High AHI and Cheyne Stokes respiration, what to do?

[Cyleong]

Thank you wr61 for the reassurance, happy you are better now, I hope Stanlee will be soon too.
I am ordering an ASV machine today.

Hello Sleeprider, thank you for your extensive feedback.
I made the screenshot of last night's use. 
I am ordering an ASV machine, the Resmed Aircurve 10 ASV. They are out of order everywhere, but I found one in the USA.

Numbers are better for last night, we had a few of these days in the last month too, but still not good enough, so I ordered the ASV ; )
I am so gratefull for this forum and the help I am getting here. 

(Our lungspecialist just doesn't have the time for each patient, especially in covid times and for 'old' people.
I told her 4 weeks ago, about the readings I found in Oscar, the still very high AHI and the CSR, and that I read that a bipap might help better, she answered, nono that's too expensive.
I said Stanlee still doesn't feel good at all with the APAP, she answered ,well yes, but it is better than before. So I thought, I will study some more myself then ; ))

   

[Sleeprider]

The part that puzzles me is that any doctor could see this as acceptable therapy.  I think it is actually questionable whether it is better than before.  The ASV should just be set to default settings of Min EPAP 4.0, Max EPAP 15.0, Min PS 3.0, Max PS 15.0.  Have a clean SD card in the machine and post data as soon as you have it.  Go to our CPAP Setup Manuals link at the top of this page and order a clinical setup manual for the Resmed Aircurve 10 ASV.  The manual has great information on how the machine works and will be valuable in setting it up.

[SarcasticDave94]

Agreed with the others on ASV. It will fix that event count pretty quick.

I'm thinking default ASV Auto settings will be fine as a start. And then edit as needed according to OSCAR info.

ASV Auto mode
EPAP 4-15
PS 3-15
From there, edits can be made. Hope you get the ordered ASV soon.

[Gideon]

Even we don't like to suggest expensive equipment or adding on additional things (the collar mentioned previously), but if that is what is called for to treat your apnea we don't hesitate.

[Cyleong]

Thank you all for your help, I am so grateful, without you I wouldn't have known what to do.
The ASV arrived today, I downloaded the manual and I've put it on the settings mentioned here below.

he had an average of 30AHI over the last 10 days

In the mean time we are going to a breathing coach, he needs to learn to relax while exhaling and he gets deep-tissue massage there because his muscles are so tense. He also has 2 exercises to do 3 times a day.
Apart from that we are going to an osteopath kinesiologist, he is also working on his lungs and the second treatment on the connection brain-lungs because the central apneas. 
after that second visit he had 2 nights of 18 AHI then again 30 but then one night of 0.82!!! with a normal breathing pattern and just 6 apneas over the whole night. Next night back to 30.
I was happy to see that his body is actually capable of having a normal night's sleep.

So tonight : )) ASV! fingers crossed.

[Cyleong]

here are the results from the first night !
Yes!!! AHI 0,37!!  incredible, finally after 3 years of searching why my husband was so tired, he will get a new life, all thanks to you here on the apnea board.

Do I need to adjust anything now, or leave it like this for a while, see how it goes?

eternal gratitude to all of you,

Cy & Stanlee.

   

[SarcasticDave94]

The only item I can suggest is trying to wean off the Ramp usage. It's stealing 15 minutes every session start and the ASV is already starting at EPAP 4. Maybe try to go down to 10 minutes Ramp for a week or so then reduce it again to only 5 minutes afterwards. Eventually getting to where you have no Ramp needed is the goal I suggest. This OSCAR chart has 6 sessions I think, so you've lost 15 X 6 = 90 minutes of total therapy time.

There wasn't much therapy negatives due to Ramp on this chart except losing the full therapy session times from Ramp at 15 minutes. However for some, the Ramp can add pressure swings and a somewhat abrupt transition to regular therapy that could be disruptive. Ramp also can add Centrals by itself as when I used an ASV.

[Cyleong]

thank you,

 
I will try tonight to turn the ramp off, if I get complaints. I'll try the weaning off method.

[Boroma]

A decade or so ago I was feeling tired and was diagnosed with sleep apnea.
Then a while ago I had shortness of breath and saw a cardiologist. Results were inconclusive.
Then I got high AHI and Cheyne Stokes respiration a couple of years ago. Both my supplier and a sleep specialist said it was nothing to worry about.
Then my health got worse. I saw a GP and he started running tests.
Among the tests was an echocardiogram.
The operator used a ruler on the screen to work out my Left Ventricular Ejection Fraction. 42%.
I had heart failure.
Basic heart failure medication cleared up the CSR and I had a battery of CT scans, MRI's and blood tests ordered by a cardiology team find out what was going on.
Big thank you to the Austin and Prince Charles hospitals.
Turns out I have a form of leukemia so that my bone marrow does not produce a specialized white blood cell to protect the heart. Not to mention some cholesterol blockage.
A year later I have a new cardiologist, walk for at least 20 min daily, my medication is being fine tuned and I'm feeling better.

[Cyleong]

Hello Boroma,
Glad you feel better now.
Stanlee is using the ASV as suggested here and since then no more CSR, nor  apneas. We turned off ramp up time and that works good. 
He's slowly recuperating and feeling better, exercises 1hr a day. Not bad at 77. 
Thank you to everyone who helped out here. Cy & Stanlee