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Will an ASV machine eliminate my centrals?

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lakechapala +0 points · about 2 months ago Original Poster

I have been treated for sleep apnea for 10 months . I started with an ahi above 40- mostly centrals and now are down to 8,mostly all centrals with the odd obstructive and hypopnia. Iam currently using an aircurve 10vauto. I seem to be stalled at this level. My question is - will an ASV machine eliminate my centrals? I do not have heart problems. I would appreciate hearing from current ASV users who have gone through the process. What are the pros and cons, if any.

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Sierra +0 points · about 2 months ago Sleep Innovater

I hope you get some responses from those that have used an ASV. I have not, but have thought about it. I generally average around 2.5 for AHI, with the majority being centrals, while using a lower fixed pressure of 11 cm. Seems not worth it to consider an ASV for now for myself.

I can't remember off hand what kind of pressures you are using. If you don't need higher pressures (over 20 cm) you most likely would benefit from an ASV. However that said since you have an VAuto I wonder if you could improve some with tweaks to your VAuto such as Trigger and Cycling Sensitivity and TiControl. See pages 5-6 in this VAuto Clinical Manual. I am afraid I have no experience here in making any suggestions in what to do. Perhaps others do?

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lakechapala +0 points · about 1 month ago Original Poster

Thanks for your response Sierra. You may recall that I spend the winter at 5500 feet and 6 months at 500 feet where my sleep doc is and I am seeing him once a month. My current settings are ps 4, 4.0-11.0 and my ahi is dropping- last night it was 6.5 My winter ahi was around 15 plus as I have trouble with altitude. He prescribed acet. which brought my winter afi down to around 8. His plan is to continue to slowly reduce pressure till we hit the sweet spot while at 500 feet and use acet.at 5500 feet. After 10 months I am getting tired of this process. I have suggested an asv but he prefers the current process. My current thinking is to ask for a 30 day asv trial when I see him next week which I think he will agree to.

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bonjour +0 points · about 1 month ago Sleep Commentator

I don't use an ASV either. I have advocated for many to get one. I'm confident an ASV, when tuned, would most likely treat your apnea to a level between 0 and 1 with zero not being an uncommon result. I'm also confident that learning to use an ASV is difficult, but ASV users usually say it was worth it. Occasionally individuals don't like the wide pressure swings that can and do occur on a breath by breath basis. ResMed doesn't even report Central Apneas because it corrects them mid breath.
I also wouldn't be surprised if you need separate settings for 500 ft and 5000 ft. This would go for any CPAP though the ASV would be the least likely to require this because of its aggressive response to events in the forming.

How to choose. How do you feel with your current therapy? What do you feel needs improving? Numbers are not allowed in your answer (Though I do understand that zeros feel awful good).

For example, based on responses posted in this forum, I strongly suspect that Sierra is comfortable with her current level of therapy and therefore I wouldn't suggest an ASV. Her CA numbers are fairly stable.

I frequently see CA number that I describe as Consistently Inconsistent. That is that they range from very good to very bad and there is nothing happening that would seem to be a cause for the variation. Usually much effort has been expended to minimize the Central events. This person is likely to benefit from an ASV.

To Qualify, this is what MediCare looks for. Most insurance companies follow the MediCare guidelines

Complex Sleep Apnea For Complex Sleep Apnea the Medicare requirements for issuing an ASV machine.

*Titrate to minimize OSA, that is the obstructive AHI to less than 5 per hour. This typically is raising EPAP or pressure until obstructive AHI is less than 5 per hour, we expect this to make the Central and Complex Apnea worse thus failing the current treatment

*Record the central apnea-central hypopnea index (CAHI) (looking for greater than or equal to 5 per hour and greater than 50% of total AHI)

*Document the presence of at least one of the following symptoms: These symptoms are specifically noted by Medicare. These are key symptoms that we look for by asking "How do you feel?". Do not limit your answers to the following and do not fabricate the answers.

-Sleepiness, "How do you feel?"

-Awakening short of breath, "How do you feel?"

-Difficulty initiating or maintaining sleep, "How do you feel?"

