CPAP vs ASV

[Hojo]

When I had my sleep study done I felt that I had a good night, in that I didn't have that much sleep apnea and my AHI was 6.77 that night.  I was told that I had central apnea and while not that bad, I told the doctor that I felt I needed something because my nights are usually a lot worse than during my study.

I was put on CPAP and I've been on it for 21 days and from little I know, it sounds like it takes awhile to allow the body to adapt to the CPAP in terms of it causing a some central apnea from all the extra breathing associated with CPAP.  On the other hand, if I have central apnea, then I'm wondering if I shouldn't be on ASV (my cardiac function is great, EF of 65% and avid cyclist and hiker).

I was initially put on CPAP of 10, then without getting any better, I was changed to 5-20.  I've been pretty much having an AHI of 5-6ish, which I know isn't terrible, but I'm envious of seeing those of you that get it down to under 2, not to mention that I'm tired of waking up with what I feel has been sleep apnea.  I had one night with an AHI of 12 and for some reason, not only was my CA rate high, it showed Cheynes Stokes Respiration of 12.44%, a night I went to bed at 10 and woke up at 3:30, ugh.

I will try to post some sleepyhead data that shows last night, and then a couple of screenshots that zoom in on my typical CA episodes.  I woke up around 3 am and couldn't get back to sleep, and I feel as though I need my lungs expanded.

https://imgur.com/a/YKieS

[Gary1of2]

Have patience. It takes wahile for yourbody to heal from the damage done from not sleeping. Some people take anywhere from 3 to 6 months. Some longer. But hang in there. Myself ite taking44months to start feeling better.My apnea sllowly got more and more under control the longer I been on it. I hope this helps.

[Gary1of2]

4 months not 44 months. Oops

[Sleeprider]

With a diagnosed central apnea, the ASV is the correct device. Your AHI remains above clinically acceptable levels, and I think as time goes on, your results will be less predictable. You could be experiencing an AHI less than 1.0 with ASV. Think about it.

Have you ever tried fixed pressure at about 9.0, or a narrower range of pressure? Your CA problems appear to be worse with pressure above 10.

[richb]

The Sleepyhead data would be helpful. CPAP machines can aggravate Central Apnea symptoms because of CO2 washout. Many people who show no Central type events during a sleep study can show Central events due to incorrect (for them) pressure settings. In your case you were told that your Sleep Apnea was primarily Central in nature during your sleep study. Using a traditional CPAP machine to treat Central Apnea will only make the symptoms worse. Most insurance plans including Medicare require that you fail at using traditional CPAP before you qualify for an ASV machine. Seems like you are failing as would be predicted by your sleep study. Adjusting your pressure settings to a minimum level should reduce the overt Central events and produce a higher rate of Central Hypopneas and Periodic Breathing. The CPAP machine is aggravating your symptoms resulting in the Cheyne Stokes pattern. You will need to discuss your CPAP failure with your Doctor and find out the next steps to get an ASV machine.

Rich

[SarcasticDave94]

My personal opinion, based on the doc comment, and you stating lack of rest, did indicate the ASV path. But that alone doesn't make it a "go direct to ASV" path. Like myself, your insurance coverage may require you to have a definite fail on CPAP, then they may require a BiPAP and another fail. I'm only guessing and could be wrong with that. As always your path could be a bit different.

If you follow what happened to me, that's what my insurance required. PSG for CPAP and fail then PSG for BiPAP and fail due to high centrals, then a new PSG for ASV. ASV therapy is still under a month for me, so it's still new. I've got reasonable AHI numbers despite not yet tuning in for best results. I'm down in AHI from an original of 70 something to around 2.2 over my first 22 days.

Helpful hint I hope. Squeak often to doc. AKA tell doc how you're feeling and include numbers. That's what I felt I had to do to get proper attention.

Best to ya.

[Hojo]

With a diagnosed central apnea, the ASV is the correct device.  Your AHI remains above clinically acceptable levels, and I think as time goes on, your results will be less predictable.  You could be experiencing an AHI less than 1.0 with ASV.  Think about it.  

Have you ever tried fixed pressure at about 9.0, or a narrower range of pressure?  Your CA problems appear to be worse with pressure above 10.

I initially was started with CPAP at 10 I was still fairly high with my AHI.  The AHI has improved slightly with the new setting of 5-10 but I'm still concerned with the CA; per Sleepyhead, with a fixed pressure of 10, I averaged 30 CA events a night, and now with the CPAP at 5-10, I'm averaging 24. 

Knowing that the body needs time to adjust to CPAP makes sense, but it doesn't make it any easier for me (I'm impatient), then in the back of my mind, I'm wondering if I shouldn't be on ASV any way.  The last time I talked with me DME I was told I may need to try BIPAP, which I understand is the normal (insurance) protocol before going over to ASV. Knowing that CPAP can cause central apnea, I'm wondering if I should change my settings of 5-20 to 3-20???

And finally, I think my AHI would be worse if I was able to sleep, I have no idea how folks can sleep with an AHI in the 30's!

[Sleeprider]

The minimum pressure on the machine is 4.0 cm. If keeping variable pressure, I would focus on maintaining lower pressure I.E. 4-9 or 5-10. It is the higher pressure that you rarely hit that cause the biggest problems. Just keep in mind you are using a very effective tool for treating obstructive apnea. In your case that is like using a screwdriver to drive a nail.

[Sleepster]

I was initially put on CPAP of 10, then without getting any better, I was changed to 5-20. 

That's not right. That's what you might do for someone with obstructive sleep apnea, but if the majority of your events were central at a pressure of 10, that change will just make things worse.

[SarcasticDave94]

Not seeming like a know and see all, because I'm certainly not, but my doc did similar act by prescribing the worst pressures according to my BiPAP PSG titration numbers. His own peers called him out on it and it began my ASV path. Now it did take me more time to actually get failing grades in said BiPAP. Again best wishes to ya.

And I agree with others, higher pressures are likely going to worse for you.