Self Titration ASV?

[MethodMan2020]

Hello ApneaBoard forum,

I'm a 25 y/o male, 170lb, 5'10, and have been suffering from the following for about 4 years:
-Daytime sleepiness 
-Fatigue
-Trouble concentrating
-Excessive sleeping without feeling rested
-poor working memory

I've been to my PCP, but all he's done for the last 4 years is give me sleeping pills and refuses to do anything else. I've had an at-home sleep test done in 2018 with only an email telling me I have no sleep apnea. I suspect some/most of the indication equipment fell off during sleep. I've tried to schedule an in-lab sleep study, but the last one I scheduled was 6 months out in advance and got canceled because of covid.

My wife tells me I do not snore in my sleep. I've recorded myself sleeping and was shocked to see myself going through coughing fits and a weird shallow breathing pattern.

I'm at the point in my life I have a decent career where I can afford to buy an ASV or CPAP machine. I'm done relying on medical "professionals" to try to help me. Has anyone gone through the route of self-titration? I've seen the OSCAR and SleepHead software that you can monitor your own sleep data from. I'm thinking of going towards the ASV route because I'm more than certain I have central or complicated apnea, and I see no reason other than cost why ASV wouldn't be the best sleep machine technology currently out.

[Jeremy H]

Are you exercising on  regular basis? Do you eat large meals before sleep? Stress? Do you meditate? I'm just trying to say if you havn't yet, look into what you can do to improve sleep. A friend of mine suffers from chronic daytime sleepiness, he took a home study as well and came back inconclusive. My advise would be try to improve your sleep conditions that you can, one being go to bed and get up AT THE SAME TIME EVERYDAY!
If you stay up late, and 'sleep in', it throws your brain out of the circadian cycle it needs to function well (on average).
You can't make up the sleep later.

One other thing, there are certain foods that can effect sleep, banana's and other foods, 'turkey' that contain tryptophan can alter your brains natural sleep cycle and you can wake up feeling very weird 'it acts like a drug'. Sleeping pills are the worst.

Hope this helps you somewhat, the real way to know is a real sleep study, but you could try these few small things first.

[Shadowpup]

I’m in rural Missouri.  Even out here, there are several family doctors, a sleep doctor, and a sleep lab at the county/regional hospital.  They got me fixed up relatively quickly(during the height of the COVID restrictions) with what has turned out to be really excellent therapy.  However, I must say members here helped me adjust my settings to really seal the deal.  Perhaps consider a new doctor or contact a sleep doctor directly.  

I also got on top of my sleep hygiene using web resources and handouts from my sleep doctor.

I’m sure there is a way forward for you and you will find it.  Best wishes.

[Sleeprider]

MethodMan, if you don't have central apnea and want to take a shot at improving spontaneous ventilation and any upper airway resistance, the ideal machine is not the ASV but the Resmed Aircurve 10 Vauto. This is a bilevel machine that offers a responsive auto-algorithm to any increasing airway resistance. It is the pressure support (difference between inhale and exhale pressure) that helps to overcome any upper airway resistance, while the positive pressure avoids any obstruction in the airway. You are self-treating and don't have a good idea of what you are trying to achieve other than to feel better. If airway resistance or flow limitation contributes to your fatigue, then the Vauto should help. There is no guarantee that your sleep wont' be somewhat disrupted by the use of positive pressure, a mask tube and all that goes with it, so you want to get the most comfortable and quiet setup possible. I think that means using the Airfit P10 nasal pillows mask which is smaller, lighter and quieter than just about anything out there, and wrapping the CPAP tube with a fleece cover to make it softer, quieter and less medicinal.

If you decide to go this route, it will be easier if you persuade your doctor to issue a prescription, however there are clearly a number of places to buy without. It's pretty certain without a diagnosis for obstructive sleep apnea, insurance is not going to cover.

[Danno ST]

Hello,

I'm also new to sleep therapy and working to self-diagnose before I go further down the official route.  I live in a metro area and watched Craigslist and Facebook marketplace specifically for the Philips DreamStation.  I found the second-hand market to be mostly small shops selling older, refurbished equipment but once in awhile an end-user would post up with a nearly new DreamStation for under $300 USD.  They get snatched up quickly but if you watch regularly you'll find one that was used for a few weeks and then sat in the closet.  

Caveats:
Used gear may not work like new - ask enough questions that you trust your source
Thoroughly disinfect anything you buy before you try it

I did a lot of reading before I decided to try this and found this forum to be an amazing resource.  This community is active and supportive.  The OSCAR software is excellent and I'm very happy with the machine I'm using.  I'm going into my second week "on the mask", have acclimated to the machine and I've started to get a better picture of what a "normal" night looks like for me.  I'll post some data soon for feedback and figure out next steps.

Good luck on your sleep journey!

Danno

[staceyburke]

Supplier #2 on the suppliers list at the top of the site sales used machines. They are sanitized and have a year warranty. If you do buy make it a ResMed S10 autoset or VAUTO. The autoset is a Cpap and the VAUTO is a bipap (about 400 more).  Don’t settle for the dreamstation it has a different program and MOST people here have found the ResMed better for their therapy. 

I have purchased 2 machines from Supplier #2 and both are great machines with 1 month, the other with 1 week of use. You can check the hour used on the machine - not just take someone’s word for how much it was used.

[MethodMan2020]

I have a ResMed aircurve 10 ASV coming in the mail. Is there any setting perimeters I should set up for the first night? I will post data as I go.

[Sleeprider]

ASV is quite simple, assuming you are setting up for complex or central apnea.  I previously suggested you should not use ASV as the machine of first resort, particularly when you have no indication that you need a noninvasive ventilator, however, I'm open minded, so here you go.
Mode: ASVauto
EPAP min 4
EPAP max 15
PS min 3.0
PS max 15.0