EPR, Central Apnea, and Aerophagia

[stevew77]

I would go for an ASV, sounds like you will get one with over 50% centrals. Sorry if this post did not get out.

[stevew77]

You can set an ASV for a static EPAP setting if you set to the ASV vs. ASVauto mode. I don't see a real advantage to the bipap ST-A set to a set respiratory rate, unless you breathe at a consistent rate when you go to sleep, or when you're asleep. The other settings seem to be rather more detailed than I would want to deal with. I would prefer to have the respiratory rate to be adaptive.

[rpierce]

First, thanks everyone for all the information. I really appreciate it. So, an update on my treatment:

My AHI is all over the place. At my last sleep follow-up, we figured we'd wait another 6 weeks to check in to see if they'd settle down, and then consider ASV. And they aren't settling down. Over the last 2 months, my AHI was under 5 on 30 nights, above 5 on 32 nights. Here's a histogram:

AHI: Number of nights
0-1: 2
1-2: 2
2-3: 5
3-4: 13
4-5: 8
5-6: 13
6-7: 9
7-8: 5
8-9: 1
9-10: 2
10-11: 0
11-12: 1
12-13: 1

Over the last 1 month, my AHI was under 5 on 18 nights, above 5 on 14 nights. So there seems to be an improving trend. My CA's are 13x my OA's, so I clearly meet the 50% threshold that insurance wants. But I'm still waking up several times during the night. While my daytime drowsiness is markedly improved with CPAP vs. untreated, I wonder if I could still feel better. So I'm wondering, is this good enough? I know people talk about not chasing numbers; should I consider my CSA treated, or should I push for an ASV? (Assume for now insurance will cover it and cost isn't an issue.) Would I get health and quality of life benefit out of it?

I'm also wondering what ASV feels like and if it will be a problem for me. I need EPR to feel comfortable and also to reduce aerophagia. But I'm also kind of unusual in that I've had years of meditation training where focus and control of breathing was drilled into me such that I find I frequently am consciously controlling my breathing rather than letting my autonomic nervous system handle it. When I get on my CPAP, I instinctively control my breathing as I try to relax and fall asleep. I'm hearing about ASV learning and then driving your breathing rhythm; I don't know if this is going to help me relax if it takes this out of my control, or make me panic as I try to fight it.

[SarcasticDave94]

Can you post a few recent samples of OSCAR charts to see the relation of CA, etc?

Yes ASV will be different, it can be made as comfortable as possible with settings. However it also needs set to treat events. There can be setting compromises as needed.

EPR isn't on the ASV, but the similar pressure support (PS) is.

If you don't think current therapy is doing you any good, and that you're willing to fight for ASV, start complaining until you get that machine. NO can be a full sentence, and it can be your answer to doc telling you to wait and see.