[CPAP] Beyond ASV with Overlap Syndrome!

[SarcasticDave94]

I had thought breath rate was part of the issue. I'm a slow breather a lot of the time, for some reason RR 10 comes to mind. I know OSCAR reports on I:E ratio from machine data maybe aren't accurate enough to determine a lot, but it seems some of my ASV reports in the past had I:E close to equal or inverted. Regardless when I was able to discuss it with 2 separate RTs and a pulmonary nurse, they all thought it was possibly part of the issue.

I did forget to address your questioning on static CPAP pressure. It wasn't good, it felt bad and didn't seem a good fit. Best way I can describe it.

FWIW my ASV makes a poor CPAP. I'm not certain what exactly was the cause, but CPAP mode just felt off, as in not correct. I felt air starved somewhat and with no range at all obviously there's no adjusting when need arises in sleep. Not exactly a disturbance into arousal type of thing but just a serious lack of not rested sleep afterwards. Like it missed a lot of events, something like that.

[Geer1]

I remember the previous inverted IE discussions. I don't trust these reported values as mine specifically are always wrong because of cardiogenic oscillations.

I believe your RT's when they say these are possible issues. I just think that if they are the issues you should be able to confirm with detailed OSCAR analysis changing possibility into reality. It is a bit trickier to interpret ASV data but some of these things like breath stacking (and inverse IE ration) should be fairly obvious.

When you used CPAP mode you had an AHI of 12 so it is not surprising you felt bad (just like recent test of Autoset).

I am not sure if I am supposed to mention this other source on here but if you aren't sure about how to interpret these fine details in OSCAR data and think the hints might be there (like I would think they should be) then AXG Sleep Diagnostics (Lanky Lefty 27 youtube channel related sleep clinic) offers OSCAR data analysis for $150 where they review a week of data with you and provide you with written recommendations on how to proceed. If you think there are indications in your data then this could be a way to get a written explanation of what is happening that you can provide to doctors to help speed up the process.

Just an idea that might be worth considering.

[SarcasticDave94]

OK thanks, I'll need to think on it. Disability money stretched already. Not saying no I'd not do it just that the monthly finances are already set for the month. The referrals and scheduling will take time anyway so it's hurry up and wait time.

[SarcasticDave94]

Small update, PCP referral to John's Hopkins is progressing. I've got an email from them today with PDF to print and send to doctors for requests to send patient files.

[OpalRose]

That sounds promising! If only, these people would move faster.

[SarcasticDave94]

Thanks, and you know me well enough, I'm pushing it through. Yet snails pace progress.

When I talked with my PCP PA about the referral, he immediately said with my past, no way the CA or COPD disappeared like UPMC claims. He's the one that suggested John's Hopkins.

[Maskman888]

If you have COPD and not "true" central sleep apnea diagnosed in a sleep lab, then an ASV's algorithm is not designed to treat your problem.  A traditional BiPAP would be a better alternative for you. This goes the same for Auto-CPAP; they are not good for individuals who have overlap syndrome

[SarcasticDave94]

The problem is that I didn't do well on the DreamStation BPAP Auto due to those pre-existing CA, so I've struck BPAP off the list, but thanks for the suggestion.

[Maskman888]

The problem may be that you used a BiPAP Auto; any auto algorithmm is not designed for the obstructions caused by COPD as it is different from obstructions fro OSA. The BiPAP or CPAP AUto's can't distinguish this and over react to the narrowing which is why most people don't do well.  You should use only fixed pressures of BiPAP (or CPAP for that matter); Did they ever try you on a fixed pressure of BiPAP even while on the BiPAP Auto?

[SarcasticDave94]

Well actually I won't do well on straight CPAP either. The last I tried that, it yielded only a few hours use when it woke me and OSCAR had AHI at 12.x.

If you look back over this incredibly long mega novel, the ASV used to work well for me for about 2 years worth of treatment. Now it is potentially inducing breath stacking. So NIV with AVAPS is where I'll probably be headed.

Good night.

PS I do have real bonafide Central Apnea still. The blind squirrel that tested didn't do something right on the latest diagnosic.