Please help...do I need an ASV?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
BreathFree
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Please help...do I need an ASV?

Post by BreathFree » Mon Nov 07, 2022 8:21 pm

Hello all,
Please help.
After failure with CPAP for three months my Pulmonologist moved me to a BiPap.
Centrals have persisted and I do not feel rested.
Please see below OSCAR data.
Further, I suffer from atrial fibrillation and had a catheter ablation done two months before starting CPAP therapy. Four months after the ablation, atrial fibrillation has returned.
Do I need an ASV or should I continue with BiPap as my Pulmonologist feels that the Centrals will go away with time.
Thanks for looking.

https://imgur.com/a/yGVLhX8

https://imgur.com/H7zkedE

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palerider
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Re: Please help...do I need an ASV?

Post by palerider » Mon Nov 07, 2022 10:27 pm

I certainly wouldn't think that going to an ASV would be worth it for those few centrals.

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ozij
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Re: Please help...do I need an ASV?

Post by ozij » Tue Nov 08, 2022 12:20 am

Who dropped your minimum Epap from 6 to 5? Why?
Why did you spend only one night on EPAP 6 - when the results look so good?

Has your pulmonolgist studied your graphs night by night?
Ditto for your cardiologist.

Did you have a sleep study? Did they say anything about positional apnea? That bunch at about 04:10 is impressive. Do you have them often?
Please post an image that shows your Flow Limitations graph.

Has your sleep at home with the CPAP been tracked with a professional pulse oximeter?

My first investment, if I were in your place, would be in a pulse oximeter supported by OSCAR.
That way, you can track your pulse and oxygenation and how they're affected by your obstructive and central apnea.


It could be (not saying it is, I don't have enough info) could be that you are simply not sleeping well, and the machine, faced with the typical irregular breathing of wakefulness, or tossing and turning, interprets that normal irregular pattern as "central apnea".

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BreathFree
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Re: Please help...do I need an ASV?

Post by BreathFree » Tue Nov 08, 2022 6:43 pm

palerider wrote:
Mon Nov 07, 2022 10:27 pm
I certainly wouldn't think that going to an ASV would be worth it for those few centrals.
Thanks Palerider,
You and my Pulmonologist may be right.
Medicare qualification is >5 centrals/hour with less than 5 obstructive apneas/hour; leakage controlled. I meet those criteria. I have atrial fibrillation and I'm in apnea 15 to 20 minutes some nights. I'm also pre-diabetic so getting as close to zero AHI as possible is my goal. I delayed seeking treatment and plowed through life long after a border line sleep study.

Further, I did a sleep study with ASV and had just 2 centrals all night, no other events. Best nights sleep in memory.

Any further thoughts shall be appreciated.

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palerider
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Re: Please help...do I need an ASV?

Post by palerider » Tue Nov 08, 2022 7:19 pm

BreathFree wrote:
Tue Nov 08, 2022 6:43 pm
palerider wrote:
Mon Nov 07, 2022 10:27 pm
I certainly wouldn't think that going to an ASV would be worth it for those few centrals.
Thanks Palerider,
You and my Pulmonologist may be right.
Medicare qualification is >5 centrals/hour with less than 5 obstructive apneas/hour; leakage controlled. I meet those criteria.
Not necessarily, they may not be legitimate centrals.
BreathFree wrote:
Tue Nov 08, 2022 6:43 pm
so getting as close to zero AHI as possible is my goal.
Chasing zero is a game of diminishing returns. Strive to get under 1.5.
BreathFree wrote:
Tue Nov 08, 2022 6:43 pm
Further, I did a sleep study with ASV and had just 2 centrals all night, no other events. Best nights sleep in memory.
With a properly functioning ASV, you shouldn't have ANY centrals, it should prevent them outright.

That said, a few centrals aren't stressful to the body.

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Pugsy
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Re: Please help...do I need an ASV?

