Obst & Central Apnea - on ASV. why do most say- resmed vs dreamstation auto sv?

[My3rd3y3]

Ok with the EPAP set to 13 or?

Got an appt for the 13th - an ENT. Unsure what to expect or even what needs to be done if I am fixable lol.

Called the pulmonologist, They said it would be quicker if I got a referral from my general dr or sleep specialist..... going to do that today. Unsure what a Pulmonologist can do or does even but will see.

[Sleeprider]

I think the ENT is the right start. Just explain your therapy experience with ASV at high pressures leaving you with apparently unresolved obstruction. He will perform at least a preliminary exam. We need to identify if there are physiologic problems that might explain the obstruction. That's all.

[My3rd3y3]

Thanks,  hopefully will be able to figure something out.   My Sleep Dr wrote me back - 


Eric, I can't access any of your new data so I can't say much about what your AHI is doing. I do want to get you in for a sooner appointment though to take a look at things. Before we get into other invasive testing, we may want to consider sending you in for an ASV titration first just to be sure. I'll have the staff call you to schedule.

I set the ASV to ASV mode vs ASVAuto 

Epap -     13 
Min PS - 3.0 
Max PS - 12.0 (Highest it would let me set it too)

Epap highest it would go adjust wise to in the ASV Mode is still 15 

[Sleeprider]

Thanks Eric, sound like you're on the right path to solve some problems. I'm going to be busy over the next few days renovating a house for a severely disabled (stroke) friend. We are doing ramps, wide doorways, lots of demolition, full bath renovation with roll-in shower and a home/hospital care room. Lot's of work to get done before he is released on the 12th. I will be checking in, but less often.

[My3rd3y3]

Well last night was def Better!  Going to leave it on this setting for now to see how it continues

Epap -     13
Min PS - 3.0
Max PS - 12.0 (Highest it would let me set it too)
Epap highest it would go adjust wise to in the ASV Mode is still 15

This first screen is my longest stretch of sleep from like midnight till 4ish -  Taking just that section and not the entire time period
My AHI shows as only 3.54



The entire "day"

[My3rd3y3]

My sleep dr appt got moved up to tomorrow! Guess we will go over the reports, talk about schedule sleep study and then my upcoming ENT appt.

Hopefully will get this all figured out.

Does a deviated septum effect apnea? How is that surgery?

[Sleeprider]

Encouraging direction in ASV mode. Looking forward to hearing more from your evaluation.

[Justbreath]

I have had the surgery..For me mouth breathing makes my OA much worse. I did elect to have the surgery and I believe it did help, although I still use nasal strips or nose vents. The recovery was ok except my uvula got crushed by the ET tube, had uvulitis for about 2weeks. The hardest part isn’t the first week.

[My3rd3y3]

Saw Sleep Doc Today, She was pissy I was changing the pressures but anywho -- She bumped up the Epap to 14,   leaving it on ASV mode.    returning in 2 weeks,   review reports then either ASV Tritration to see if other settings would be more optimal.

She did mention if ever needed more Epap it would be thru the Trilogy Ventilator but its super expensive,   but insurance would have to allow if its medically needed.   If I fail on the Trilogy then yea its over lol......   I guess the Trilogy  is more for well my pressures needs ? and end stage COPD -  I do have COPD but not end stage.   Just found out today there are stages lol.

https://www.usa.philips.com/healthcare/p...ifications

Some of its Specs / Settings
Specifications
IPAP - 50 cm H₂O
CPAP - 4 - 20 cmH20 (passive leak port circuits) cm H₂O
EPAP/PEEP (a) - 0 - 25 cmH20 (active valve circuits) cm H₂O
EPAP/PEEP (b) - 4 - 25 cmH20 (passive leak port circuits) cm H₂O
Pressure support - 0 – 30 cmH2O cm H₂O
Tidal volume - 50 - 2000 ml
Breath rate(a) - 0 - 60 BPM (AC mode) beats per minute
Breath rate(b) - 1 - 60 BPM (all other modes) beats per minute
Inspiratory time - 0.3 - 5.0  -s Synchrony features
Rise time - 1 - 6 (relative scale)
Ramp start pressure (a) - 0 - 25 cmH20 (active circuits) cm H₂O
Ramp start pressure (b) - 4 - 25 cmH20 (passive circuits) cm H₂O
Ramp start pressure © - 4 - 19 cmH20 (CPAP mode) cm H₂O
Ramp time - 5 - 45 min
C-Flex - 1 - 3 (relative scale)
Flow trigger sensitivity - 1 - 9 l/min

[Sleeprider]

I don't disagree with the doc. You have not had a workable prescription for pressure, and without guidance, most of us take our care into our own hands. Her recommendation is in the direction we were headed, so I can't argue. At least we have a professional vested in this process that knows enough to say your current therapy is not working as expected. That is progress.