[Health] Interpreting sleep study results, EERS enhanced expiratory rebreathing space

[JoeyWallaby]

This sleep doctor uses acetazolamide for treatment emergent sleep apnea
https://www.youtube.com/watch?v=Syv7YcHbTCI&t=64m0s

[JoeyWallaby]

not using bilevel right now. no EERS. took off mask in sleep.

[mper6794]

...would you know your sleep position during CA's? back?

atb

[JoeyWallaby]

Don't know

[JoeyWallaby]

I probably wouldn't have gone to ASV if my CAs weren't as persistent even after long duration treatment and with EERS... plus I now know the hypopneas on my sleep study can be central or obstructive and I have NO IDEA which they are. So 25% of my events in my sleep study are confirmed central (central apneas)... potentially 100% of my events were central if all those hypopneas were central... 

but I have no idea because they're not subclassified!  



Just waiting on ASV to arrive now... 

[JoeyWallaby]

With EERS
Chart says no flow limitation but it's incorrect
Took off mask in sleep

[JoeyWallaby]

[mper6794]

Hi, Joey,

don't know HYF. However, it looks very poor results; I see some important anomalies: MV, E:I, pretty much asfixiated at some points. I am afraid you not survive to this for longer periods.

good luck

[JoeyWallaby]

Yea I know it sucks... I haven't been using CPAP lately and I can tell I've been grinding my teeth bad, my jaw joint hurts a bit when I wake up! Lucky I have a bruxism splint I use.

Anyways... I have an ASV ordered, express shipping... should arrive within about seven days.

What do people think what settings I should use? I was thinking max EPAP and max PS at maximum, min EPAP at about 8.5 and min PS about 4.5

[mper6794]

Hi,

I have to confess I have not gotten yet even a middle understanding of this ASV machine. I do hope you will be able to get good information and eventually better therapy going to to ASV. It is going to be a good learn for so many; I am crossing my fingers and supporting you.

I have just taken a look at an AASM's paper and in the Resmed manual, where they say machine is designed CSA, PB, and Complex Apnea.

It looks that, in theory, ASV, while responding breath by breath and adjusting parameters, would be a great machine. However, from ASV-AB’s cases I have been curiously following (other than the machine was designed for), unfortunately, I have not seem yet satisfactory results (might be missing older cases).

In two more recent cases (1-UARS+PLMS; 2-only UARS) I followed closely the machine added large instability on sleep, by bumping pressure during PLMS events and during the simple so frequent arousals/awakenings (pretty much always followed by discountable/fake CA’s), typical of UARS, or UARS+PLMS.

Therefore, I have not understood yet how ASV can be used to treat UARS; I would be prompt to go for it once I see the first case in which both fellow was able to adjust setting and machine worked properly.

However, I put a large credit to Dr. Barry Krakow, not only because he is a UARS-sufferer, but also because his large experience while treatting so many cases. And, indeed, he has been talking on using ASV to treat UARS and its comorbid issues (I have not understood how yet), like in this interview:


Sleep Review: With regard to treatment, you’ve had success using ASV (adapt-servo ventilation) versus standard PAP devices with insomnia patients. Why do you prescribe more advanced devices?

Krakow: Yes, I’ve had great success, personally, using ASV for nearly 4 years. It eliminates 95% of awakenings at night, which are noticeably fewer disruptions than what I experienced with other PAP devices. ………. During expiration, the discomfort from standard pressurized airflow seems to trigger an anxiety response that the insomnia patient cannot overcome; whereas with the use of auto-bilevel devices, including ASV, the patient’s comfort level is noticeably higher.......

SR: How do you get insurance to pay for ASV?

Krakow: You can’t start with ASV for the majority of patients. In our setting, the patient can objectively and subjectively fail CPAP or BPAP at either the desensitization period or the early phases of the titration. Also, we can quickly spot that the device is not eliminating RERAs; instead the device is producing expiratory pressure intolerance. Other objective markers of an inadequate titration that show up include: failure to generate REM sleep, excess sleep stage transitions, and other signs of sleep fragmentation. After these adverse findings are observed, the sleep tech switches the patient to the advanced technology for the rest of the night. The sleep tech then must constantly override the auto mode, because only through a manual titration combined with the device set for auto mode do we gain the best chance to treat RERAs. With this method, there’s a potential for normalizing the air flow curve, rounding both the inspiratory and expiratory limbs.
About half to three-quarters of patients do well on standard auto-bilevel devices initially, but some patients have residual central apneas. When outcomes are not improving, patients typically are covered by insurance to return for another titration, which we think of as a “treatment procedure.”......

atb