Post by Pugsy » Tue Nov 08, 2022 7:40 pm

Before I started worrying about those few centrals I would first
1...make sure that those were real asleep centrals and not SWJ sleep/wake/junk .
2...I would turn off EPR (or reduce it) just in case it was a factor in the centrals (assuming real asleep centrals and not SWJ centrals).
I doubt it will change the results but there is a remote chance that turning off EPR will reduce real asleep centrals.
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Pugsy
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Re: Please help...do I need an ASV?

Post by Pugsy » Tue Nov 08, 2022 7:43 pm

All the centrals flagged here....I wasn't asleep. I know for a 1000% fact I wasn't asleep. Bad case of insomnia that night.

Image

A more normal night for me is below.

Image
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BreathFree
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Re: Please help...do I need an ASV?

Post by BreathFree » Tue Nov 08, 2022 8:28 pm

Thanks for your thoughtful insights Ozij! :D
ozij wrote:
Tue Nov 08, 2022 12:20 am

Who dropped your minimum Epap from 6 to 5? Why?
Why did you spend only one night on EPAP 6 - when the results look so good?
Great point, I'll try EPAP 6 again tonight

Has your pulmonolgist studied your graphs night by night?
I'll ask, he has not suggested any changes, I've done it all with the help of those on this blog and Youtube, especially Jason!

Ditto for your cardiologist.
No, they just advised aggressive treatment of all apneas

Did you have a sleep study? Did they say anything about positional apnea? That bunch at about 04:10 is impressive. Do you have them often?
Please see three attached via IMGUR, 2nd and 3rd lab Yes, every night, that's how the centrals show up, in bunches

We apology that I may not have the images in the correct order... :?: :?:

Please post an image that shows your Flow Limitations graph.
To follow due to ten link limit together with 1st home study

Has your sleep at home with the CPAP been tracked with a professional pulse oximeter?

My first investment, if I were in your place, would be in a pulse oximeter supported by OSCAR.
That way, you can track your pulse and oxygenation and how they're affected by your obstructive and central apnea.
Great idea, I'll do it.

It could be (not saying it is, I don't have enough info) could be that you are simply not sleeping well, and the machine, faced with the typical irregular breathing of wakefulness, or tossing and turning, interprets that normal irregular pattern as "central apnea".
May be...I have some restless leg syndrome as well, please see sleep studies
ASV Study of 9/1/2022, near perfect nights sleep.
https://imgur.com/eH1y6qN
https://imgur.com/upaRXt9
https://imgur.com/WLuTTSz
https://imgur.com/0hANcz8
https://imgur.com/b1Hrph3

CPAP Study of 9/27/2022, did not sleep long enough to go to centrals?
https://imgur.com/DL2gNza
https://imgur.com/NGetYW1
https://imgur.com/nnUSlL4,
https://imgur.com/7sL0gKS
https://imgur.com/vmEk1xR

BreathFree
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Re: Please help...do I need an ASV?

Post by BreathFree » Tue Nov 08, 2022 8:46 pm

ozij wrote:
Tue Nov 08, 2022 12:20 am

(Continued due to ten link limitation...thanks again Ozij!)

Did you have a sleep study?

First home sleep study of 11/2/2021
https://imgur.com/XcvFsaq
https://imgur.com/aMio5ul

Please post an image that shows your Flow Limitations graph.
Last night...
https://imgur.com/HtxIzK9

BreathFree
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Re: Please help...do I need an ASV?

Post by BreathFree » Tue Nov 08, 2022 8:52 pm

Pugsy wrote:
Tue Nov 08, 2022 7:40 pm
Before I started worrying about those few centrals I would first
1...make sure that those were real asleep centrals and not SWJ sleep/wake/junk .
2...I would turn off EPR (or reduce it) just in case it was a factor in the centrals (assuming real asleep centrals and not SWJ centrals).
I doubt it will change the results but there is a remote chance that turning off EPR will reduce real asleep centrals.
Thank you...I'm running BiPap, no EPR,
ResMed
AirCurve 10 VAuto
PAP Mode: VPAPauto
PS 5.0 over 5.0-24.0 (cmH2O)
I'll drop Pressure Support back to 4...should I drop EPAP to 4?

