ASV machine the main solution to central apnea?

Just curious if an ASV machine is the prescribed solution to take care of central apnea. I understand from reading on this site and elsewhere that a patient and their sleep doctor need to demonstrate that they've exhausted all other remedies prior an insurance company paying for an ASV machine. Any thoughts would be appreciated. -Chuck-

You are correct. The BiPAP ASV is used to treat central sleep apnea or complex sleep apnea. The other machine you may hear is the BiPAP AVAPS-thats usually used to treat pts that hypoventilate (small breaths) i.e. neuromuscular patients.
There have been some (limited) studies done that show that some patients with central sleep or complex sleep apnea got better after using regular cpap for a year. This was believed to be due to carbon dioxide chemoreceptors in the body "re-calibrating" and working properly again. The idea being that OSA at night leads to higher carbon dioxide levels which will cause the body to start using the oxygen chemoreceptors to initiate a breath instead of the carbon dioxide levels. After a year on cpap apparently they (chemoreceptors) normalized and the centrals were gone.
Again, this was seen on some patients and not all AND it depends on what the underlying cause of the centrals is (medications?). Your MD should be able to tell you more
But in a nutshell, yes the ASV is used to treat centrals and it does require more documentation for the insurance to authorize (they are pricey)

I'm struggling on the resmed ASV but it seems to be the best machine. I don't know why I suddenly got central apneas it seems 3 years ago. I have asthma and have exhalation wheezing and I wake up with headaches and cognitive, memory problems.
Oxygen also helps. I use the fit life mask but it is kind of uncomfortable, I keep it a little loose at the top but it allows leaks

I don't know if theophylline helps? I read on a forum that it helped someone after a month, but it is toxic and could cause heart problems at higher doses

After four years of CPAP, Bilevel and AUTO at every conceivable pressure and combination I could never get an AHI below the low 20's or high teens. The last six month average was 28. I asked for a trial of ASV in the lab and seemed to respond so it was ordered for me. I had never had many if any centrals during my sleep studies and my S8 did not record centrals. On the ASV I am averaging 3-4 centrals an hour with a 30 day AHI down to 16. I have been on ASV since March.
But, yes, ASV is the treatment of choice for central apnea or complex apnea.

swa, forget the theophylline or ask your doctor to prescribe it and you tell us if it helps. You've been asking this question for a year it seems like.

I have a Resmed VPAP ASV and no more centrals.

Depending on the type of central apneas you have, your doctor might prescribe a BiPAP S/T unit (or Resmed's VPAP S/T ... "BiPAP" is a Respironics trademark for a BiLevel machine .. just as "VPAP" is the trademark for Resmed for a BiLevel machine).

And if a S/T device will do the trick, you want that. It takes time and effort to adjust to the variable pressure of an ASV unit.

Chuck Connors wrote:... I understand from reading on this site and elsewhere that a patient and their sleep doctor need to demonstrate that they've exhausted all other remedies prior an insurance company paying for an ASV machine. ...

Just read that more closely. The answer to your specific question is that it depends. Some doctors can clearly demonstrate the medical necessity and you won't have to go through other units. Some want to try all other options before you go to ASV.

Also, you will want to stay away from medications to address the central sleep apnea. There are plenty of studies that show they are not as effective as ASV units. Not by a long shot.

JohnBFisher wrote:Depending on the type of central apneas you have, your doctor might prescribe a BiPAP S/T unit (or Resmed's VPAP S/T ... "BiPAP" is a Respironics trademark for a BiLevel machine .. just as "VPAP" is the trademark for Resmed for a BiLevel machine).

And if a S/T device will do the trick, you want that. It takes time and effort to adjust to the variable pressure of an ASV unit.

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John,

This is now getting more complicated. There are different types of central apneas? I obviously need to do some more homework. I know that you can't rely on Wikipedia as the ultimate source of information, but it has been helpful in understanding more about sleep apnea. Also, it sure would be nice to have a Consumer Reports on sleep apnea related equipment.

From Wikipedia:
Bi-level pressure devices
Main article: Bilevel positive airway pressure
"VPAP" or "BPAP" (variable/bilevel positive airway pressure) provides two levels of pressure: inspiratory positive airway pressure (IPAP) and a lower expiratory positive airway pressure (EPAP) for easier exhalation. (Some people use the term BPAP to parallel the terms APAP and CPAP.) Often BPAP is incorrectly referred to as "BiPAP". BiPAP® is the name of a portable ventilator manufactured by Respironics Corporation; it is just one of many ventilators that can deliver BPAP.

Modes
S (Spontaneous) – In spontaneous mode the device triggers IPAP when flow sensors detect spontaneous inspiratory effort and then cycles back to EPAP.
T (Timed) – In timed mode the IPAP/EPAP cycling is purely machine-triggered, at a set rate, typically expressed in breaths per minute (BPM).
S/T (Spontaneous/Timed) – Like spontaneous mode, the device triggers to IPAP on patient inspiratory effort. But in spontaneous/timed mode a "backup" rate is also set to ensure that patients still receive a minimum number of breaths per minute if they fail to breathe spontaneously.

John, I can see why you would recommend the S/T. It seems that you are getting 2 for 1 in that machine.

-Chuck-

ozze_dollar wrote:I have a Resmed VPAP ASV and no more centrals.

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ozze_dollar,

I'm curious. At what point did you and your sleep doctor determine that you should be using a VPAP ASV machine? Were you on a CPAP machine 1st for a period of time and then move to a VPAP ASV? What was the range on the numbers for your centrals? Was there an adjustment period for getting used to the VPAP ASV? Thanks for any information you'd like to share. -Chuck-

Adding an O2 flow to a XPAP machine can reduce centrals in some cases. That is what they attempted to do during my sleep study, and I have been on straight CPAP with 2L O2 flow for the last couple of months. This has helped with my centrals, but still leaves me feeling like heck.

I had to keep on my Pulmonary doc about that fact that my events came in strings. It did not matter to me that I was registering 7-11 AHI every night. Looking at the details showed that I had specific hours with AHIs of 25+. Looking even deeper showed that these events often hit in groupings that lasted 4-5 minutes. It finally took showing her the specific graphs over an entire week where this was happening every single night to get her to approve an ASV titration. Without that low level of detailed data they would have said I was doing fine on my therapy.

So yes, do give it a couple of weeks to see how you respond. But no, do not quit fighting for the therapy that will increase your health if needed.

I tried the lower pressure settings I felt much worse than on higher max PS with the ASV, but I still can't sleep well on it though the fit life mask helps. I also take 5 liters of oxygen and that helps also. I find that taking prednisone helps and I have asthma and wheeze