Suddenly my Centrals got a lot more disruptive

[SarcasticDave94]

For other markets than US it appears the ResMed AirCurve 10 PaceWave ASV is your correctly named answer. If you can get them to do it.

Does the comments your doctor states is that ASV will breathe for you or that a BPAP will? Because neither ASV or other regular BPAP will become a breathing for you ventilator.

[Sleeprider]

The Lumis 150 will do ST mode which allows you to breath spontaneously, but it will trigger IPAP on a timed basis. That is actually a step-up in capability from the VPAP S or Vauto which is fully based on spontaneous breathing, but can adjust trigger sensitivity to trigger IPAP with less flow. It should work fine. My only issue with the ST is the square-wave pressure transitions from EPAP to IPAP. The iVAPS algorithm on that machine is really intended for individuals that cannot maintain their respiratory volume without mechanical help, so I doubt that will be the mode you will use. If any machine will "breathe for you" it is the Lumis 150 in iVAPS or PAC mode, so I'm not sure your specialist really understands these devices. The ASV allows for spontaneous breathing, but will step in with pressure support when a breath is missing or lacks volume, so it treats both obstructive and central apnea with pressure support as needed, when needed.

[tcinoz]

For other markets than US it appears the ResMed AirCurve 10 PaceWave ASV is your correctly named answer. If you can get them to do it.

Does the comments your doctor states is that ASV will breathe for you or that a BPAP will? Because neither ASV or other regular BPAP will become a breathing for you ventilator.

She was referring to the BPAP when she said that.

One of the Resmed shop assistants once told me that all their machines are variations of the basic CPAP machines and if that wasn't working for me the chances are none of them would and I would need some alternative type of treatment or procedure(s).

I'm beginning to believe I need to get my heart and lungs fixed for any significant improvement - especially this weird zombie feeling I get from the end of my deep sleep stage onwards even when the AHI figure is relatively low. It could be CO2 related, heart failure or lung (mal)function, or a combination of any of them, but making headway in getting to the root of my CA problem is painfully slow when I have to deal with three different medical practices (sleep clinic, GP and cardiologist) all with long waiting times. Nearly six months on from my first sleep clinic appointment, I've only just this week had some blood tests done - and the results won't be discussed till my next appointment on 17 June.

If the universe has been trying to teach me something through this ordeal, it needs to work on a sharper message delivery!

[stevew168]

Yep, those pesky centrals keep popping up mainly during the REM sleep. Yet counter-intuitively the flow limitations seem relatively settled by then compared to during the N3 stage.

It depends on what muscles are causing the obstructions. If they are mostly paralyzed during REM sleep, your flow limitations will reduce. I notice my obstructive apneas go way down when I have had more than a couple glasses of wine late at night. I don't have centrals using the ASV.

[tcinoz]

Steve, or anyone else, I would appreciate if you could explain Flow Limitations to me.

I switched to a nasal pillows mask last night but kept the pressure low to avoid that pumped up feeling from a more direct flow than the nasal mask I was used to. I may be able to turn it up gradually as I get accustomed to it.

The results were mixed. The AHI figure was relatively low, especially during the REM stage. However, Flow Limitations were almost double my usual average, while my O2 average level (measured with my new Wellue O2Ring) at 96 was about the same as usual, but unusually I had four dips below 90. Each of the dips occured when I was up and about in between sleeps and coincided with spikes in heart rate.

The reason I have to get up after the deep sleep stage is that ever since I was diagnosed with sleep apnea (six months ago) I wake up with brain fog usually accompanied by high blood pressure, irrespective of the AHI figure. Both my heart and lung function are less than optimal. If I go straight back to sleep the sensation gets worse every time I wake up, so I have to move about a bit to clear the brain fog and get my circulation going again.

So what exactly causes Flow Limitations? If it's some sort of subconscious resistance to the air that's coming in because I can't breathe it in quickly enough, I'd expect it to have manifested as leaks (through my mouth). My leaks are actually down with the nasal pillows.

Does turning up the pressure generally help with reducing Flow Limitaions, or does one's internal resistance simply increase? Also, presumably reducing Flow Limitations means better O2 retention, right? Maybe all this is again pointing to a BPAP machine as a preferable option if a BPAP deals better with Flow Limitations.

Thanks again, everyone. Any observations much appreciated as always. Last night's screenshots attached.

[attachment=64026]  [attachment=64027]

[SarcasticDave94]

Flow limits are the lowest restriction level and represent the beginning of an Apnea. Hypopnea are between these two. To address, it typically means either EPR or PS needs to increase, and if not available then pressure needs to increase to be a stronger air stent.

[tcinoz]

OK, thanks very much Dave - clear answer. 
I have EPR on max for my machine and no PS available, so I shall increase the pressure incrementally, starting tonight.

[tcinoz]

I am having one of my worst nights ever. I have slept only two and a half hours and although the pattern of my sleep is typical (waking up after a deep sleep and needing to get up for a while because something just feels 'wrong'), this time I haven't been able to get back to sleep. The second section with the high number of CAs represents me just lying there awake with what feels like a massive block to my entire energy flow.

I switched to a nasal pillows mask recently and although I much prefer it for comfort, my Flow Limitations have almost doubled.

I am attaching three screenshots, two of them zooms, all from tonight, and would be grateful if someone could comment on what's going on with my breathing and what causes Flow Limitations in the first place. Can it just be stress? Or do I have a problem with my lungs - maybe from the Covid I had last year? I wheeze a bit but it's only at night that any real problem rears its head.

My O2 sats and heart-rate (measured separately) are fine. My BP, which I take meds for, is highish when I take it after waking up, but nowhere near dangerously so.

Thanks in advance.

               

[SarcasticDave94]

I can't quite tell here, but it appears EPR 3 is active, so there's no higher EPR/PS to go to. This leaves us with higher pressures to combat the flow limits.

It does appear you're using the For Her mode which I think edits the response to soft. Any difference in your sleep results and events in standard mode?

[tcinoz]

I switched that option on as a random decision, thinking it might act as a kind of extra level of EPR. Maybe I shouldn't have?  But either way I always have flow limits of 0.12 or above, even with higher pressure when I was using a nasal mask. I realised I may have to go to BiPAP to reduce them, but was wanting to understand what caused them so that I can try and eliminate them at source. I was wondering if those breathing patterns gave any clues (one zoom - the shallower one - when asleep, the other when trying to sleep). Maybe even the beta blockers I take for my BP could be a factor?