CPAP vs ASV

[richb]

I highly recommend that you install Sleepyhead software.  You need to see what is going on with your breathing patterns at different pressures.  It is not easy to get through the bureaucratic maze leading to an ASV machine.  I had 5 sleep studies to get there.  Again as we all have said, lower pressures will reduce the scored centrals on a CPAP or Bi-Pap machine.  I got my best AHI scores at a fixed setting of 5 cm H2O on a CPAP type machine.  

Rich

[Hojo]

I highly recommend that you install Sleepyhead software.  You need to see what is going on with your breathing patterns at different pressures.  It is not easy to get through the bureaucratic maze leading to an ASV machine.  I had 5 sleep studies to get there.  Again as we all have said, lower pressures will reduce the scored centrals on a CPAP or Bi-Pap machine.  I got my best AHI scores at a fixed setting of 5 cm H2O on a CPAP type machine.  

Rich

I've posted some data previously, but this thread was just from some general comments for my peach of mind.  Here are the results from last night.

https://imgur.com/a/0SHvG

[theebrad]

Of how much value would an ASV machine be compared to a BiPAP auto for someone with mixed OSA and CSA requiring only low pressures? max 10cm

[Sleeprider]

Of how much value would an ASV machine be compared to a BiPAP auto for someone with mixed OSA and CSA requiring only low pressures? max 10cm

A BiPAP auto treats obstructive sleep apnea.  I have NEVER seen someone with complex apnea, improve with the use of a bilevel VPAP/BiPAP without a backup rate.  When complex and central apnea are present, best results generally involve avoiding changes in pressure between IPAP/EPAP and even auto CPAP pressure.

[PsychoMike]

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.

They are probably running through their protocols to get the "definite fail" on CPAP (or they didn't read the CA diagnosis and are using their "this fixes everything" playbook).

Hang in there...lots of folks on this board can attest that it sometimes takes a while to get a) on the right machine and b) to get everything firing right to get good sleep. You'll get there, but don't let the DME push you around...be an advocate for your health (because, unfortunately, not many you'll come when it comes to CPAP / ASV therapy will).

[Hojo]

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.

They are probably running through their protocols to get the "definite fail" on CPAP (or they didn't read the CA diagnosis and are using their "this fixes everything" playbook).

Hang in there...lots of folks on this board can attest that it sometimes takes a while to get a) on the right machine and b) to get everything firing right to get good sleep. You'll get there, but don't let the DME push you around...be an advocate for your health (because, unfortunately, not many you'll come when it comes to CPAP / ASV therapy will).

I agree with your statement that I am buying put through the usual playbook protocol.  What I'm trying to find out is how long do people take to acclimate with OSA in relation to the new CO2 adjustment (now getting more air).  This could help with my argument that I shouldn't be on CPAP for months on end before going to ASV, if that is indeed what I need.

[richb]

Hi again Hojo. Your question is relevant to the problem of using CPAP for Central Apnea. The CPAP machine can wash out CO2 from your system raising blood pH. This in turn reduces your respiration drive causing an increase in Central Apneas and even Cheyne Stokes respiration. You can't "get used to" a CPAP machine if you have Mixed or Central Apnea. Lowering the pressure on a CPAP machine can reduce the CO2 washout and thereby reduce the full blown Centrals and Cheyne Stokes breathing. You will see an increase in Central Hypopneas which are not a complete cessation of respiration but often result in O2 desaturations.
Sometimes people with OSA experience Centrals when starting CPAP. Narrowing and reducing the pressures helps reduce the CO2 washout allowing the CPAP machine to deal with the OSA.

Rich

[Hojo]

Hi again Hojo.  Your question is relevant to the problem of using CPAP for Central Apnea.  The CPAP machine can wash out CO2 from your system raising blood pH.  This in turn reduces your respiration drive causing an increase in Central Apneas and even Cheyne Stokes respiration.  You can't "get used to" a CPAP machine if you have Mixed or Central Apnea.  Lowering the pressure on a CPAP machine can reduce the CO2 washout and thereby reduce the full blown Centrals and Cheyne Stokes breathing. You will see an increase in Central Hypopneas which are not a complete cessation of respiration but often result in O2 desaturations.
Sometimes people with OSA experience Centrals when starting CPAP.  Narrowing and reducing the pressures helps reduce  the CO2 washout allowing the CPAP machine to deal with the OSA.

Rich

Rich:  You hit the nail on the head with "Sometimes people with OSA experience Centrals when starting CPAP. Narrowing and reducing the pressures helps reduce the CO2 washout allowing the CPAP machine to deal with the OSA." 

This is one thing that I plan on presenting to my doc with enough of my data, is that over time, my CA didn't go up when starting CPAP, but hasn't gone down yet either, indicating a true Central and need for ASV.