Newbe with Complex Apnea - Best ASV to get?

[racprops]

From their notes:

Hyponeas and obstructive apneas were not significantly reduced with PAP during NREM and REM sleep.
CPAP was introducted and Titrated from 5 Cm to 19 CM and Bi-Level PAP at 19/15CM was sampled at the end of the night. Snoring was eliminated at 5 cm. CPAP was ineffective as a result of having developed complex sleep apnea (CPAP induced Central Apneas) and there was insufficient time for an adequate Bi-Level PAP titration.

Does that help?

[PaulaO2]

AHI: 68.1 HR
RDI:68/hr
A Obstructive index of 27.5/HR and a Mixed apnea index of 0.8/HR

You clarify later that this is the data WITH the CPAP. I'm not sure what the mixed apnea index is or means. Does the information split the AHI of 68.1 down? How many of that was obstructive, hypopnea, and central? Did the central increase in count as the pressure was increased?

If you do indeed have mixed apnea, then you need to know all the data. Such as how many of each event happened and when.

In looking up "mixed apnea index", I came across this.
http://www.resmed.com/us/clinicians/abou...clinicians
Interesting reading and defining between the three.

[PaulaO2]

CPAP pressure induced central events are common and most of them go away with time. Starting at a pressure lower than the true treatment pressure then increasing over time may help. An AutoPAP will also help. I have a history of this but did not experience the phenomena when I started with the Autoset, despite a much higher pressure.

[SuperSleeper]

From their notes:

Hyponeas and obstructive apneas were not significantly reduced with PAP during NREM and REM sleep.
CPAP was introducted and Titrated from 5 Cm to 19 CM and Bi-Level PAP at 19/15CM was sampled at the end of the night. Snoring was eliminated at 5 cm. CPAP was ineffective as a result of having developed complex sleep apnea (CPAP induced Central Apneas) and there was insufficient time for an adequate Bi-Level PAP titration.

Does that help?

Yes, that helps. Assuming that this sleep lab did everything correctly (which may be an incorrect assumption), then you indeed need higher pressures to combat the OSA, but when those higher pressures are reached, centrals rise to unacceptable levels. It would be nice to find out exactly how many centrals occurred at that 19 cmH2O CPAP pressure level, if that could be obtained.

What really needs to be determined is at what level of pressure did the centrals start increasing while on CPAP? (I suspect at slightly over 15 cmH2O, given the above notes), and that's probably why he started you on Bi-level at 19 IPAP and 15 EPAP.

So, he was trying at least to go from least expensive option to most expensive as far as the machine is concerned. (CPAP, then Bi-level, and now wanting a new titration to re-test bi-level and perhaps ASV if Bi-level doesn't do the job).

I can see now why they wanted you to come in for a second titration night.

If you still want to do this on your own, the cheaper way would be to get a trial of a data-capable Bi-Level to test and see if it might work at the higher levels without inducing an unacceptable level of centrals (setting the lower exhalation pressure setting at or near 15, while incrementally increasing the upper pressure 1 cmH2O each night and noting the effect upon AHI and centrals). If that doesn't work, you may have no choice but to switch to an ASV. Or, you could just start off with an ASV that is auto-titrating and go that route.

Again, this is all not medical advice, as I'm not a doctor. My personal opinion now that I know a bit more about the facts is that going in for a 2nd titration night would be the safest route, as long as you can afford it. Going on your own with ASV right off the bat with no clear titration information in a sleep lab could be marginally successful, since it's going to be hard for someone brand new to all this stuff to self-titrate with good results using an ASV, not knowing all the ins and outs of ASV titration. Yes, it can all be learned, but at some point, with health care, it's safer to pay a professional who has done it many times before.

Hopefully other more knowledgeable folks will be here this evening to chime in on this.

In any case, I'll leave the thread for now and let ASV users respond to your original question of which ASV is best.

[racprops]

Thanks again Supersleeper.

I am beginning to fear your right...

But with a good ASV machine running around $1400.00 used and around $1800.00 new (open box) I hate to add another $725.00 to the layout, specially if the ASV will do most of the work...

I really like the way a ASV works, it does nothing until I fail to breath, then it cuts in and makes me breath and as soon as I take over it shuts down and waits until it is needed again. AND it uses my breathing rate as well..it does not try to make me breath at a preset rate.

ALL other PAPs even a Bi-Level seem to push air no matter what I am doing.

Correct me if I am wrong

[Shastzi]

Hmm. The ASV is going to need an experienced tech to set up the first time, otherwise it may not be much help. :/

[racprops]

Shastzi: That is the big question, does it??

They are so automatic I really wonder if they really need any setup.

Rich

[Shastzi]

Hmm. Unknown, rac.
I am looking at the ASV and seeing a lot more doo-hickies that would need fine tuning.
I hear the thing can be configured as a straight CPAP, and can collect some real data but then you need someone experienced to *evaluate* the data and so get you 'dialed in' right.

If someone local to you can help with this that would be the ideal thing.
A local pulmonary specialist with that kind of exp & training, who is not associated with the folks you are currently sparring with, perhaps? Someone objective that does 'not have a dog in this fight'

Best of Luck!

[Shastzi]

This looks like more of a product comparison but maybe it could be some help.

http://www.lakesidepress.com/CPAP/ASV.htm

[racprops]

I have been looking.

Well I will watch for some more feedback.

Wish there was a Doctor in the house.

OR a sleep tech.

Thanks everyone for your input.

Rich