a new sleep study with ASV

I saw my sleep doctor yesterday, and she suggested a new sleep study with an ASV, which if you can believe it, was then scheduled for the same evening! Talk about fast service!

At issue was whether straight CPAP has been quite good enough. Although it sure beats nothing, my AHI remained above 5 about 25% of the time. The machine records virtually all my residual events as centrals, and increasing pressure did not reduce them (not surprising if they were indeed centrals), nor has changing masks. It has certainly been the case that those days when my AHI is higher, I feel significantly worse. Even so, my elevation has been mild enough that the doctor was not sure whether I have complex apnea-- it seems to be kind of borderline. As I've posted before, there also seems to be something hormonal/cyclical going on with my AHI. The doctor said another treatment option might be using birth control pills to control the hormonal fluctuations, and see if that helps. But I'd rather not have to take pills, and it sounded as though that approach would be kind of experimental-- she had not previously seen or heard of work that has found this clear relationship between the menstrual cycle timing and AHI.

As for the study itself-- I have to say that I did not enjoy sleeping with the ASV. I had no problem adjusting to CPAP, but I found it it significantly harder to fall asleep with that machine-- it didn't seem to sync with my breathing while I was awake. On the upside, although I don't have the formal results yet, the technician said that I responded beautifully to it-- close to zero centrals! He tried switching to BiPap mode in the middle of the night when I complained about discomfort, and the centrals immediately came back-- and went away again when he went back to ASV. So it looks as though I'm going to get one of those, assuming the insurance company doesn't balk anyway. I hope I can adjust to it ok.

Also of note - my doctor said that my insurance company, as a cost control measure, is very shortly going to be switching to a new apnea "screening" firm that is known to be much tougher about approving sleep studies and treatment. Especially since I seem to have a borderline case of complex apnea, she thought it best to get me in under the wire... really, it seems like a stupid measure to try to prevent people from getting studies and treatment, given that it will likely only result in worse health and more cost down the road!!!

You think your cycle has an impact on your AHI's? Wait til you're my age and you'll know it! Perimenapause is not for sissies...

wolewyck wrote:I saw my sleep doctor yesterday, and she suggested a new sleep study with an ASV, which if you can believe it, was then scheduled for the same evening! Talk about fast service!

At issue was whether straight CPAP has been quite good enough.......

As for the study itself-- I have to say that I did not enjoy sleeping with the ASV. I had no problem adjusting to CPAP, but I found it it significantly harder to fall asleep with that machine-- it didn't seem to sync with my breathing while I was awake.....

I have almost the same story. My initial sleep study put me into a normal CPAP machine, but (after starting CPAP) it was noted that I had more issues with central events than obstructive, so new test was done that resulted in an update to VPAP. While I really wish I didn't need VPAP, I'm glad the option was available.

While I'm no expert, I'd love to comment on your issue with sleeping under VPAP. I had the very same shock with starting to sleep and feeling like the machine was fighting me rather than helping me. This was 4x worse during the sleep study then when I got home (perhaps it was being nervous or even the settings that the put on the machine as a start). Once I started the new machine in my home, it was a lot easier to learn how to manage going to sleep. After a couple of months, I still have a touch of that initial shock feeling when I hit the "on" button, but you make friends with the machine very fast. You can even play with it to make it push harder or softer (that can be fun when you can't get to sleep right away, but it drives my wife nuts ). In summary I found the test a lot worse than home use and I don't think you'll have a hard time learning how to get the momentum smooth once you play with it for a while.

You can even play with it to make it push harder or softer (that can be fun when you can't get to sleep right away, but it drives my wife nuts )

Yep, it's fun to hold your breath and let the machine have a go. Insomnia can be fun. I woke up screaming into it during a nightmare early this morning, and the poor machine was all confused.

But, wolewyck, be aware that this is a pap on steroids, and learning to work with it can be a challenge. I hope the lab techs at your sleep lab have a lot of experience with them.

wolewyck wrote:I saw my sleep doctor yesterday, and she suggested a new sleep study with an ASV, which if you can believe it, was then scheduled for the same evening! Talk about fast service! ...

