New CPAP User ready to quit - Central Apnea, ASV

[Big Guy]

What keeps you sticking with it Big Guy?  That’s been my mental battle and it’s only been a few weeks.  Are you getting benefits?

I'm hoping that I'm just a late bloomer. I'm shooting for one more year. There are times when I just don't feel like gearing up for the night, only to realize that if I do, I usually end up regretting it. 

My wife says that I don't snore nearly as much as I used to when I don't gear up. I'm not promoting the non-use of CPAP. It's just that for me, I see this therapy as a long distance race, rather than a sprint to the finish line. 

I'm committed to the therapy for now, but it has to be on my terms. I can't be 100% compliant and that's okay with me. I'll settle for anything less than that.

[AFM1]

Good morning.  I am new here and have been using CPAP for the past two weeks.  Using the Resmed Airsense 10. They have changed my mask three times.  I have used the Mirage FX, the F20 and am now using the F30.  I am getting the worst sleep of my life.  I am keeping the mask on for 5-6 hours a night but (despite the smiley face) I am getting large leaks at the mask (25-31L) and my AHI has not come down.  Any ideas would be appreciated.  I have attached a screenshot from last night.  Hoping this is the right location for this post. Thanks!

I started on a trial in September with a Resmed Airsense Auto 10 and my AHI continued in double digits, and every mask I tried whether nasal and full face leaked, about a week age my sleep doctor put on an old Resemed S9 Vpap machine, as I am having Central Apneas and Restless Leg Syndrome. and low and behold my AHI's have dropped to  0.1 2.2.
The point is persist and try different machines, as there are many on the market and OSA is just one of them

[tntfrahm]

Sleeprider pid='316519' dateline='1572022823'][attachment=16527]         This is going to seem a bit off-the-wall-, but one of the easiest solutions to try is a soft cervical collar.  Your events are being recorded as central, and we usually see obstructive events in positional apnea.  Before you jump to conclusons that it sounds awful, read these two articles:
Positional Apnea http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft Cervical Collar: http://www.apneaboard.com/wiki/index.php...cal_Collar

The soft collar approach is inexpensive, usually helps with mask fit and reduces events regardless of sleep position.  My other therapy suggestion was to set your machine to CPAP mode at a pressure of 6.0 with EPR off.  I hope you will try the pressure change tonight, and if events and leaks continue, add the soft collar.  We will learn from these experiments, and hopefully solve some problems while we're at it.

Thanks again to all for the input. Here are my last two nights at 6.0 with EPR off.

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I am supposed to get the soft cervical collar Tuesday. Hoping for good things!

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What keeps you sticking with it Big Guy?  That’s been my mental battle and it’s only been a few weeks.  Are you getting benefits?

I'm hoping that I'm just a late bloomer. I'm shooting for one more year. There are times when I just don't feel like gearing up for the night, only to realize that if I do, I usually end up regretting it. 

My wife says that I don't snore nearly as much as I used to when I don't gear up. I'm not promoting the non-use of CPAP. It's just that for me, I see this therapy as a long distance race, rather than a sprint to the finish line. 

I'm committed to the therapy for now, but it has to be on my terms. I'm can't be 100% compliant and that's okay with me. I'll settle for anything less than that.

That is so great that you are finding benefits to keep you motivated.  That motivates ME. Thanks for the input.

[Big Guy]

This is going to seem a bit off-the-wall-, but one of the easiest solutions to try is a soft cervical collar.  Your events are being recorded as central, and we usually see obstructive events in positional apnea.  Before you jump to conclusons that it sounds awful, read these two articles:
Positional Apnea http://www.apneaboard.com/wiki/index.php...onal_Apnea
Soft Cervical Collar: http://www.apneaboard.com/wiki/index.php...cal_Collar

The soft collar approach is inexpensive, usually helps with mask fit and reduces events regardless of sleep position.  My other therapy suggestion was to set your machine to CPAP mode at a pressure of 6.0 with EPR off.  I hope you will try the pressure change tonight, and if events and leaks continue, add the soft collar.  We will learn from these experiments, and hopefully solve some problems while we're at it.

Thanks again to all for the input. Here are my last two nights at 6.0 with EPR off.

---

I am supposed to get the soft cervical collar Tuesday.  Hoping for good things!

---

What keeps you sticking with it Big Guy?  That’s been my mental battle and it’s only been a few weeks.  Are you getting benefits?

I'm hoping that I'm just a late bloomer. I'm shooting for one more year. There are times when I just don't feel like gearing up for the night, only to realize that if I do, I usually end up regretting it. 

My wife says that I don't snore nearly as much as I used to when I don't gear up. I'm not promoting the non-use of CPAP. It's just that for me, I see this therapy as a long distance race, rather than a sprint to the finish line. 

I'm committed to the therapy for now, but it has to be on my terms. I'm can't be 100% compliant and that's okay with me. I'll settle for anything less than that.

That is so great that you are finding benefits to keep you motivated.  That motivates ME. Thanks for the input.

Yes, definitely stick with it. Everyone seems to find success at different levels and/or periods of use. I figure the longer I use it, the better off I am. 

