't had an episode of that for a while. he's been on an asv for several years now.

I don't think that the VAuto would do you much good, while it can be made to be more sensitive, or change the timing of the breaths, it still won't breathe for you, if you have a central... and the greater pressure support that's the main advantage of the VAuto would likely exacerbate the centrals.

Could you zoom in on one of those sessions, say the one that's around 4:15, and just show about half to an hours worth?

I am with PR. I don't think the VAuto is going to be able to do much for you except offer you a wider range between inhale and exhale which might even make the centrals worse...
It all depends on if the pressure support (that difference between inhale and exhale) is causing or making the centrals worse.
It might be a cause and might be making things worse....and it might not. It's possible something else is causing them.

Pugsy wrote: ↑

Thu Nov 28, 2019 11:26 pm

Has anyone ever actually talked ASV use with you? Pros and cons?
Or did you come up with this idea on your own (and it's a very valid idea so I mean no disrespect.)

So...have you actually brought all this up with your doctor?

Hi Pugsy,

I am seeing my Nurse Practitioner on Monday, to ask for a referral to a Pulmonologist at Tucson Pulmonology. They are the referral choice for both my cardiologist and DME. So no, I have not actually talked ASV with a medical person yet. This ideas was not really my own, but after research on this Forum, and of course Google.

As I mentioned before, I had expected that the Centrals would decrease once my lungs cleared and I recovered. But I have not seen any such trend, so am wanting to be more proactive about this now. I don't expect anyone to endorse using ASV "on my own", but there seems to be a consensus that VAuto would not be helpful for Centrals.

palerider wrote: ↑

Thu Nov 28, 2019 11:50 pm

Could you zoom in on one of those sessions, say the one that's around 4:15, and just show about half to an hours worth?

Palerider, here it is.

KatieW wrote: ↑

Fri Nov 29, 2019 9:43 am

Pugsy wrote: ↑

Thu Nov 28, 2019 11:26 pm

Has anyone ever actually talked ASV use with you? Pros and cons?
Or did you come up with this idea on your own (and it's a very valid idea so I mean no disrespect.)

So...have you actually brought all this up with your doctor?

Hi Pugsy,

I am seeing my Nurse Practitioner on Monday, to ask for a referral to a Pulmonologist at Tucson Pulmonology. They are the referral choice for both my cardiologist and DME. So no, I have not actually talked ASV with a medical person yet. This ideas was not really my own, but after research on this Forum, and of course Google.

As I mentioned before, I had expected that the Centrals would decrease once my lungs cleared and I recovered. But I have not seen any such trend, so am wanting to be more proactive about this now. I don't expect anyone to endorse using ASV "on my own", but there seems to be a consensus that VAuto would not be helpful for Centrals.

Just a word of advice which I am sure you already know - sometimes doctors don't like it when you say you found things on Google/on a forum. Just ask a direct question: "Do you think it would be worth considering an ASV?" "Would it have any complications for me?" etc.

Can you zoom in a little closer? Right now looks like almost an hour segment.
Maybe cut it in half to 25 minutes?

Pugsy, hope this is what you need. The machine settings, (which got cut off) are: Min 9, Max 13, EPR 3, Ramp 8 for 5 min. My current settings are now Min 10, Max 14, EPR still 3, no Ramp.

By the way, I ordered the Contec CMS50F Oximeter from Amazon.com. Should have it by Sunday. That should give me some useful info.

That works. You can see the pattern a little better. Looks classic CSR to my eye.
I wish you could tolerate a reduction in EPR just to test the theory that EPR/pressure support is any sort of factor in the central triggering.
It wouldn't be impossible with your history of the shallow breathing and needing some help because it's a prime recipe for washing out too much carbon dioxide and it's the low levels of carbon dioxide that is causing the brain not to send the breathe signals and the body doesn't breathe because it doesn't feel the need.

Now it is also very possible that you would have way too many centrals happening even without EPR/pressure support in the mix but it's really the only thing that you can do with this machine to see if you can reduce the centrals or not.

Monday isn't too far away when you can have a heart to heart with the NP about this situation.