New on Bipap ASV, have a few questions

[WillSleep]

Also just to be clear I don't have a Resdmed, only ever had Phillips products so far.

I'd like to try a Resmed ASV if i get the chance, ASV cleared by OA and CA events without giving me aerophagia.
Was still getting lots of hypopneas, but hoping the Resmed faster/stronger reaction to events could help there.

Hi tcolar, 

This is all about you.. 

I have a feeling we have not really seen enough full day & 2 min segment screenshots (including those when you got 5-6 AHI on the DreamStation APAP) to know exactly what you need.   



And probably not enough about your personal desired approach to drive this to closure.  

A few quick thoughts:  

• We can certainly help you as you methodically tritate any high end PR or ResMed machine to get better than the 17 AHI.  I recommend we methodically follow the published old school clinical tritation processes.  ... first EPAP high enough to take out OA, then PS/IMAP high enough to take out hyponea, then CAs or anything else.    Seems like chasing a lot of CAs without the foundation laid sends us in circles for a while. 
  
• Rather than the prolonged scientific approach if  maybe your preference more to 'just throw something at it."   In that case the and if the possible return process does not bother you then go for the ResMed 10 ASV.  You never know.   The ASV might solve enough at lower pressures, etc the topics I pointed out above do not surface and therefore are not a concern.    Even if the ASV does not work out it likely will clean up some of what you were seeing better exposing any remaining problems to be solved.  
    
• Door #3:  Honestly, this is option I recommend.  It seems like you have enough data for your Doctor order a really extensive overnight sleep study that might find your real solution much faster than any other approach.  It is often hard to get insurance companies to agree to pay for these studies and you have good data in hand now.  So personally, this is the route I would do.   
  

WillSleep

[tcolar]

just wanted to give an update, that just as expected the Bipap ST has been worthless, I get aerophagia even at the lowest settings and it's not treating my events, I'm getting better sleep not using it, so I've pretty much stopped using it :-/

I don't now what to do about the aerophagia, nobody has given me solutions to that and I've tried elevating my bed, wedges, side sleeping etc etc ...

The ASV was working better because I could et it at the minimum (less aerophagia), but it would kick in high for events (although a bit too slowly).

I'm letting my Dr know about my displeasure abut this machine, and unless they switch it I'm gonna just end this .... or possibly buy one on my own.

The ASV's are super spendy though, I was curious about the Airsense autoset, that's obviously not an ASV but itseem to have some similar characteristic and supposedly have a fast response time (which I seem to need), how does it compare ?

[SarcasticDave94]

I really didn't yet go through the whole thread, I don't remember if you'd bought that Respironics ASV yourself or if Doc issued it for Central Apnea treatment. Recent exceptions applied, my ResMed ASV has done remarkably well in controlling my CA that was 124 on the sleep study.

An ST doesn't sound like it fits your needs, if you're displeased enough to quit. To address aerophagia, if the room is available within your treatment "window", lowering the pressure a bit can help sometimes.

[WillSleep]

... just as expected the Bipap ST has been worthless ...  even on lowest settings.  

The ASV was working better because I could et it at the minimum (less aerophagia), but it would kick in high for events (although a bit too slowly).

Hi tcolar, 

"just as expected the Bipap ST has been worthless ...  even on lowest settings."  

The ST does not include EasyBreathe like the ASV, VAuto and Autoset.   I would expect the ST to perform lower if you have not yet tried to dial in / tune the settings in the ST needed to fill the gap EasyBreathe covered for you, Rise Time, Ti Control, Trigger and Cycle.  

If you want might post daily screen shots and a few zoomed in to 2 min periods of example behavior and ask the group to help you tune the ST.  I do not have ST experience but others here do and I am sure would be happy to help tune the ST to help you get the most out of it. 

WillSleep

[tcolar]