BreathFree
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Re: Please help...do I need an ASV?

Post by BreathFree » Tue Nov 08, 2022 9:30 pm

Pugsy wrote:
Tue Nov 08, 2022 7:43 pm
All the centrals flagged here....I wasn't asleep. I know for a 1000% fact I wasn't asleep. Bad case of insomnia that night.

Point well taken, I'm sure that I'm asleep when the storm of centrals set in. They generally wake me up.

Image

A more normal night for me is below.

Wow, .33, that's my dream!

Image

BreathFree
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Re: Please help...do I need an ASV?

Post by BreathFree » Tue Nov 08, 2022 9:32 pm

Pugsy wrote:
Tue Nov 08, 2022 7:43 pm
All the centrals flagged here....I wasn't asleep. I know for a 1000% fact I wasn't asleep. Bad case of insomnia that night.

Image

A more normal night for me is below.

Image
My home study showed 9 centrals per hour without therapy hardware and I was sound asleep

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palerider
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Re: Please help...do I need an ASV?

Post by palerider » Tue Nov 08, 2022 9:52 pm

BreathFree wrote:
Tue Nov 08, 2022 9:30 pm
Pugsy wrote:
Tue Nov 08, 2022 7:43 pm
All the centrals flagged here....I wasn't asleep. I know for a 1000% fact I wasn't asleep. Bad case of insomnia that night.

Point well taken, I'm sure that I'm asleep when the storm of centrals set in. They generally wake me up.
Centrals don't wake people up, because they're *NOT* stressful, they're just your body not thinking it *NEEDS* to breathe for a few extra seconds.

Perhaps you should re-evaluate your assumptions.

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Accounts to put on the foe list: dataq1, clownbell, gearchange, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

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palerider
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Re: Please help...do I need an ASV?

Post by palerider » Tue Nov 08, 2022 9:58 pm

BreathFree wrote:
Tue Nov 08, 2022 8:52 pm
Pugsy wrote:
Tue Nov 08, 2022 7:40 pm
Before I started worrying about those few centrals I would first
1...make sure that those were real asleep centrals and not SWJ sleep/wake/junk .
2...I would turn off EPR (or reduce it) just in case it was a factor in the centrals (assuming real asleep centrals and not SWJ centrals).
I doubt it will change the results but there is a remote chance that turning off EPR will reduce real asleep centrals.
PS 5.0 over 5.0-24.0 (cmH2O)
A PS of 5 is like EPR on steroids.

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR and come chat on IRC: #cpaptalk on irc.libera.chat

Accounts to put on the foe list: dataq1, clownbell, gearchange, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

BreathFree
Posts: 13
Joined: Mon Nov 07, 2022 7:37 pm

Re: Please help...do I need an ASV?

Post by BreathFree » Tue Nov 08, 2022 11:06 pm

palerider wrote:
Tue Nov 08, 2022 9:58 pm
BreathFree wrote:
Tue Nov 08, 2022 8:52 pm
Pugsy wrote:
Tue Nov 08, 2022 7:40 pm
Before I started worrying about those few centrals I would first
1...make sure that those were real asleep centrals and not SWJ sleep/wake/junk .
2...I would turn off EPR (or reduce it) just in case it was a factor in the centrals (assuming real asleep centrals and not SWJ centrals).
I doubt it will change the results but there is a remote chance that turning off EPR will reduce real asleep centrals.
PS 5.0 over 5.0-24.0 (cmH2O)
A PS of 5 is like EPR on steroids.
What pressures should I try... PS 0 IPAP 10 EPAP 10-25?
Last edited by BreathFree on Wed Nov 09, 2022 8:40 am, edited 1 time in total.