Needing some advice..

[SleepyWeasel]

Hello,

I started my journey in April 2022 with some scary episodes of falling asleep at bad times.  I met with my GP who recommended me for a sleep study.  I was given an at home study in June which indicated AH of 31/h.  Total count of apneas for the night was 227 all but one was central.  The one outlier was obstructive.

I was then scheduled for a split night study in mid-August which also confirmed CA.  I have attached some portions of the split study report.

The recommended therapy, based on trying different methods, was Bilevel ST.

Here I am in mid-September still waiting on a machine.  The DME is extremely slow to respond. Not sure how much is supply chain or just how the system works.  I'm supposed to call in today for an update on getting a machine.

I have insurance but I'm also not opposed to paying out of pocket or purchasing a used/reconditioned machine.  I'm really wanting to get started and begin feeling better and frustrated with waiting on the DME for a machine.  I have local friends who waited for about 6 months for a machine.

I'm 52 years old.  5'6" 159 lbs.  I'm physically active (running, hiking, biking).  I'm on blood pressure medication and have elevated cholesterol.

           

There's one last image which I'll attach in another post.

My questions:

Is a used machine a good way to go?
What machine?
Is the recommended treatment going to work or is it based on insurance requirements?

Any other direction or recommendations would be extremely helpful.  I'm a bit overwhelmed at this point.

Thanks for your help.

---

Here's the last part of my results from the in lab sleep study.

   

[OpalRose]

My questions:

Is a used machine a good way to go?
What machine?
Is the recommended treatment going to work or is it based on insurance requirements?

Any other direction or recommendations would be extremely helpful.  I'm a bit overwhelmed at this point.

Hi SleepyWeasel,
You were diagnosed with CSA (Central Sleep Apnea) and they recommended the
Bipap ST.  The only other machine to treat Central Sleep Apnea would be a ASV machine.

I would try the insurance route first as these are very expensive machines.  With the supply chain issues, there is no way of knowing how long this would take.  And just so you know, your experience with DME's, Doctors and Insurance is about normal.  

If you decide to buy outright, check Supplier #2, as they have a good reputation and sell good low hour used machines.  I don't know about availability though.

Look for the ResMed AirCurve 10 ST or the ResMed AirCurve 10 ASV.

[Nightynite]

I would think if you bought a used machine to start therapy now and continued to wait for the new one to arrive would be a good choice as long as your savvy about the purchase of the used machine. Hours ? Is it quite? smoke free home ? Cost ?

A backup machine is always a good thing once your new one arrives.

I have a backup machine and backup power supply.

Keep us posted and I hope that new one arrives soon.

[Gideon]

Severe CSA was diagnosed.  Was ASV discussed?  ASV was designed specifically to treat Central Apnea and it does so by maintaining Minute Volume on the same breath that is about to cause the Central Apnea.

The ST is designed to deliver a constant inhale and exhale pressure and used a timed backup to initiate a breath after xx seconds without one.

The ST Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions. Which does your husband have?
The ASV or ASV Auto Treats [b]Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB). [/b]Again, Which does your husband have?

My suggestion would be to advocate for the ASV.  Ask what is the path to an ASV and how do WE expedite getting there?

Do note that before the ASV existed the ST was a good choice, but that is IMHO very Old School.

The following is from the Wiki http://www.apneaboard.com/wiki/index.php...AP_-_BIPAP

his info is from the ResMed Sleep Lab Titration Guide

• CPAP (continuous positive airway pressure) Fixed pressure delivered with optional expiratory pressure relief (EPR). It Treats OSA
  

• AutoSet/APAP (automatic positive airway pressure) Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas. It treats OSA
  

• AutoSet for Her/APAP Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas along with an increased sensitivity to each flow-limited breath, providing a more comfortable therapy for women. Increases sensitivity to each flow-limited breath, providing a more comfortable therapy for women (OK for men too). It Treats OSA
  

• VAuto Automatically adjusts pressure in response to flow limitation, snore and obstructive apneas; Pressure Support (PS) is fixed throughout the night and can be set by the clinician. It Treats OSA, non-compliant OSA
  

• S (Spontaneous) Senses when the patient is inhaling and exhaling, and supplies appropriate pressures accordingly. Both treatment pressures are preset: inspiration (IPAP) and expiration (EPAP). It treats Non-compliant OSA and COPD
  

• ST (Spontaneous/Timed) Augments any breaths initiated by the patient, but also supplies additional breaths if the breath rate falls below the clinician’s set “backup” respiratory rate. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• T (Timed) Supplies a clinician-set respiratory rate and inspiratory/expiratory time, regardless of patient effort. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• iVAPS (intelligent Volume-Assured Pressure Support) Maintains a preset target alveolar minute ventilation by monitoring delivered ventilation, adjusting the pressure support and automatically providing an intelligent backup breath. It Treats COPD, Neuromuscular disease (NMD), Obesity Hypoventilation Syndrome (OHS) and other respiratory conditions
  