-Frequent awakenings, or "How do you feel?"

-Nonrestorative sleep, "How do you feel?" Nonrestorative sleep is defined as the subjective feeling that sleep has been insufficiently refreshing

-Snoring, Can be documented on OSCAR

-Witnessed apneas Most of us have this one with our significant others

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lakechapala +0 points · about 1 month ago Original Poster

The last year has been a struggle bonjour. In May 2018 I felt awful -tired, not sleeping well, needing afternoon naps. My Doctor of 30 years could not find anything wrong so I got a new Doctor who referred me immediately to a neurologist/ sleepDoctor who immediately set up a sleep study in mid July 2018. Got the results in mid September - Ahi of 67 made up principally of hypopneas and to a lesser extent obstructives ( I used to sleep on my back). I had no centrals. Then he put me on a cpap machine. A second sleep study recommended a pressure of 20. Had trouble keeping my mask on. I switched to a Resmed 10 curve v auto. I then went to Mexico where I winter at 5000 feet until April 15, then back to Toronto - 500 feet.I found that the high altitude increased my Ahi significantly and my readings were in the high twenties, and mainly centrals. I used acetazolamide which brought my AHI down to the mid teens. My sleep docs strategy is to get my centrals under 5 at 500 feet in the summer and then use acet in the winter at 5000feet. Currently my AHI is around 8 with almost all centrals and one or two obstuctives and the odd hypopnea. We are slowly reducing pressure . He has also suggested a mouth piece which I have refused. The last thing I need right now is screwing around with my teeth/mouth. I have suggested an ASV machine but he is reluctant, but will agree if I push him. My take right now with my one year of experience is that I have Treatment- Emergent Central Sleep Apnea whereby the centrals are being caused by my sleep apnea machines and the most effective treatment is via an asv machine. I also expect that I will need different settings at 5000 feet, perhaps including acet.

I feel a lot better than I did at 5000 feet but i still get brain fog and am tired. I need an afternoon snooze around 2 hours and sleep around 8 hours a day. My memory Has become worse I live in Canada, my province does not cover asv machine so I have to pay the total cost. Based on the US model, I would qualify. I wake up several times a night but I do not have shortness of breath. It usually happens when I have obstructives or a bunch of centrals. When the wind starts blowing, my wife can tell that I am having an obstructive.

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bonjour +0 points · about 1 month ago Sleep Commentator

I'd suggest a trial at altitude, set PS at 2 (I believe you are currently at 0) with the purpose being to increase the effectiveness of your physical breathing at altitude, you should see an impact (increase) in your Minute Vent on that chart. PS = 4 is the normal starting point BiLevel Pressure Support. I'd like to see it at PS=4 but I don't want to just jump there. I'd ask your Pulmonologist what he thinks of this strategy. ASV works by applying various amounts of PS to maintain your normal Minute Vent volume. Looking to mimic that action a little bit. I'm betting you have a sweet spot with a PS greater than zero.

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lakechapala +0 points · about 1 month ago Original Poster

On May 3rd my sleep doc changed my settings to ps4 over 5.0-14.0 and changed them slowly to the current ps4.0 over 5.0-11.0. My ahi has gone down slowly. Median minute vent has gone from 5.88 in early May to 6.25 recently.

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Sierra +0 points · 27 days ago Sleep Innovater

The thing to watch for on minute ventilation is the amplitude of how much it fluctuates. It is kind of like a measure of your car speed when the cruise control is not working properly. The car goes too fast then too slow, and the cycle continues without stabilizing. The underlying issue with central apnea can be this inability to stabilize the breathing rate and depth. You don't really see it in the graphs until you expand the scale in the area where you are having centrals. MV cycling up and down tends to be a precursor of central apnea.

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bonjour +0 points · about 1 month ago Sleep Commentator

Look at what is happening to Minute Vent thru the night, not just the median value.

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lakechapala +0 points · 22 days ago Original Poster

I switched to an ASV 12 days ago. AHI 0.2. Last two days were 0. It has been a year of frustration but now feel great! Appreciate all the help I received!

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