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Bipap events

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LasVegas +0 points · 11 months ago Original Poster

I have a ResMed air curve 10 BiPap machine. I also use a Wellue continuous 02 reader. I have mixed apnea with the majority of events being central apnea. I noticed that there are the same if not more events using the bipap than when not using it. It doesn't feel like the bipap is forcing air when I stop breathing. So my 02 gets in the high 80's during an event, until my ring vibrates to wake me up. I am more tired with it then without using the bipap. Is there a way to make the machine increase pressure when it doesn't feel you inhale for awhile?

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PutSleepApneatoBed +0 points · 11 months ago Sleep Commentator

Las Vegas: A prevalence of centrals can make treatment considerably trickier. Treating pure OSA is more straight- forward Do you, by any chance, also have CHF?

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Sierra +0 points · 11 months ago Sleep Patron

It depends on the model of AirCurve 10 that you have. Take a look at the AirCurve 10 features document at this link. The Models with a T or ST I believe have a timed backup manual pressure increase to promote breathing. The ASV model detects that you are not breathing and initiates an automatic response.

As a starting point you may want to download OSCAR and have a look at what is happening during the night. This will give you a better idea what is going on. You need a PC or Mac and a SD card reader to view the data on your SD car.

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LasVegas +0 points · 11 months ago Original Poster

I have the vauto air curve 10.

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LasVegas +0 points · 11 months ago Original Poster

I have the air curve 10 VAuto.

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Sierra +0 points · 11 months ago Sleep Patron

The VAuto should record data on the SD card. It would be worth looking at the data using OSCAR. Or you could take your SD card to your sleep clinic and have them look at the data for you.

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LasVegas +0 points · 11 months ago Original Poster

Can my Dr change the settings to give me more air when I stop breathing with the VAuto?

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Sierra +0 points · 11 months ago Sleep Patron

I did a little investigation into the VAuto when I first was using a AirSense 10 Auto CPAP and having issues controlling central apnea events. I managed to get a pdf of the technical manual for the machine. It should have three modes to select from; Auto, S, CPAP. The Auto automatically adjusts pressure support. The S mode does appear to have a timed backup feature that can be turned on to provide a minimum of 10 breaths per minute. And the CPAP mode just uses fixed pressures. So it would appear that this backup 10 bpm feature could help you, if you really do stop breathing often. It would be best to get a sleep clinic technician to set it up for you. This is a fairly complex machine and there are a few other settings that may help as well. I think your starting point though is to either use OSCAR to view your data, or get the sleep clinic to view your data on the SD to see if this is a real issue that could be helped with the timed backup feature.

With some adjustments to my AirSense 10 and switching it into fixed CPAP mode I was pretty much able to solve my central apnea event frequency, so I have not pursued the VAuto any further.

If you want a copy of the VAuto technical manual send me a private message with your email address, and I can send it to you. It gives some pretty detailed explanations of how the machine works.

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LasVegas +0 points · 11 months ago Original Poster

I don't have CHF that I know of. My problems happened after I had COVID. So far they haven't found anything else wrong with me that would be causing my mixed sleep apnea. I have mostly central apneas with about 20% Obstructive apneas....mostly those happen on my back. I saw a cardiologist because I want my heart checked and I am going to have a scan soon and stress test. Mostly I just have a fast heart rate, although I always have, even when I was an athlete in college. I do have a hard time absorbing B vitamins and magnesium. I notice that my legs get restless and feel crampy and after I take magnesium and liquid b vitamins the leg cramping and restlessness gets better and I get fewer apneas.... they're still there, but I don't have as many events.

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PutSleepApneatoBed +0 points · 11 months ago Sleep Commentator

I asked because if one has both CHF and central apnea, sometimes PAP usage is contra-indicated. There was a large NIH study recently looking at he alternative of O2 treatment for that complicated situation, but unfortunately the study was defunded prior to completion, so no firm conclusions were reached.

You need a thorough workup by your doctors, so seeing a cardiologist and completing your upcoming tests sounds as though you’re on the right track. And, of course, the onset after COVID may be a big clue. Good Luck! And let us know how it turns out when you get the explanation/solution.

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Sierra +0 points · 11 months ago Sleep Patron

I believe this issue is restricted to ASV therapy, not all PAP therapy.

Special Safety Notice: ASV therapy for central sleep apnea patients with heart failure

These warnings were issued back in 2017:

  • Stop prescribing ASV to treat central sleep apnea in patients with symptomatic heart failure and LVEF<45%. Until more is known, this evidence suggests such treatment may be harmful for such patients.
  • Before starting a patient on ASV, each patient should be assessed for the presence of heart failure. If heart failure symptoms are present, an objective assessment of LVEF is indicated to see if they are in the higher risk group.
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CyrusManz +0 points · 11 months ago

That initial study was later debunked by another study that showed no relationship between LVEF and use of ASV. It appears that the patients who died in the first study, would have died on or off the machine and just because they died while under study, it does not necessarily mean that they would have stayed alive, if they were not on the machine. If you like, I can post a link to that other study.

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Sierra -1 point · 11 months ago Sleep Patron

Yes, I would like to see the other link. As far as I know the warning is still in effect.

