Treatment Resistant Central Sleep Apnea?

[asdz123]

I bumped up the EPAP Minimum to 6 last night and it seems to have helped reduce my AHI to <1. Anecdotally, I do feel a lot less tired this morning compared to when I was using the CPAP. However, I did still wake up 3 times last night and had some issues with bloating. Should I try reducing the EPAP Min to 5 tonight?

[SarcasticDave94]

I would suggest not dropping the EPAP Min. The results of that added 2 on Min EPAP looks good on OSCAR as in we're headed in the right direction. OSCAR also shows your Max EPAP was 8.12, so try dropping EPAP Max from 15 default down to 10. You can also drop PS Max down to 12 if you want. This still gives you an IPAP Max 22 while your IPAP Max on the chart was 17.62. If the drop of both EPAP and PS is not what you want, just drop EPAP Max at this time and see if it helps.


Thumbnail on pressure edit
NEW
EPAP 6-10
PS 3-12
IPAP 9-22

OLD
EPAP 6-15
PS 3-15
IPAP 9-30

[asdz123]

Thanks Dave, I set my EPAP and PS to the settings that you recommended yesterday, although there didn't seem to be an option to set the IPAP from the S9's clinical menu.

Here's the results from last night:

   

My AHI looks great, but I did still wake up a few times throughout the night and I'm not feeling that rested this morning. I'm still looking into addressing the aerophagia issue as well, possibly either with a chin strap or mouth tape given how I've seen others deal with it on the forum.

EDIT: Now that I think about it, the reason for me waking up at night could just be due to it being hotter than usual locally these past few nights.

[SarcasticDave94]

I'm sorry about the IPAP and my not explaining it. ResMed's ASV has settings for EPAP and PS. The machine algorithm that does the auto pressure adjusting also controls IPAP based on your settings of EPAP and PS that are selected at that moment. So all 3 EPAP, PS, and IPAP are ranges that go between the Min and Max respectively. Data still looks good, so the lowered pressures didn't hinder treatment.

If you need it, drop your Max numbers a bit again to get aerophagia under control to a tolerable level. I've found that sleeping on the left side and a slight upper body elevation helps minimize this too.

OK, a bit of feedback from you then a new setting edit. Can you think of anything that didn't feel good or any disturbances overnight in breathing, discomfort, etc.? I ask because I see activity on your Flow Limit chart.

I know you want to lower all settings but if you're up to it, try the following for EPAP and PS, and remember IPAP will automatically change due to these new numbers.

EPAP 7-10
PS 3-10
(auto configured) IPAP 10-20

This raises your lowest number by 1 to attempt to tame FL and lowers Max by 2 to see if aerophagia responds positively. If it helps but not enough, drop PS Max down 1 or 2 more to give PS 3-8 or 9. But try the new settings if possible above a whole night if you can before dropping PS down to a range of 3-8 or 9. If aerophagia is real bad and you try out further PS reductions then that's fine, but give the other slight reduction a good try first. Makes sense I hope. If not, ask.

[asdz123]

Got it and much appreciated, I think I see how IPAP works now. 

I didn't recall having any discomfort issues overnight other than some bloating, but I'm going to try sleeping with my wedge pillow tonight and see if that improves things.

[SarcasticDave94]

OK great to hear it. If your settings from the first edit do serve well by helping the aerophagia then keep that first set. Only adjust downward if you must. Again, by the numbers, it looks good.

[asdz123]

I set the settings to EPAP 7-10, PS 3-10, IPAP 10-20 last night which produced my best AHI yet. 

   

The aerophagia was definitely a lot better last night thanks to the reduced max, and sleeping with a wedge pillow helped too. I'm wondering whether the spikes in flow limits are due to me turning & tossing at night, which I'm now suspecting is RLS. I still felt tired waking up this morning, but better than previous nights. I think that means the therapy is working! 

I might try reducing my max numbers again to see if I can further limit the aerophagia issue, but I'll revert it to EPAP 7-10, PS 3-10, IPAP 10-20 if my AHI worsens.

[SarcasticDave94]

OK that looks very good still on the numbers. You say it is doing good and aerophagia is down. All wins I would say. If you do decide to adjust pressures down, take it off the EPAP and PS Max, maybe drop it by 1 either/or, if both as required. Have in mind that eventually, after a week or so, you go back up to this setting that you have currently.

Congrats on the win.

[jaswilliams]

The spikes in flow limitation is nothing to worry about on an ASV you get a spike when the ASV encourages you to breath and a full breath is not taken. I would not change anything else for now the areophagia will reduce over time I expect, reducing the PS will reduce the effectiveness of the ASV

[asdz123]

Noted on keeping the settings where they are, the therapy is clearly working and the aerophagia isn't bad enough to warrant reducing the maxes. Thank you so much SarcasticDave94 for helping me to dial them in. 

I left it on EPAP 7-10, PS 3-10, IPAP 10-20 last night and got my first 0.0 AHI!

   

I do feel less tired upon waking lately, but my daytime sleepiness also seems to have gotten worse since I started using the ASV. I imagine that this is due to me either finally paying off my sleep debt, or it's because I still need time to adjust to the new breathing pattern of the machine.