VAuto Journey

[Gideon]

I'm inclined to bumping up EPAP. While increasing PS sounds good, it also means increasing CA events.

[lbl82]

   
My AHI was lower than it's ever been on this machine.  My CA events increased and my hypopnea decreased.  Could just be a random. Increase EPAP and reduce CA? Thoughts?

[SarcasticDave94]

There would be the randomness of CA to contend with, that consistently inconsistent factor. Tomorrow the CA may be very different in count. Is the results after that sleep session with a 2.0 AHI that you're still tired or some other discomfort? The chart looks quite good taken by itself.

[lbl82]

   
   
   
As you can see my AHI averages out to be 2.63 over the past 38 days.  My Ti Min is 0.3s and Ti Max is 1.6s. Trigger is very high. Cycle is High.  Although, the past couple of days my AHI has steadily increased.  The last 2 night my AHI has been around 5.00.  I've been a lot more tired the last two days during the day as well. I did start a new job on Monday.  Could stress affect quality not quantity of sleep? Any suggestions on machine settings?

[SarcasticDave94]

While stress and other external factors will impact sleep, so does CA that is not treated in the correct medical fashion. It appears CA is mostly twice that of OA per night consistently. I would consider this a fail. It's not capable of addressing your CA, and evidence says you aren't avoiding these either. ASV is the only answer.

[lbl82]

While stress and other external factors will impact sleep, so does CA that is not treated in the correct medical fashion. It appears CA is mostly twice that of OA per night consistently. I would consider this a fail. It's not capable of addressing your CA, and evidence says you aren't avoiding these either. ASV is the only answer.

When I put my trigger sensitivity to high my CA’s events are less. If it’s not treating the CA’s then what is it doing? I need to be able to explain this to my sleep doctor. Also, wouldn’t it be difficult for a Doctor to prescribe me an ASV titration study with my 
AHI numbers so low?

[SarcasticDave94]

The ASV is the only type of CPAP device that can treat CA, other machines can be programmed to avoid some CA as in what you have now more or less. Avoidance is via lower pressure swings, no EPR on AutoSet etc. How to get the doc to pay attention to CA you have? Note down all complaints/symptoms of fatigue and how the sleep is not restful. I know you're below 5 AHI, but if the CA are blocking restful sleep, make it known loud and clear to doc.

[Sleeprider]

The use of a high trigger is something we have observed to work with transient, therapy onset central apnea in some individuals. This is not a documented therapy application or claim by Resmed or any medical study, so it is strictly anecdotal. If it works, great! If no, then we move to the next level of therapy which is ASV.

The nature of central apnea like this is to be consistently inconsistent, and we need to see longer term trends before draw conclusions that any treatment is effective. Please focus your efforts on obtaining a Resmed Aircurve 10 ASV. Although your central apnea initially responded to this approach, it now seems to be returning to be a problem. I don't think we ever misrepresented that this is a substitute for ASV. I looked back a few pages (17) and I see Dave, myself and Fred all pointing to ASV as the likely solution.

[SarcasticDave94]

I see it as the VAuto attempt was a worthy shot at treatment, but as CA is still present in about double OA event counts rather consistently, the attempt isn't good enough at the avoidance game for your CA. The ASV will treat these CA in quick fashion. I'd venture to say the first night with a ResMed AirCurve 10 ASV would show immediate results/good difference. And that will lead you to restful sleeping.

[lbl82]

I see it as the VAuto attempt was a worthy shot at treatment, but as CA is still present in about double OA  event counts rather consistently, the attempt isn't good enough at the avoidance game for your CA. The ASV will treat these CA in quick fashion. I'd venture to say the first night with a ResMed AirCurve 10 ASV would show immediate results/good difference. And that will lead you to restful sleeping.

I have an appointment with the MD tomorrow. Here’s how I anticipate this going. She will look and see that my CA’s are very low since I adjusted my trigger sensitivity to very high. She will probably say that’s it’s treating the CA because of that. Since I don’t really know how to interpret and read these graphs I will have no response for her. How would I should her on the graphs that’s it’s not really treating my CA?