BIPAP making my CSA worse

[ImAlwaysTiredd]

>With ASV you would need to have at least PS 5, and more likely 8. 

In response to this, should I attempt to adjust to a higher PS now in preparation for my titration study and using an ASV?
It seems using anything above a PS 2 causes more centrals

[Sleeprider]

Using a bilevel without a backup rate and consistently high PS is not going to solve any problems, and as you correctly note, would likely increase central apnea that the machine will not touch. Regardless of PS setting, your machine will remain at EPAP until it detects spontaneous inspiration. The way ASV works is it allows for spontaneous respiration but will apply pressure support to help you take a breath if your breathing rate falls below your previous 90 second average. While you are spontaneously breathing, the ASV only applies the minimum set PS, but will increase that if your minute vent volume falls below the 90 second rolling target. This means you don't get into the perodic breathing pattern of hypoventilation/hyperventilation/apnea/hyperventilation, because the ASV works on a breath by breath basis to keep respiration even.

[ImAlwaysTiredd]

So I had the sleep titration, I kept waking up after they switched from normal bipap and eventually was put on bipap s/t and maybe asv, I dont know. It seemed like half way during a breath out or in it would flip and change pressure dramatically, so I was constantly fighting to breath in or out, I dont know if it just wasnt adjusting properly, or what. I was quite out of it between masks and when the wakeups happened, and one point I was completely confused where I was and thought I was being suffocated. Between that and 6 mask changes (guess I cant use any nasal masks with good fit and I mouth breathe), I was told I didnt sleep long enough, and I should have been prescribed ambien. That did not go well at all.

One thing I couldnt get a straight answer about at the sleep study, was what PS setting they use, it seems they dont or its auto, which makes me wonder what the at home machine is supposed to match? Previous titration only gave an ipap and epap, but no PS

[Sleeprider]

Good luck. I suspect it will be a couple weeks to get results.

[ImAlwaysTiredd]

Results! no measured apneas when using asv, so I guess it works? I seem extremely restless with it, technician said it was anxiety.

[Sleeprider]

Yeah but, look at the sleep efficiency and SpO2. Everything just works with the ASV. Maybe it just works because it is designed to treat your central SDB problem.

[ImAlwaysTiredd]

o2 is the same as without it. Sleep efficiency is just % of time in bed asleep. Comparing to my first study, I normally slept at 3-4am, and they wanted me to sleep at midnight, so of course efficiency would be low when I couldn't use a sleep aid.

Arousals were high, and I knew it, I didn't sleep well at all.


But the kicker is how magically bipap 11/5 went from 3ahi to 50ahi for the 2nd study

And they waste most of the time testing 13/7 bipap on an asv study

Looking at the final hour you can see the sleep architecture with asv is absolutely garbage

The amount of my life I've had to waste staying where I am , waiting for all this bs makes me rage so much

[Sleeprider]

I don't understand what you're saying. Bilevel therapy failed, and ASV worked. Other than the awkward interpretation of the tech, is that a problem?

[ImAlwaysTiredd]

Sure asv eliminated apneas, but not arousals, if arousals are the reason I'm tired, it's not really helpful.

[Sleeprider]

I understand that. Sleep disruption can be a problem with ASV, although most users seem to adapt or adjust to it in time.