LisaASV - Therapy Journey

[LiaASV]

I was diagnosed with complex sleep apnea in 2022 and was given an ASV machine after a sleep study and multiple failed titrations on CPAP/BiPap. I started therapy more recently with the ASV and decided to find another doctor to cover my treatment. She said its likely my OSA was simply the cause of my central events. 

I had 148 central events, 68 apneas, and 126 hyponeas during my PSG. This new doctor said that my central events gave me an AHI of 29.9 and a total AHI of 69 when combined with my obstructive events. My central events just seemed to be too high to be solely caused by my obstructive sleep apnea. Should I continue down the road of looking into the central apnea? I was thinking a neurologist could be the first step if I thought there was a different cause of my central events other than OSA.

[SarcasticDave94]

Welcome to the club.

If this doctor is attempting to indicate the CA are treatment emergent, I'm not buying.

Just making certain, you said counts were 148 CA, 68 OA, 126 H. That was from the sleep study, correct? If true, there was no therapy involved, as in no PAP pressure to initiate any treatment emergent CA.

If you have it, which you should, maybe you'll want to post the redacted version of the sleep study. I'm still leaning towards the CA are the real McCoy.

[Sleeprider]

That is a pretty novel theory that a diagnostic sleep test is wrong and that CA are the result of OA events. Wow! With moderate to severe complex apnea that is predominately central, it's a good thing you got on the right therapy with ASV. We already know CPAP and spontaneous bilevel would fail based on a clinical titration. Hopefully you have fired that quack and are looking for a competent doctor. Meanwhile, if you are using ASV and have some Oscar charts, we'll be glad to help you optimize it or troubleshoot any issues you're having. It appears on your profile you are using ASV auto with EPAP min 12, EPAP max 15 and we don't know what pressure support range is in use. Depending on what we see in your Oscar results we may look for opportunities to reduce EPAP pressure which is for the obstructive events only. Links in my signature show how to organize and attach an Oscar chart to your posts.

[SarcasticDave94]

IMO that EPAP sounds a bit high. Yep, we need some OSCAR charts. Even so, I still doubt TECA.

[LiaASV]

Yes sleep rider, those are the numbers. I’ll post a redacted full sleep study report tomorrow. The first doctor didn’t even mention my central events until the titration and then he said it was treatment emergent central sleep apnea. I had to go through my own report to tell him “what about the central events marked during the PSG without any pap therapy being used.” He skirted around that and said “you have complex sleep apnea.” He also put me on an ASV without any heart tests as well.

[Sleeprider]

The risks to your heart are negligible in the absence of advanced congestive heart failure, and that warning is an over-reaction to a 2015 study SERVE-HF that was poorly designed and poorly conducted that found an increased risk of sudden death in individuals with left ventricular ejection fraction well under 45%. A newer study ADVENT-HF has not confirmed those results. Leaving that behind, your sleep study will be interesting, but if you want real "bang for your buck" to optimize ASV you will post an Oscar chart.

[SarcasticDave94]

The ResMed ASV is easy to dial in by self titration, so it probably won't take much time.

I have a heart condition that lowered my LVEF to 55%. ASV didn't concern me or make me the worse for using. In fact after on it for a while, my LVEF went up to 63%.

Choice of mode
EPAP Min, Max
PS Min, Max
That's it besides humidifier and heated hose
Coffee time

[LiaASV]

Here is my redacted sleep study results and OSCAR data. I included the titrations for the sleep studies as well. This study was also done when I was 40 pounds heavier than I am currently, and I had taken Nyquil and melatonin, which made my osa worse, I would assume.

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I was only able to add two pages of the very long sleep study. If you want to see any other pages let me know. I had two titrations and one PSG.

[LiaASV]

I will also include a day when I had a lower leak rate and a lower AHI. I'm trying to get back to that with this chin strap. I've had it for a week, and that first night with it, I had the lowest leaks until I messed with the strap tightness, and now it's leaking a bit more.

[SarcasticDave94]

Just my opinion, I think the settings on the ASV could be made better.

EPAP 12-15
PS 2-10

I would possibly lower the EPAP numbers, and swap those onto the PS.

Example:
EPAP 7 or 8 Min and 12 or 13 Max
PS 3 or 4 Min, 15 Max

EPAP numbers should be based on controlling obstructive apnea, while PS combats the centrals.

And yes, if that first chart with lots of CA was the sleep study, and not a split or titration, treatment emergent CA would not be possible. Not buying their excuse.