RE: Switched from CPAP to Bilevel but results no better
Now for a change, a significant one.
Decrease your min by 3, thus setting EPAP = 10 and making your PS = 6
For helping your CA's and making you more comfortable. If this gives you too much trouble set EPAP back to 13 (I'd prefer 12) Note PS=4 is considered a starting place for BiLevels.
RE: Switched from CPAP to Bilevel but results no better
@SarcasticDave94 Thank you for explaining about the test. I am more concerned about the stress on my heart from the apnea than a perceived and contradicted effect from the ASV! Haha.
@sleeprider Thank you for the link. Knowledge is definitely empowering, especially in the medical world and it is important for us each to be responsible for our own health, when able. That's why this forum is so helpful!
My doc is semi retired, older gentleman and we communicate via messaging. I have not seen him in person since last year. Of course I would rather not have to be in the sleep lab overnight again to "try" the ASV but this is what he is saying. Here is what he wrote when I suggested the ST model wasn't right for me and the ASV would be better.
" I do think that the ST model is designed to treat both obstructive and central sleep apnea but it just does not always work well for patients. I think you did have difficulty tolerating the higher pressures that they used and the backup rate. For many patients the ASV is more comfortable works better. This whole thing gets even more complicated because there were at least 2 types of ASV machines. Your situation while discouraging and frustrating, is not all that rare. Central sleep apnea comes into the picture the treatment becomes more difficult."
What I would like to do therefore go ahead and arrange for you to come back to the lab and try the ASV machine. I will go ahead and arrange for this. In the meantime let us see how you do with the present BiPAP ST and try making some minor adjustments to see if we can't improve how you are doing in the meantime. Central sleep apnea does not appear to disrupt sleep nearly as much as the obstructive apneas."
@Bonjour I was tempted to go back and use my regular CPAP machine until the change to ASV became available. I used it last night and I was in and out of sleep all night long. My AHI was 30 this morning on 5 hours of sleep. So, not good. I have pulled the ST back out and made the adjustments you suggested for tonight. IPAP is 16 and EPAP is 10. Doc adjusted my Resp Rate from 10 down to 7. Falling asleep against the pounding air is what I struggle with the most.
RE: Switched from CPAP to Bilevel but results no better
Ask your doctor if you can simply try a home trial with ASV. Show him the simple titration recommenation. A clinic will not do anything differently and you can save a lot of money. Get the Resmed Aircurve 10 ASV and use it with EPAP min 5.0, EPAP max 15.0, PS min 3.0 and PS max 15.0. It WILL work and we can fine tune to your needs. We can have you comfortable by the second night of use. With the Resmed ASV, the breath rates and volumes are all automatic, based on your own breathing rate and volume; the ASV just maintains it when central occur. It is fully automatic. Try to avoid a sleep study unless you have really good insurance and the costs to you are low.
Speaking of insurance, I don't know what your copay is for a machine, but
Supplier #2 sells the Aircurve 10 ASV lightly used at $1350. Use that as a reference point.
RE: Switched from CPAP to Bilevel but results no better
OK, I will suggest that. Thank you for the encouragement and excellent resource list!
I do have good insurance but I still hate to waste time and money if it's not necessary. Not to mention that in-lab studies here require a Covid test and then quarantine for the days between the test and the study.
RE: Switched from CPAP to Bilevel but results no better
My doctor agreed to put in a request for the ResMed AirCurve ASV Auto with the respiratory company. I'm waiting to see if they say additional tests are required or if they just call me to come pick it up.
I could not use the ST for one more night even with the new setting you suggested, Bonjour. The force of the air with every intake of breath is so disconcerting that it is impossible for me to fall asleep on it. Is this something unique to the ST model or will the ASV force breaths like that, too? It feels like the machine is trying to breath for me.
My regular CPAP machine doesn't do that. I've gone back to using that machine until the ASV is available.
RE: Switched from CPAP to Bilevel but results no better
To treat Central Apnea the machine HAS to breathe for you. The trick is to let it do so only when you need to.
With the ST the backup rate is what drives this, but the pressures are fixed, so that higher pressure needs to be available, and used, ON EVERY BREATH.
The ASV is variable and makes changes on every breath, but first 'learns' your breathing. Then it applies only as much pressure as needed to resolve your central apnea.
The ASV maintains your minute vent at a fairly constant value, meaning that your air intake is constant. With ASV you will at times feel that 'force of air' and you need to forcefully blow back which tells the machine that you are not ready yet, try again so it will repeat it's 'learning' cycle.
The PS of 6 was an attempt to get the PS high enough to impact your Central apnea. Setting PS = 3 will put it into the same territory as your CPAP with EPR = 3.
RE: Switched from CPAP to Bilevel but results no better
Good news there for you and doc trying to get you to the ASV. I believe the ResMed AirCurve 10 ASV will fix this as soon as you get it and get therapy from it.
Mask Primer
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
RE: Switched from CPAP to Bilevel but results no better
Try and ensure you get the Resmed ASV it’s more effective than the Philips
RE: Switched from CPAP to Bilevel but results no better
The respiratory company informed me that my insurance company will not approve the ASV machine because my central apneas were less than 50% of my total apneas during my sleep study in June. I think they measured 32. I could have another study done but I declined because I don't think it would be much changed since June.
So... On Monday I am going to have a consultation about having an oral appliance made for the OA portion of my apneas. I will continue using my ResMed AirSense 10 to address the CA's with the hope that the two combined will have some affect overall. The ST machine only made matters worse and I will turn that in this week.
I will start a new thread here once I am on this new treatment plan and have some data output from my CPAP to see what is occurring. Thank you all for your encouragement and advice. It's a journey...
RE: Switched from CPAP to Bilevel but results no better
Appeal! What you need is a titration study using CPAP BPAP an ASV to identify the portion of your sleep disordered breathing that is central. You may not have had quite enough CA events during your diagnostic sleep study, but with the therapy onset centrals you must have ASV. Talk to your doctor and don't let the insurance company run the show. You have a problem your Airsense 10 and a dental device won't address. More money out of your pocket that solves nothing. Your insurance company would have you take an antacid for a heart condition. Appeal, appeal appeal! Get the doctor involved.
You said, "The respiratory company informed me that my insurance company will not approve the ASV machine". What is the respiratory company? Is that the equipment supplier or DME? You must get a doctor's order to proceed with a titration study that will demonstrate the need for, and efficacy of ASV.
