Frustrated

I was diagnosed with sleep apnea in June 2018, since then I have had a sleep study, and home study! I was having 45 events per hour. I was on a CPAP for three months could not get my AHI below a 5, 10, 14, etc. with central sleep apneas. Now I have been on a BIPAP for a month and my central apneas are more, AHI worse. My dr. has done a lot of adjustments and nothing is working. He mentioned a ASV. I am really getting nervous about the AHI' #,s. Are these causing any damage? What percentage of time does a ASV work? What would be next? Just want to be able to function

Dealing with central apnea is not easy. I suffer from it to some degree. I can get my AHI down to the 3.0 level, but over half of that will be central apneas. I just use a standard Auto CPAP, and actually now have it set at a fixed pressure of 12.2.

Here is what I know about treating central apnea. The usual first strategy is to keep the pressure as low as possible but still deal with the obstructive apneas. Expiratory Pressure Relief (EPR) or Flex is usually not used as it forces the inhale pressure up. Has your doctor tried minimizing the pressure? What sort of pressures have you tried?

If that fails, then sometimes using EPR may help some. The thought is that it assists breathing and helps to prevent you from stopping breathing. EPR is limited to 3 cm though and does not do that much. So, the next step is to try a BiPAP. It can add quite a bit more than 3 cm to the inhale pressure (Pressure Support). Depending on the model there can be some adjustments which change how the machine switches from inhale pressure (IPAP) to exhale (EPAP). Again that may help to keep you breathing. And again depending on the model of machine you have they may have a backup breathing feature. When it detects you are stopping breathing it attempts to assist your breathing with the pressure support. I believe ResMed calls it S mode. What BiPAP do you have?

The next step if a BiPAP fails is to use an ASV. It follows your breathing pattern and changes pressure support to assist your breathing on a breath by breath basis. I think the main difference is that a BiPAP follows the trend in your breathing, while the ASV looks at each breath and makes adjustments in real time. Here is a link to a ResMed product page for the AirCurve 10 ASV. It explains how the machine addresses central apnea. There is one precaution to be aware of though. A heart function test called the Left Ventricle Ejection Fraction (LVEF) needs to be done before an ASV is considered. If LVEF is <45% an ASV will not be used.

Sierra,

Thank you so much!