Fast indeed. But it seems the doctor wants to be certain you get therapy you need and avoid the fight with the insurance company. Your doctor seems to be a keeper!

wolewyck wrote:... At issue was whether straight CPAP has been quite good enough. Although it sure beats nothing, my AHI remained above 5 about 25% of the time. The machine records virtually all my residual events as centrals, and increasing pressure did not reduce them (not surprising if they were indeed centrals), nor has changing masks. It has certainly been the case that those days when my AHI is higher, I feel significantly worse. Even so, my elevation has been mild enough that the doctor was not sure whether I have complex apnea-- it seems to be kind of borderline. ...

Perhaps borderline, but if you sleep and feel better when you have a lower AHI score, then it should be addressed.

wolewyck wrote:... As I've posted before, there also seems to be something hormonal/cyclical going on with my AHI. The doctor said another treatment option might be using birth control pills to control the hormonal fluctuations, and see if that helps. But I'd rather not have to take pills, and it sounded as though that approach would be kind of experimental-- she had not previously seen or heard of work that has found this clear relationship between the menstrual cycle timing and AHI. ...

On this one, I remain clueless. I trust others to help you here!

wolewyck wrote:... As for the study itself-- I have to say that I did not enjoy sleeping with the ASV. I had no problem adjusting to CPAP, but I found it it significantly harder to fall asleep with that machine-- it didn't seem to sync with my breathing while I was awake. On the upside, although I don't have the formal results yet, the technician said that I responded beautifully to it-- close to zero centrals! He tried switching to BiPap mode in the middle of the night when I complained about discomfort, and the centrals immediately came back-- and went away again when he went back to ASV. So it looks as though I'm going to get one of those, assuming the insurance company doesn't balk anyway. I hope I can adjust to it ok. ...

You will be amazed at how you will eventually adjust to the ASV unit. It took me several months to stop fighting the unit. The Resmed version of the ASV seems to be more of a task master about breathing than the Respironics unit. Oddly, I find it harder to sleep with the Respironics unit than the Resmed unit.

The biggest issue is that the ASV unit attempts to help break the cycle that can lead to central apneas. As you may have seen me describe it, most often central apneas result from an undershoot/overshoot cycle. For whatever reason, your body fails to breathe enough air to keep your CO2 levels down. This is the undershoot side of the cycle. Often a central apnea is preceded by hypoventilation (not breathing enough). The central apnea occurs. The CO2 level climbs to the point where your body arouses enough to allow you to breathe. Often during this time, the body overcompensates. It hyperventilates. It blows off too much CO2, which depresses breathing. This is the overshoot side of the cycle. Your respiration decreases and even ceases. The cycle starts all over again.

The ASV unit breaks this cycle by sustaining breathing while asleep. If you undershoot and have either hypoventilation or a central apnea, the machine increases the pressure to help continue ventilation. This is the Adaptive Servo-Ventilation part of the machine. By helping you maintain respiration, your body avoids the undershoot/overshoot cycle.

It takes several weeks to several months to fully adjust to an ASV unit. But you will find that you come to trust the unit to help you breathe, regardless of your situation. It is there to help, even when you are having a bad sleep night.

wolewyck wrote:... Also of note - my doctor said that my insurance company, as a cost control measure, is very shortly going to be switching to a new apnea "screening" firm that is known to be much tougher about approving sleep studies and treatment. Especially since I seem to have a borderline case of complex apnea, she thought it best to get me in under the wire... really, it seems like a stupid measure to try to prevent people from getting studies and treatment, given that it will likely only result in worse health and more cost down the road!!!

Insurance companies, like most companies are very short sighted. They only see the costs and profits NOW. They do not care that avoiding the cost could lead to much more serious costs and complications. You might not be their risk at that time.

And as you will find out the ASV units are VERY expensive. But once you adjust to it, you will LOVE the experience.

One additional note. I find that I need a full face mask with this type of machine. The sudden increase in pressure would tend to blow the seal in the throat and mouth. So, a full face mask helps that. In addition, I find a mask liner from REMzzz helps me maintain the seal in spite of HUGE swings in pressure. Padacheek also offers mask liners.

http://www.remzzzs.com/
http://www.padacheek.com/PAC_Maskliners.html

I use the REMzzzs mask liners for my Quattro FX full face mask. I am thinking of purchasing a Pad A Cheek version. It would be more durable and stay with the mask.

Anyway, best wishes with your new therapy ... and welcome to the crowd.

Thank you all for your kindness and input!