How concerned should I be about the length of these Centrals?

[SarcasticDave94]

BTW if you're interested, here's my thread on the ASV path.

READ IF YOU WISH BY CLICKING HERE

Thanks for the comments everyone. I will read your journey, Dave. I need all the help I can get to start making these phone calls tomorrow. As for tonight, I think I'm going to take Sleeprider's suggestion and change my settings this way from my original thread "BiLevel Machine...Advise needed" post #25:

"Personally, I think you could do very well in Vauto mode at EPAP min 9.0, PS 4.0 and IPAP max 16.0." 

good plan to do those settings, at least you'd gain some relief for now

[Matt00926]

I concur with trying the VAuto mode...PS of 6 should more than likely never be used unless you have a known respiratory issue. By upsetting the balance of carbon dioxide in a person with normal CO2 levels it can cause central apneas. I would try this before getting an entirely new machine.

If you need more air, you can try increasing both IPAP and EPAP by 1cm H2O (keeping the same pressure support level) or make the rise time (only in S mode - there is no rise time in VAuto mode) a notch faster to increase the flow rate as long as it does not feel turbulent. Faster rise time fills the lungs and reaches peak pressure faster -it's actually recommended when you have 'air hunger'. Or try another mask. Some people find nasal/nasal pillow masks suffocating no matter what.

I am honestly not sure how they arrived at your 18/12 settings when you have zero AHI aside from centrals. Usually people at least have some events no matter how much tweaking they do.

If you wouldn't mind, could you post all of your current settings (rise time, Ti min and Ti Max, etc)?

[LookingForward]

Well, I can't say enough good things about Sleeprider's advice! 

I switched the machine to Auto with those settings and the results are in a range that maybe I don't even need an ASV!

I don't think I woke up as much as before but I'm still a bit short of breath even after being awake for 3 hours now. I'm also really tired still. But I assume that after a few nights like last night, my body will respond better as far as the symptoms go. I'm not sure if I just got used to the high blast of air at 18/12 but the amount of air last night seemed very minimal, too low. But the results speak for themselves. 

If you want any other information on there or a close up of something, let me know. 

At this point, I'm not sure that I'm going to call the doctor's office today and push for the ASV. I kind of want to give my current machine a little more time and see if it will work for me on Auto.

Oh, and of the 4 centrals that I had last night, two of them were 14 seconds, one was 13 seconds and one was 12 seconds! Amazing! 

Thanks again for all the support!

Here are last nights results!!   

[attachment=9074]

[LookingForward]

I concur with trying the VAuto mode...PS of 6 should more than likely never be used unless you have a known respiratory issue. By upsetting the balance of carbon dioxide in a person with normal CO2 levels it can cause central apneas. I would try this before getting an entirely new machine.

If you need more air, you can try increasing both IPAP and EPAP by 1cm H2O (keeping the same pressure support level) or make the rise time (only in S mode - there is no rise time in VAuto mode) a notch faster to increase the flow rate as long as it does not feel turbulent. Faster rise time fills the lungs and reaches peak pressure faster -it's actually recommended when you have 'air hunger'. Or try another mask. Some people find nasal/nasal pillow masks suffocating no matter what.

I am honestly not sure how they arrived at your 18/12 settings when you have zero AHI aside from centrals. Usually people at least have some events no matter how much tweaking they do.

If you wouldn't mind, could you post all of your current settings (rise time, Ti min and Ti Max, etc)?

When the setting was 18/12 in S mode, the other settings were:
IPAP: 18.0
EPAP: 12.0
Easy-Breathe: On
Ti Max: 2.0s
Ti Min: 0.3s
Rise Time: Min
Trigger: Med
Cycle: Med
Mask: Pillows (or Nasal)
Ramp Time: Off
Climate Ctrl: Manual
Tube Temp.: 81
Humidity Level: 2

[Sleeprider]

I don't think you should have to resort to legal threats to get treatment, but persistence in calling can go a long way towards motivating them to get you off their back. All they need to do is release the prescription to you and/or the DME of your choice. Hopefully the doctor is not financially involved with the DME dispensing business. It is the DME that will contact your insurance for authorization, not your doctor. The doctor should provide you with a copy of the ASV study, physician's recommendation and a prescription. You can then use this at the DME of your choice, and maintain copies for your records after you fire this clown.

You should prefer the Resmed Aircurve 10 ASV over the Philips Dreamstation. I suspect your doctor will have it set up in fixed ASV mode. You will want to move to ASV auto mode as soon as possible to take advantage of auto adjusting EPAP pressure.

[LookingForward]

Sleeprider, I just posted last night's results. Should I still pursue the ASV?

Thanks again.

[SarcasticDave94]

I sincerely hope legal assist won't be required for the pursuit of ASV, but it's out there if needed.

I myself didn't need that route. I did certainly pursue calling daily until they provided my ASV. Once again, best sincere wishes on pursuit and possession of the ResMed 10 ASV machine.

[Sleeprider]

I had missed that we were back in the original therapy thread. What an amazing difference these settings made! We don't know the results of your titration test, but if they did a good job, they might have found, your old settings in S-mode were just wrong, and your blow-hard doctor is having a hard time eating his words. I actually think we can use a lower pressure if you want. Let me know.

Tell me again, why we waited so long to do this?

[Matt00926]

Your new settings are giving beautiful results. If you keep at the same settings, those remaining centrals may also settle down with time, if they are all in fact real centrals even. A few centrals are not really harmful unless you get a nasty cluster of them, as far as I am aware. I'd leave what you have now for at least a week and then reevaluate as needed.

[LookingForward]

Tell me again, why we waited so long to do this?

I had gone back to the original thread to get your recommendations. On that thread you made several suggestions. On a few nights I did switch to one of the suggestions you gave but I ended up switching back and not trying anything else because I realized how angry my doctor was when I told him that I started off using my mom’s machine to help me get used to therapy before my machine arrived. He also got really angry when I pushed to get the Auto machine when he was only willing to let the sleep tech stay on Spontaneous mode for the sleep study back in June. The doctor was mad that I went out on my own and started learning about all this. So I didn’t change the settings further because I didn’t want to further rock the boat. I wanted him to stop being angry and possibly work with me. 

Now that the new ASV study is done, he won’t look at what I’m doing with my current machine and he’s still angry. So now I will change the settings! 

Last night I went back to that original thread and looked up your recommendation for the Auto setting and decided to give it a try. 

I’m still a bit short of breath and very tired even though it’s noon. But I’m willing to make further changes in the settings for tonight if you think you can help me not wake up short of breath anymore.