All my machines have been via the Dr/DE so far, I can give you a quick recap

10/18 - Originally got diagnosed with mild apnea (home study, AHI was 18 IIRC)
11/18 - started using dreamstation ABAP machine, prescribed settings 7-11, so-so results, AHI in the 10-15 range
early 2019: Still on same setting, occasional aerophagia, say once a week
3/19 - increased the pressure to get better results. Decent results (3 to 5 AHI) with pressures of 11-14, however aerophagia became more frequent
5/19 - Set the machine to 8-14, a tradeoff between AHI (~ 5 to 7) and amount of aerophagia, worked well for a while, but eventually aerophagia got more and more frequent (tried bed wedges, positional therapy and a bunch of stuff to no avail)
8/19 - used on and off during summer, struggling with aerophagia, better ()but not great) sleep without cpap (no waking up because of aerophagia)
9/19 - Sleep study at the sleep clinic (in which I barely slept), result " This was a challenging titration study due to sleep onset and treatment emergent central apneas and aerophagia. Dr. Nathaniel Watson, the attending-interpreting physician, suggests a trial of Bilevel PAP (positive airway pressure) with a pressure setting of 9/6 cm H2O with a back up rate of 12."
9/19 - DME gives me a Dreamstation auto ASV. I get poor results with the default settings (AHI around 15, lots of mixed events)
9/19 - I change Backup rate to 10, my normal breathing rate is around 10 or 11, so BPM of 12 was very weird to me
9/19 - With help of this thread change setting to Min EPAP 4.0 Max IPAP 29.0 PS 6.0-23.5 (cmH2O) and get better AHI (~8), however there are NO CA or OA events, only hypnoeas, and they appear to be CA events that were just treated too slowly (the machine takes ~18 seconds to rise from to a pressure around 17 to clear the event)
9/19 - DME inform me they gave me the wrong machine and swaps me a Dreamstation Bipap ST
10/19 - Really crappy result with the ST, it does not treat my events and I now get aerophagia every single day, even with super low settins like 5-8.
11/19 - Pretty much stopped using cpap, as sleeping through the night (with events) still feels better than not sleeping (aerophagia)

Now considering giving up on cpap, and unless the DR is willing to put be back on the ASV, just going on my own and buy a machine.
Not really sure it's worth i though, because if I just get aerophagia with any machine and we can't find a fix for that, it might be hopeless.

[tcolar]

@WillSleep, yeah I definitely had to fix some of those settings:
- The BPM of 12 was just too high for me (80% triggered breath), my normal breathing rate is around 10 or 11, so I set BPM to 10
- The default TI of 1.2 was also horrible for me, I changed it to 2.5 (after checking graphs to find this look to be my normal when sleeping well)
 
I don't have any Trigger and Cycle settings on my machine IIRC

[Sleeprider]

just wanted to give an update, that just as expected the Bipap ST has been worthless, I get aerophagia even at the lowest settings and it's not treating my events, I'm getting better sleep not using it, so I've pretty much stopped using it :-/

I don't now what to do about the aerophagia, nobody has given me solutions to that and I've tried elevating my bed, wedges, side sleeping etc etc ...

The ASV was working better because I could et it at the minimum (less aerophagia), but it would kick in high for events (although a bit too slowly).

I'm letting my Dr know about my displeasure abut this machine, and unless they switch it I'm gonna just end this .... or possibly buy one on my own.

The ASV's are super spendy though, I was curious about the Airsense autoset, that's obviously not an ASV but itseem to have some similar characteristic and supposedly have a fast response time (which I seem to need), how does it compare ?

First, the Airsense 10 Autoset is a CPAP and won't help because it cannot provide pressure support or backup breaths.  You did pretty good on the ASV loaner, and I think that's where you belong.  You should consult with a gastroenterologist about your aerophagia as has to do with the lower esophageal sphincter (LES) and is often related to GERD.  If you must buy out of pocket, it will help to know your general location.  I often see ASV for sale in Craigslist, Offerup and other marketplaces online at very reasonable prices.

[tcolar]

Oops, sorry I mean to say the "Resmed AirCurve 10 VAuto", I get it's not really ASV, but seems to have many of the same features and vey configurable.

I'm also very tempted to try Resmed because it seems the Dreamstation is too slow to respond to my events and supposedly the Resmed is quicker.

Ideally I can convince the Dr to put me on an ASV ... and also to use a different DME, because this one only seem to do Phillips (and seem very tied to the sleep clinic, as they eve have representatives there), but anyway they haven't been been very receptive so far, so I might endup just going get one on my own .... but the Resmed AirCurve 10 VAuto is qute a bit cheaper if you agree that could do.


I haven't checked with a gastroenterologist but I want to say I have pretty much never had aerophagia (or even heartburn) when NOT using cpap.

I'm in the Seattle area.

[Sleeprider]

There are two ways air can enter the esophagus and reach the stomach. The upper esophageal sphincter (UES) which keeps food from entering the bronchi, and the LES which prevent stomach contents from entering the upper esophagus and blocks air the other way.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3525982/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3525983/
Either way, it's uncomfortable, and there may be some exercises or methods to reduce the problem. An interesting one is to actually use higher pressure prior to sleep onset to make the UES more resistant to passing air to the LES (second article). The UES is under a voluntary muscle control and higher pressure might precondition it to resisting pressure as you fall asleep and relax. Do a search on "management of CPAP emergent aerophagia" and see what you can find.

[SarcasticDave94]

Just my opinion, but the ResMed ASV may be the better option when you say the Respironics took too long to respond. It could make a world of difference. It seems you've indicated the other ASV was possibly where you noticed the best results of what you've been dealt so far.

Aerophagia as mentioned can be related to GERD. I've experienced both and it's not fun. It's worth checking out what a doc may do to help this.

Best wishes to your finding success.