blizzardboy wrote: . . . Hi jnk, I had come to believe that ASV was the new gold-standard in CPAP therapy due to its rapid response and minimised pressure support. If one took away the question of price, wouldn't the majority of CPAP users be as well/better off on ASV? I would be really interested to learn more about your hesitation to use ASV unless absolutely necessary.
I think your view is the view of many. But I personally would still want to give plain CPAP (not APAP) the full shot, then bilevel (not autobilevel), to see how stable things could get with my sleep hygiene using them before trying an auto or trying SV, especially if I were a sensitive, easily aroused sleeper prone to a bit of central dysregulation.
I think ASV is amazing for those who need it. But there are trade-offs in using one, just like anything else in life. I am not so much referring to the quality of the machines as the modes of treatment that are designed specifically to address problems that I would not want addressed unless I had proof I actually suffered from one of the problems the modes of operation were for. I would want to see if my centrals went away with plain CPAP for comfort reasons and ease-of-treatment reasons, myself. But my view may be as nonstandard on this as it is on other matters.
I reckon that the occurance of central events can sometimes be addressed adequately with straight CPAP. The summary of your diagnostic report said the following:
Mild to moderate snoring was noted frequently during the study, especially when supine. . . . Obstructive hpopnoeas and apnoeas were noted during both REM and NREM sleep . . . [There were] 28 arousals detected per hour of sleep. Most of these arousals were temporally related to obstructive respiratory events. There were frequent obstructive hypopnoeas and apnoeas seen during his sleep.
Then a very interesting combination of statements is made that indicates to me that maybe some mixed events got scored as centrals:
Central apnoeas became increasing [sic] frequent during the last sleep cycle. These obstructive events . . .
Then the following statement is made:
Depending on the clinical situation, a trial of CPAP +/- adaptive servo-ventilator therapy might be beneficial.
I would want to be sure to give the "-" in the "+/-" the full shot before moving to the "+" myself. But hey, that's just me.
The report for ASV titration may have given the actual diagnosis of the doctor that may have been made after the doc reviewed the tech's work with the diagnostic study. It did not say "complex" or "central" there. It said this:
Previous diagnostic study confirming significant OSAS.
Now, grant you, that may be one of the many "typos" in the reports, along with average 20 bpm for heart rate. But still.
I don't mean to come off as anti-ASV. And if it works for you, great. And I am not questioning the actions of your clinicians. I am only expressing a personal preference of what I personally might do if in similar circumstances.
I hope that clarifies my muddying of the waters. My apologies to the more experienced posters in this thread for that.
