NEWBIE- Any adjustment to CA or try ASV ?

[Luiz.A]

Hello Everyone!

Since last year started to wake up tired and snore very loud all night, so i decided to see a Sleep Doctor. 
The Doc asked me to make a PSN and the results are:  

My Profile
Man 
6.03ft 
203 lb 
No heart disease 
Don't take any prescription 
Good Health

Sleep Study ( PSN ) 


- High Level AP/HP ( 59,3 Hr ) 

- Lower SaO2 86% 

- CA rate - 26,7/Hr 

- OA rate - 32,6 /hr 

- Snore 93,9% time 

- Sleep efficiency 86,5%  
- micro-wakeup  - 53,5 /hr 

Result - Severe sleep apnea

After analyzed, he decided to CPAP, but kept clearly that possible  " upgrade" to a ASV if CA persists at a high level.

He prescribed 
-RESMED AUTOSENSE V10
- MASK - Dreamwear - Nasal cushion

- Autoset 

- Pressure 5-15 
- EPR 3 - RAMP only 

- I read with attention forum threads about CA and call the Doc about changing the EPR to OFF, he told me to set EPR LEVEL 1 - FULL TIME and set the pressure to 6 ( Min ), which i did.

- I started five days ago, I guess CPAP helps me a lot with my respiratory disturbance, my wife said that i don t snore anymore, but i wake up more frequently than normal because of the Mask, and still tired during the day.

Thank you so much in advance for the suggestions.



           

[Luiz.A]

More two nights 

       

[Sleeprider]

Welcome. CPAP at 6.0 to 15 pressure with EPR 1 has resolved OA events, and considering your sleep study, the CA event rate is much lower than expected. With an obvious diagnosis of severe complex apnea, I suspect that in time, the central event rate will be inconsistent and may very likely increase. Your settings are a bit different than the prescription, with EPR at 1 and since ramp pressure is set at 6.0, it is very difficult to distinguish from therapy. Your respiratory statistics are generally good with a tidal volume near 500 mL and 11-12 breaths per minute. The only anomaly is that inspiration time is greater than expiration time, however this cannot be influenced by your current machine. I don't see any settings that I would change at this point. CPAP is mostly a tool for obstructive apnea, and increasing pressure or EPR is likely to make the central events worse. As you gain more experience with the CPAP, we may see an increase in the central apnea rate, or you might be one of the lucky ones that resolves the problem with CPAP. Keep us posted on your progress and we will try to help if things change or you find you are not getting good sleep.

[SarcasticDave94]

My humble opinion is even though the Central component is addressed reasonably as shown, due to what we've seen here on the Apnea Board (and what I had to deal with myself) Central Apnea events will have inconsistency as a component. Due to that, I think eventually you may be best served with an ASV to minimize sleep disturbances.

If there's a breath timing component to consider, a ResMed ASV may not be best but the Respironics DreamStation Auto SV might be better.

If you do not need timing control, the ResMed AirCurve ASV is excellent, and it's what I'm on now.

[Dormeo]

Hello, Luiz. To double-check the ratio of inspiration to expiration, you might want to post a screenshot in which you zoom in on a one-minute interval of your flow rate, in a period of time you are pretty sure you are asleep. This will enable us to see a little better what your breaths look like.

To zoom in, you can just left-click on the area you've selected until you get to a one-minute view.