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08-17-2024, 01:55 PM (This post was last modified: 08-17-2024, 01:59 PM by avhenry.)
Hit a dead end with Bilevel. Do I need an ASV?
Currently I'm using a Resmed 10 VAuto (bilevel) with good results data wise, yet I still feel tired. So I've been on a journey to increase my pressure levels to treat what appears to be UARS*. The dilemma is this: if I increase my air pressure (currently 13cm IPAP / 8cm EPAP) any further, I get severe aerophagia, which is painful and wakes me up. If increase the pressure support range (currently 5) any further, I get lots of treatment induced central apneas (some as long as 30 seconds). Based on the research I've done, it appears the only solution is to get an ASV machine to correct the treatment induced CAs that are occuring. I've tried lots of things to fix the aerophagia problem, but they haven't worked. So it looks like treating the CAs is the only path forward.
Does it make sense to get an ASV? Or is there something else I'm missing here?
Thanks guys.
*for more details of my treatment journey check my post history
08-17-2024, 02:12 PM (This post was last modified: 08-17-2024, 05:28 PM by SarcasticDave94.
Edit Reason: Edit
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RE: Hit a dead end with Bilevel. Do I need an ASV?
ASV for UARS? Maybe.
Your other thread didn't mention much in the Central Apnea, the requirement probably isn't there, for CA treatment alone.
You have had some aerophagia, and that issue plus the ability to handle PS range that the ResMed ASV puts out, I think you'll be in the same boat as now. ASV can be tuned to minimize aerophagia, but it will compromise therapy.
Example of my settings when on ASV, for comparison sake.
ASV Auto mode
EPAP 7-12
PS 3-15
IPAP 10-27
Granted, it doesn't need to be this exact setup. But for ASV to work against CA the PS needs to be higher than your current VAuto regardless of what it is. The ASV will force a PS range of 5 meaning the least PS will be 0-5, but at that it's not taking care of the majority of CA an average Central Apnea treatment needs.
What info was on the sleep study and current OSCAR? If your CA is low, ASV isn't a great idea in my opinion. You seem to struggle using VAuto, ASV is going to be harder.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
08-17-2024, 04:53 PM (This post was last modified: 08-17-2024, 05:02 PM by avhenry.)
RE: Hit a dead end with Bilevel. Do I need an ASV?
Deborah,
• My pressure is static, not auto, so there's nothing to see there.
• The flow limit chart shows nothing because it's not tracked in static mode. It's a quirk of the Resmed 10 VAuto apparently. But when I've had in auto it shows nothing also.
• The event flags chart is at the top and the leak chart is the 3rd one down :-)
I'll also add the only events that do show up are marked as "unclassified" for some reason. They are in fact CAs when I zoom in, as the flow line just goes flat for 10+ seconds.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
RE: Hit a dead end with Bilevel. Do I need an ASV?
Ok I've attached the image instead, and made it bigger. Hopefully that helps. (you can zoom in on imgur btw)
Dave,
I've done the "no range" auto mode before to see flow limits, but nothing was ever there so I just keep it simple by staying in static mode. There's no reason beyond that.
RE: Hit a dead end with Bilevel. Do I need an ASV?
OK thanks that's better. Honestly I'm not nearly as good at pulling out hidden issues within OSCAR. Until I get my new machine, I'll finally get to practice in OSCAR after 4 years off therapy due to Dr. Quacky McDuck.
On the surface it looks decent.
Understood on S vs Auto. It's your choice then if it makes no therapy difference. I'm facing running VAuto and S myself and having run ASV for 2 years with pressure ranges, I'm leaning into thinking I'll not like static. With my COPD, I need the therapy with leverage.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
08-17-2024, 06:38 PM (This post was last modified: 08-17-2024, 06:42 PM by avhenry.)
RE: Hit a dead end with Bilevel. Do I need an ASV?
One more thing I'll add: In the chart you'll see periodic leak spikes, these are the main thing I'm trying to eliminate. I had a data analyst with Jason of TheLankyLefty27 (youtube) and he said these are likely gasps for air (not mask leaks) which indicates that higher pressure is needed (and possibly meaning I have UARS). The leak spikes correlate with the pulse rate spikes so that leads me to believe Jason is correct in his diagnosis. It's pretty much the only thing noticeably "off" with my charts. I also fit the profile of a typical UARS patient, that being a tall young male with a slim/athletic build (I think Jason mentioned this in one of his UARS videos).
