Machine is hyperventilating me!

[Sleeprider]

A BiPAP with backup respiratory rate can be used but it is not the preferred method for Centrals. If an ASV can be used than that's the one that should be used. In this case it sounds like an ASV should be used.

From my reading, the usual treatment approach for centrals (outside of low EF heart failure) is that CPAP is first line (and/or supplemental oxygen as appropriate), ASV is second line, and BPAP with backup rate is third line.  So it does seem curious that they are skipping ASV and going to BPAP with backup rate.

On the other hand, I think it is very unlikely that a Yale SOM doctor would knowingly prescribe a less effective machine for financial reasons.  We're not talking 10x less expensive or something where the medical literature discusses cost effectiveness.  IMO, it's more likely that he either made a mistake and prescribed the wrong machine, that he knows something we don't know, or that he has a different "expert opinion" based on something or other...

I think you're on to something here.  Most likely, his last titration included BiPAP and ST, but not ASV.  The doctor is not about to explain why he did not order ASV titration and is willing to let his patient show him ST (which had something like 6 AHI in titration) does not work, before he orders a new sleep study for ASV.  We can only guess why a patient with a central apena Dx did not receive ASV titration, but that's my best guess.  It would be a nice concession to at least schedule the ASV titration to determine efficacy, but the VA works in mysterious ways.  The patients are usually accustomed to taking orders and respecting authority, rather than loudly advocating for proper treatment.  I don't care how smart you are or where you graduated, a mistake is a mistake...this is a mistake.

[Josephdfco]

So here is last night's data: https://imgur.com/a/MvsYH
I have to say, it was a really good night! I slept for more than 2 hours straight between wake-ups, and that hasn't happened in many years. I woke up for the first time in ages without that lousy headache/nausea/short of breath feeling. After class, I ended up taking a 2 hour nap, and I woke up feeling better. The machine was set to ST, with most of the original prescription settings except I set  trigger and cycle to low instead of medium, back up rate to 8 instead of 12, Ti max to 2.4 instead of 2.7, rise time to 300ms instead of min. IPAP/EPAP is 15/8, IBR off, and Ti min 0.3 as originally set.

[Josephdfco]

Also, you're right; they didn't try ASV during the titration.

[Shin Ryoku]

So here is last night's data: https://imgur.com/a/MvsYH
I have to say, it was a really good night! I slept for more than 2 hours straight between wake-ups, and that hasn't happened in many years. I woke up for the first time in ages without that lousy headache/nausea/short of breath feeling. After class, I ended up taking a 2 hour nap, and I woke up feeling better. The machine was set to ST, with most of the original prescription settings except I set  trigger and cycle to low instead of medium, back up rate to 8 instead of 12, Ti max to 2.4 instead of 2.7, rise time to 300ms instead of min. IPAP/EPAP is 15/8, IBR off, and Ti min 0.3 as originally set.

Looks and sounds very promising!

[Sleeprider]

Those numbers are good enough! If you can get comfortable with this and sleep, you won't be considered for ASV. It may be worth looking at close-ups of that flow rate since there is a lot of irregularity, for example 07:00-0720, 0520, and some other areas.

[Josephdfco]

Those numbers are good enough! If you can get comfortable with this and sleep, you won't be considered for ASV. It may be worth looking at close-ups of that flow rate since there is a lot of irregularity, for example 07:00-0720, 0520, and some other areas.

Thank you, Sleeprider and Doc! Yeah, that's what I was thinking, too.  They seemed determined to make this machine work, so I'm sure these results aren't going to change their minds.  I'll always be wondering if my sleep quality could be even better wit5h ASV, and it will drive me nuts thinking about it.  Doc posted something, and I believe you may have mentioned it too, about how ST can worsen centrals, so this may not be the end of all this. I'm going in in a couple weeks to be fitted for a full face mask (I need a chin strap due to snoring), and hopefully that will improve things. What do you mean about flow rate, and how can I fix that situation?  Last night's results:  https://imgur.com/a/HwWit
Thanks again, guys!

[Sleeprider]

Looks good again, and I suspect the machine is doing a lot of the breathing for you. It appears that pressure support is enough for your centrals. If you're getting comfortable with this and sleeping, then this is a fine solution. A number of people do use ST successfully, and I'm pretty certain that if this efficacy holds as a trend, you're not going to be moving to ASV.

[Josephdfco]

So what should I be doing now to "dial it in"?

[Sleeprider]

I don't see any "dialing" to do. If this is going to work, you need to get a week of data and make decisions from there. At that point, if hypopnea are predominate, I would increase pressure support, less than 1-cm. I'm pretty amazed, but this thing is resolving your centrals. I suspect you are mostly dependent on the backup rate, so as you adapt, you might move that up to 10.

[Josephdfco]

I don't see any "dialing" to do.  If this is going to work, you need to get a week of data and make decisions from there. At that point, if hypopnea are predominate, I would increase pressure support, less than 1-cm.  I'm pretty amazed, but this thing is resolving your centrals. I suspect you are mostly dependent on the backup rate, so as you adapt, you might move that up to 10.

That sounds like good advice. I'll slowly increase my rate towards 10.  Do you think I should slowly work my way from low trigger and cycle back to medium (as prescribed)? Also, how do i increase pressure support?