Sleep test Titration with ASV

[Geer1]

As I wait patiently for my dr to tell me what to do next, I have a question that I can’t find an answer to. My results from ASV titration to max ps 20, max epap 5, min ps 6, min epap 5, rate 10 bpm show 2 central apneas and 94 central hypopneas. 

From what I understand, the Resmed ASV doesn’t record centrals because it stops them in their tracks. Why didn’t my sleep test do the same?

Not sure where you came up with that idea. Resmed ASV attempts to treat centrals and is one of the most effective central apnea treatments but it doesn't "stop them in their tracks". The only reason Resmed ASV doesn't record centrals is because the backup breaths interferes with the forced oscillation technique they use for scoring apnea so every machine that uses backup rate (including ASV) does not attempt to determine apnea type and instead scores all apnea as unknown apnea.

As for why your sleep test didn't fully treat central apnea.

A) I can't help but wonder if the sleep technician ever done an ASV titration study before? 16 AHI and 67 arousal/awakening index and they didn't bother to try adjusting the settings at all during 7.5 hours... Why did they use a high min PS of 6 (which can induce/worsen central apnea effects)? Phillips Respironics titration guide recommends min PS of 0 or as needed for patient comfort, Resmed recommends min PS of 3. PS of 6 is high especially with more square wave form PR uses. Frankly I think that titration study was a waste of time and that these poor settings likely were effecting your sleep in numerous ways, unfortunately because they didn't do their job and try other settings I can't confirm that... I personally would be asking the clinic to redo it or refund you. 

B) We often see more residual hypopneas with PR ASV because it is less aggressive than Resmed. This might have been part of the reason but I think the poor settings was just as significant (if not more so).

[Rubicon]

You seem to have more awakenings on graph (at least 18) than are counted in the tables (11).

Your REM is severely delayed.

PLMs may not necessarily require treatment (they only need to be treated if they cause arousals, and that index (7.3) is small potatoes in the big scheme of things). That said, IMO PLMs tend to be overscored (i.e., they're not real, they're a result of arousal, not a cause). If so, that would make spontaneous arousals 305 instead of 268. Either way, we're still talking train wreck sleep.

What medications are you taking?

Is there an accompanying interpretation?

Do you have a diagnostic NPSG?

[1Joyous1]

I called the dr’s office and told them that I would be there in the morning during the walk-in clinic to get help. I’m a zombie. Not even 2 minutes later, the sleep lab called to ask me what DME I wanted them to send my prescription for an ASV to. I asked about the plms and awakenings. “Your dr. will discuss all of that with you after you have used the machine for 2 months.” 

[Rubicon]

If you're not happy with the way things are going, ask them for a DVD copy of the entire sleep study (raw data and scoring mask) with the Physician Reader program (I don't know if that particular software has a Physician Reader option, but it should).

[1Joyous1]

I will Rubicon. This whole experience has been questionable. The cd will prove it. 
I called the DME and guess what? They have received nothing.

[kappa]

1Joyous1, do you have any previous sleep study reports? Data from existing/previous CPAP/APAP/BiPAP you can share, etc? We don't have a lot of history here - how did you get to an ASV titration sleep study?