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CyrusManz +0 points · 11 months ago

There are several studies that were done both before and way after which debunk that study, now thought to have been purely political for business reasons. Look up Google scholar or [www.Clinicaltrials.gov] for the latest research. Here is one that is being conducted in Canada, thought to be the largest ever and due to end in Dec/2022: https://clinicaltrials.gov/ct2/show/NCT01953874

here is another one: https://www.sciencedirect.com/science/article/abs/pii/S0167527308009820 and another https://www.atsjournals.org/doi/full/10.1164/ajrccm.164.4.9908114 and another https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-10-0082/_article/-char/ja/ and one more, but there are more), https://www.jstage.jst.go.jp/article/circj/79/5/79_CJ-15-0221/_article/-char/ja/

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Sierra +0 points · 11 months ago Sleep Patron

Here is a more up to date publication on the risks of using an ASV while having heart issues. Looks like it was published in 2021. My quick read is that if you are using an ASV you should check with a cardiologist and it may not be advised to stop using it. However if you have heart failure and are contemplating using one, it probably is not advised. Some alternatives are suggested like a CPAP and or medication treatment.

https://www.thoracic.org/patients/patient-resources/resources/adaptive-servo-ventilation-asv.pdf

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CyrusManz +0 points · 11 months ago

I am not sure why you are not on an ASV machine, if as you say, most your events are "central". Change your machine because you are not getting the therapy that you need. A Dreamstation BiPAP Auto SV is the best, if you are not worried about the recall. (only the use of Ozone cleaners tend to damage the foam, so a brand new machine without ozone cleaners should be fine).

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Sierra +0 points · 11 months ago Sleep Patron

I had very high rate of centrals when I first went on an APAP. But, I managed to sort it out. My AHI averages about 0.8 now, but the predominant component is still central apnea. Centrals are aggravated by higher pressures, so a BiPAP is not an obvious solution to mixed or central apnea. I kind of think you can solve it with either a well optimized APAP, or a full ASV, if that fails. A basic fixed pressure CPAP may also work if you take the time to optimize it. My current treatment could be done on a basic fixed pressure CPAP.

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CyrusManz +0 points · 11 months ago

At 0.8 AHI, you should not even have a concern. 0.8 is better than 99.99% of the general population:-)

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PutSleepApneatoBed +0 points · 11 months ago Sleep Commentator

Sierra, I assume you mean a residual AHI of 0.8?
When I moved from a RESMED gen 8 to gen 10 Airsense for Her, my residual AHI went from 3.0 to 0.3 and I felt an immediate significant improvement. But had I been presenting at diagnosis with an AHI of 3.0, I would never had been treated. But here’s the rub: at diagnosis i had an overall AHI of 19, but during REM it was 83 (when I could STAY in REM, which wasn’t often….)
Which leads me to wonder what theREM AHI of a lot of people with an overall AHI of 4 might be? It could be 20 to 30, or more, but they won’t get treated….

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Sierra +0 points · 11 months ago Sleep Patron

Yes, at diagnosis my AHI was reported to be 37 if I recall correctly. I also believe that I incurred treatment induced central apnea events, and they did not go down with time in the auto mode. The conclusion I came to was that I was incurring significant hypopnea that was central in nature, not obstructive. The ResMed algorithm responds to hypopnea as if they are obstructive and increases pressure. The increased pressure then induces more and more central apnea. To control this, I initially limited pressure in Auto mode, and then finally switched to fixed pressure CPAP mode. I also suspected that a blood pressure medication called bisoprolol was reducing my heart rate and blood circulation. I convinced my doctor to half the dose and I think that also helped some in avoiding central apnea events. I used to have frequent Cheyne Stokes events, and now they have become quite infrequent. Central apnea is complex when you have both obstructive and central events. I frequently see an obstructive event trigger a cycle in minute ventilation. It becomes worse and worse until it gets to the point of causing a central, which often repeats. Sometimes it locks in to flag Cheyne Stokes.

In any case this is why I believe in some cases a simple fixed pressure CPAP can do just as good a job on central apnea or better than a BiPAP can.

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PutSleepApneatoBed +0 points · 11 months ago Sleep Commentator

I have seen people with centrals treated by experts with a fixed pressure on CPAP, but getting to the optimal pressure setting can be tricky.

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PutSleepApneatoBed +0 points · 11 months ago Sleep Commentator

Sorry, I just assumed that with centrals you’d be on an ASV, rather than a CPAP or APAP. Centrals require some form of VPAP.

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CyrusManz +0 points · 11 months ago

Sierra;

There are several studies that were done both before and way after which debunk that study, now thought to have been purely political for business reasons. Look up Google scholar or [www.Clinicaltrials.gov] for the latest research. Here is one that is being conducted in Canada, thought to be the largest ever and due to end in Dec/2022: https://clinicaltrials.gov/ct2/show/NCT01953874

here is another one: https://www.sciencedirect.com/science/article/abs/pii/S0167527308009820 and another https://www.atsjournals.org/doi/full/10.1164/ajrccm.164.4.9908114 and another https://www.jstage.jst.go.jp/article/circj/advpub/0/advpub_CJ-10-0082/_article/-char/ja/ and one more, but there are more), https://www.jstage.jst.go.jp/article/circj/79/5/79_CJ-15-0221/_article/-char/ja/

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Sierra +0 points · 11 months ago Sleep Patron
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