• ASV (adaptive servo-ventilation) Targets the patient’s minute ventilation, continually learning the patient’s breathing pattern and instantly responding to any changes. It treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

• ASVAuto Provides an ASV algorithm plus expiratory positive airway pressure (EPAP) that automatically responds on the patient’s next breath to flow limitation, snore and obstructive sleep apneas. It Treats Central or mixed apneas, complex sleep apnea, Periodic Breathing (PB)
  

• PAC (Pressure Assist Control, also known as Pressure Control) The inspiration time is preset in the PAC mode; there is no spontaneous/flow cycling. Inspiration can be triggered by the patient when respiratory rate is above a preset value, or delivered at a set time at the backup rate. It Treats Neuromuscular disease (NMD), pediatric patients
  
  

[clownbell]

Gideon is the expert, of course. I'd just like to report that my wife just received an ASV because of having predominantly central apnea. It works great, difference between night and day. I vote for ASV. It is a purpose built machine to handle centrals.

[SleepyWeasel]

Thank you all for the input.  I'll have to see what I end up with in terms of a machine.

I asked about and ASV machine.  My doctor indicated that ASV not necessarily better than bipap but would depend on how a patient responds.

Sounds like I will have to see how I respond to bipap before considering ASV.  It does look like my sleep study results showed favorable response to bipap.

I'll stay on top of my progress and see how things go.


I heard yesterday that insurance was approved and that I should hear from DME supplier for mask fitting and pick up my machine next week.

[Gideon]

Insist on a ResMed device!!! IMHO the best on the market.

[mesenteria]

Note that there are restrictions and advisories over the use of an ASV for people with such problems as heart failure.  If you go to their websites, you'll find a list of caveats over the recommended use of an ASV and when they're not recommended.

[SleepyWeasel]

Hello,

It has been a while since my first set of posts.  Since then I have started BPAP with a Aircurve 10 ST.  Recall that my situation is extreme central apnea.  As you can see from my data, it appears as though BPAP has greatly reduced my AHI.  

At first I felt that my settings were "pushing" my breath rate to the point it was uncomfortable and I was having trouble with aerophagia.  My therapist remotely lowered my pressure settings from 8-12 to 7-11.  There were also settings adjustments made that helped with the breathing rate.  Unfortunately, I did not record where they were prior to the change.  The settings changes did improve breathing comfort and eliminated the aerophagia.  I'm thinking now that I may be able to tolerate the higher pressure if that would improve my results.

However, I'm still having trouble tolerating treatment.  I often pull off the mask for about an hour or more in the middle of the night.  At that time I feel hot and restless and I feel like I want the mask off.  I've played with the humidity and hose temp a bit but not in a constructive approach.  I'm not sure if removing the mask is due to responding to apnea and restlessness or mask discomfort.

Here are my current settings:

EPAP 7 cmH20
IPAP 11 cmH20
Resp Rate 10.0
Ti Max 2.0 sec
Ti Min 0.3 sec
Rise 300 ms
Trigger Med
Cycle Low
Climate Control (humidity and heated hose)

I'm using the same medium N30i cushion that I was given with the machine.  I've tried a small cushion and a medium P30i pillow.  The medium N30i gives the best comfort and low leaks.

I started BPAP on 11 October and have been consistent in using it every night.  Initially, I felt good but over the last few weeks my sleep has been restless.  I'm not sure if it is that I am still getting used to treatment or if there are any improvements that I could make to help make it through the night.  I realize it could take a while and if there are no red flag issues with my settings then I'm content to continue to get used to therapy.

Any feedback would be greatly appreciated.

My therapist has been responsive to email questions and has set up a visit in the coming weeks.  While the clinician patient relationship is going well I will continue to work through the therapist to get things changed.  However, I would still like some other input on where to go next so that I can ask the right questions and understand where my treatment is going.

Thank you all.

[SleepyWeasel]

It has been a while since I posted.  Treatment has been OK but I am still not getting consistent restful sleep.  My AHI average is just under 5 but I often spike for several days up to around 10 or 12.  I gained some small improvement by increasing Trigger to Very High.

I am still having sleep disruptions due to events, I wake up and it may take a while for me to get back to sleep.  I guess this makes my AHI appear lower since I have no events while I'm awake but the machine is on.

I'm really interested in what ASV will do so I have purchased a reasonably used Resmed S9 VPAP Adapt #36037 with very low hours.  It should arrive in the next few days.  I'm looking for advice on where to start with settings.

Here's where I am now:

EPAP 7 cmH20
IPAP 11 cmH20
Resp Rate 10.0
Ti Max 2.0 sec
Ti Min 0.3 sec
Rise 300 ms
Trigger Very High
Cycle Low

I'm hoping that ASV will help with this.