[Treatment] ASV settings for treatment of complex sleep apnea

[Geer1]

One moment you say ASV is a success then you state you think you need medication. Which is it?

The diamox is for treating central apnea. Are you certain that is what is causing your PS to fluctuate (and not flow limited breaths etc which would indicate other setting changes)? You should be able to tell if this is the case.

Have you been tracking your subjective sleep quality and made a conclusion that your sleep is worse on these days that show more apneas being combated by the machine?

[JoeyWallaby]

Well, success as in, better than the other machines. I think it's the CAs, flow limitation is either mild or no limitation depending on where I look.

This video and study are really good
http://www.youtube.com/watch?v=Syv7YcHbTCI&t=45m30s
https://academic.oup.com/sleep/article/4...33/4868556

Last night I adjusted the settings to experiment, stability was a bit better still pretty bad at 5:30 to 6:30


This image might be useful

[JoeyWallaby]

[JoeyWallaby]

I've been waking up for a few seconds, multiple times a night, for like the last week. Looking at the overview things seem ok but zooming into flow rate, the arousals are obvious and numerous. Bruxism is still present, although reduced. I'm going to try acetazolamide and maybe I should try something to reduce arousal threshold.

[mper6794]

Hi, Joey
Situation somewhat similar to mine: too many unbearable arousals!
After an almost one year of own learnings, i think i am able to discriminate between respiratory-driven and RLS/PLMS- driven arousals. Respiratory was pretty much 100% resolved daily with the Vauto; after back to zero and started ALL over in a self titration.
Then, i have been trying best suitable medication, with bearable side effects: already disregarded pramipexol, pregabalin, and Valerian. These days i am trying propanolol; low hopes. Next texto is going to be zopiclone.
Best solution thus far: clonazepam 0.5/0.6 mg; leads to less arousals, less too early wake ups; and back to sleep quickly; best sleep efficiency ( > 80% in general).

It looks to me you would not have resolved respiratory-driven arousals yet, maybe (bruxism, indication of effort on your charts with asv desistabilizing your sleep, maybe...).
I could suggest Try to make sure on that discrimination and enentual new titration (mode S was good solution for me).

Good luck

[mper6794]

.....not able to update untill next week: currently on Vauto, 11.8/7.2/4.6...ipap Max = EPAP + PS......Trigger Med...cycle Med....ti 0.8...2.0.
It looks i am going to take a Very long while under those numbers.
I have realized How sugnificant would be a systematic titration ( Resmed protocols look work Very Nice).

ALL the best

[mper6794]

...... in time: what i meaned to discriminate is between/among respiratory-driven and whatever remain: plms, catathrenia, any other stimilum which might be present...

[Geer1]

Do the arousals correlate with any of the breathing issues, specifically your moments of slow respiration and falling minute ventilation? It seems like they might be following those times?

[70sSanO]

I'm always leery of posting when there is so much technical discussion because I can take only so much data analysis and then my brain says enough. The following is not scientific, but it seems to work for me.

During my first sleep study in 2001, complex sleep apnea was present, which was a moot point back then. I fought a good fight until about 6 months ago. Did an ASV titration and got an Aircurve 10.

Six years ago I started using a cervical collar, not because I knew anything about chin tucking, but due to a suggestion to help keep the airway open. I had lost a lot of weight and had, in fact, developed obstructive clusters back then.

I only bring this up because I didn't wear it during my ASV tittration which I aced, although I didn't sleep very well and felt lousy the next morning.

When I got my ASV machine I didn't use it and had an AHI of 0.3 with no apnea events, much less clusters. I felt lousy the next morning. Keep in mind I've been doing this stuff for almost 20 years and usually felt good in the morning. Next night, same thing; until I gave up in the middle of the night and put the collar back on. Slept great. My first night flow limitations were about 0.7 and dropped to almost 0.5 after that.

I started tweaking the setting. Went to ASVAuto. EPAP 5.0-10.0. Kept PS at 3.0-15.0. Did not go well. I slightly raised the Min and narrowed the EPAP range and and made some slight tweaks to PS and things got better.

But what really helped was trying to find the right bed pillow setup. I think I've go it to where I pretty happy with it. Generally my flow limitations are around 0.3 or less. Occasionally they will go up to 0.4 or so. The best thing is that I hardly wake up in the middle of the night anymore. Like everyone else, though, events of the day can throw that out the window.

I have no idea if this is of any help at all. You can dismiss it. It was founded on how things were done years ago before all the data. Data is great and I wouldn't go back. But there are only so many settings you can dial up.

John

[SarcasticDave94]

I think John has a point. Numbers can only tell us part of the story. The answer to "how do you feel?" probably needs to guide you along using the numbers to reference. Great numbers mean nothing if you don't feel great for the effort.