There are nights when all goes very well and I was glad that I geared up. It's situations like those that do keep me motivated. That, and this forum and all of it's fine members who offer advice and support. 

Without this forum, I would have given up months ago.

[Sleeprider]

TNT, we see an improvement with fixed pressure and EPR off. Events remain mostly central with hypopnea. I am not optimistic that a soft cervical collar will help to resolve these events, and I think we need to start discussing a strategy that moves you towards ASV therapy. I'll encourage you to keep these settings for a while, but let's get an understanding where you stand with your doctor and insurance.

Does your doctor seem receptive to your input? If so, time to share these results and ask about the centrals. Better yet be direct about asking for an ASV titration. Does your insurance provide reasonably good coverage? Do you have deductibles that restart in January that would make it advantageous to defer testing and a new machine until next year? Finally, how do you feel about pursuing a self-funded option that would provide the treatment you need and drop your AHI to less than 1 for about $700 or possibly less?

[Sleeprider]

I'm going to answer your question on what the differences are with ASV in the thread rather than your PM. ASV is "adaptive servo ventilation". It is a bilevel positive air pressure device (BPAP BiPAP) that detects your breathing on a breath by breath basis. It is like auto-CPAP because it will raise your exhale pressure (EPAP) when it detects obstructive apnea airway restriction that does not respond to pressure support. Pressure Support (PS) is the difference between inhale and exhale pressure IPAP-EPAP = PS. This machine is an advanced bilevel PAP that maintains your breathing rate (breaths/minute BPM) and targets your last 90 seconds of minute vent (the volume you breathe in 1-minute in litres per minute) to ensure you maintain a natural breathing rate and volume without central apnea or hypopnea. It uses pressure support when needed, as needed to keep your breathing rate and volume constant. These are feats your CPAP and other BiPAPs cannot do.

We have a couple wikis to read: http://www.apneaboard.com/wiki/index.php...tion_(ASV)
http://www.apneaboard.com/wiki/index.php...ackup_Info What you nave to understand is that these machines are expensive, and insurance is reluctant to fund them unless it is shown that both CPAP and conventional BiPAP are ineffective, and that ASV can be effective. This requires a number of sleep / titration tests and trials on different machines, as well as support from a doctor that understands the issues and is willing to appeal insurance decisions to get you the therapy you need. This bureaucracy ensures the process is expensive, time-consuming and frustrating. That is why I suggested considering self-treatment and asking permission later. We have many members that use ASV, and the support for that machine on Apnea Board is unlike anyplace else on the web. We can virtually assure you that your AHI will be near zero using a Resmed Aircurve 10 ASV, but you have to stick with it to win the game.

The title of this thread is how everyone that gets ineffective therapy feels, and why most quit before finding a solution to the problem. Without peer support and help from your doctor, you will not recognize the problem, and become part of the big "couldn't tolerate CPAP and quit" statistics. You have to earn this one. Think about how you want to proceed, and it you want to achieve good health with no sleep disordered breathing, you will have to work for it and advocate for yourself. We will support your efforts and encourage you along the way. Like I said, you can take a shortcut for a reasonable amount of money, but we have coached many members through the process to obtain a prescription and dispensing of a new ASV. Your first step is to tell your doctor of your high AHI, your frustration and desire to feel better. Tell him you want to move towards ASV, but the next step will be a clinical titration using CPAP and possibly evaluating BiPAP.

[tntfrahm]

Thank you. It is definitely frustrating and it seems that nothing I have done has done anything to make it better.   I will reach out to my doctor tomorrow. What portion of the report shows the central apneas? I want to know a little more about that portion before going back to him.  Thanks!

[Sleeprider]

In your daily details all of the magenta hashes are CA (central apnea) and the blue hash events are Hypopnea. You have virtually no obstructive events. Your Resmed machine tests each apnea using the Forced Oscillation Technique (FOT) to determine if your airway is open or obstructed. In your case, the airway is open and you could breathe, but your brain is not sending the signal to do so. That are many reasons this can occur, including too little carbon dioxide in your bloodstream (Hypocapnea) as a result of the CPAP ventilation or some central nervous disorder. We will assume it is idiopathic or without-cause, as is the case with most of your members.

The best way to visualize this is to use the zoom feature of OSCAR to look at 2-minute segments of your flow rate chart. This is your breathing wave-form, and to understand more about it, I wrote a wiki: http://www.apneaboard.com/wiki/index.php...ailed_look When you have a central apnea, the graph will settle on the zero-flow line and you will see the squiggle of the FOT testing. When you have a hypopnea, you will see the flow rate diminishes from normal meaning you are breathing less air. If you want to post some examples of close-ups, we can look at them and tell you what to discuss with the doctor.

[tntfrahm]

Perfect!  Thank you!

[jaswilliams]

Just to add to the information that Sleeprider has given the Hypopnoeas on your chart could also be CA’s that result in a reduced breath rather than no breath. But the Resmed machines do not distinguish the type of Hypopnoea ie is it obstructive or Central in nature.

It might be possible by looking at the flow graph to decide if your Hypopnoeas are central or Obstructive, but it does not change the treatment an ASV is the way to go.