[Symptoms] clear airway

[67badger]

Thank you, I will try these settings for a week and see what happens

[Sleepster]

Basically, The ASV is used to treat central sleep apnea, usually when lesser machines were unsuccessful.

Most medical practitioners consider an index of 5 or higher to be the threshold. In other words, an average of 5 events per hour.

[palerider]

What determines need to consider ASV?
Percentage CA or number of CA per night

number, percentage is meaningless.

[vsheline]

What determines need to consider ASV?

In USA, some insurance companies require the CAI (CA Index, number of CA per hour) to be at least 10 or even 15 to be eligible for coverage of an ASV machine, but I think most are like USA Medicare, which (if memory serves) allows ASV coverage if the patient with non-ASV treatment has a CAI of at least 5 (yours is) and if the CAI is larger than the OAI (yours is), and if the patient is still having symptoms of excessive daytime sleepiness, and if an ASV titration shows that ASV therapy is able to reduce the AHI or RDI to acceptable levels (which your ASV titration will likely show).

[67badger]

Hey 67badger, the numbers are not too bad for someone early in their therapy. Let me explain your settings. You have an auto bilevel machine and are using it in a fixed pressure mode. The TiMAX of 2, TiMIN of 3 and rise time are defaults. You are using IPAP at 13.4 and EPAP at 9.4 which means you have a pressure support of 4.0 cm.

Your OA+H are pretty acceptable, but you have somewhat excessive CA. It's not enough to justify ASV, so we will not go there for now. The CA may go away without any changes or intervention, but I know it could be reduced with slightly modified settings. If I was setting it up, I'd recommend mode Vauto, IPAPmax 15, EPAPmin 8.4 and pressure support 3.0. This would start your therapy at 11.4/8.4 (IPAP/EPAP) and would allow it to go as high as 15.4/12.4. So the starting pressure is only 1-cm lower than your current prescription, but the Vauto mode will increase pressure as needed to respond to obstructive events. This lower pressure and pressure support should reduce CA events, but may slightly increase OA. If we find OA is unacceptable, the next step would be to increase EPAPmin by 0.6 to 9.0. If H is too high, we might go back to pressure support of 4.0. It will take some time, and trial and error to fine-tune.

This is nearly the same as your prescription, but lowers pressure and allows the machine's auto algorithm to respond to OA and will reduce the stimulation from pressure support that is the likely cause of CA. Feel free to run that idea by your doctor, or just try it out. You can always go back.

Thank you Sleeprider, I have been using your suggested settings for a week now and have had a high AHI of 2.6 and a low last night of 0.9 (best ever in almost 8 years of CPAP use).