What Resmed Machine for BPAP with Many Central Apnea events?

[bcorlando]

Been on CPAP for 11 years.  My doctor changed me to Bi-PAP (set at 19 / 15 ) after sleep study in 2015.  Currently using Resmed S10 Auto in S mode, and am quite happy with Resmed machines.  Now 5 years and eligible for new machine.  My concern is that I am constantly showing a Lot of Central apnea events in any one nights offload. This truly concerns me, and I frequently don't feel well refreshed after nights sleep -- even though AHI usually shows under 3.0. Any help or machine suggestions for me before I discuss new machine with my doctor.  Please note that when I asked / showed concern about the central events, his response was basically, "Oh, we don't really look at that...", which to me does not address my question or concern. This in spite of the fact that he is a pulmonologist, and also teaches at a major university in our area. I think that I am going to have to guide, or control (which I can) the preferred Resmed Auto or BPAP machine choice that he writes up / prescribes. Help?

[SarcasticDave94]

Assuming the data is available, we can better answer if you can post sleepyhead data. This will allow us to "see" what is happening. If in fact there's central apneas involved, there are 2 paths to approach successful treatment. Optimized pressure settings on a BPAP can work for some. Gurus viewing the data will suggest setting adjustments to get things working well. Second path is that the optimization of a BPAP does not work, in that case you may need to consider an ASV. But again, it is very difficult to know which direction without seeing data. I know I'm redundant.



PS if that Duck doctor isn't willing to explore your statement of centrals existing because (paraphrase) "we just don't look at those", replace the doc as he's wasting your time. You need a doc willing to address your complaint, IMO.

[Walla Walla]

Since your in S-mode you can try reducing your pressure support by either raising your EPAP to 16cm or reducing your IPAP to 18cm and see if that helps reduce the CA events. Probably increasing the EPAP is the better move to avoid increasing obstructive apneas. As far as machines I'd recommend the Resmed VAUTO. I have both the VAUTO and Dreamstation Auto BiPAP and I think the VAUTO is the better machine. YMMV.

[Hojo]

On the flip side, an AHI of <5 is considered treated, but that being said, how many minutes of apnea do you have per night and how long is the machine on?  I ask that because there were nights when I had very few CA events but the amount of time in apnea was very alarming.  The data that my doc saw was very minimal and the Sleepyhead data showed more specific info and I took it to the doc's office and he agred with my need for ASV.

[ardenum]

The problem with pulmologists is that they only care about O2 saturation.

I'd suggest switching to a neuro sleep doctor, will not only care about CA's which are neuro-based. will also help you address any subjective problems you might have with the therapy itself. As a side step.

As for the machine I never used Respironics but I am on Resmed VAuto and it works.

[bcorlando]

Thanks. Will look for a "neuro sleep doctor".  And I agree ref I only use Resmed machines.

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Thanks!  I will try this also.

[Ron AKA]

Not any kind of an expert on these type of machines. However, if I was forced to just pick a ResMed machine to help with significant central apnea issues not well addressed with an Auto CPAP, it would be their AirCurve 10 ASV. It offers an Auto ASV mode that potentially will detect central apnea events assist some with breathing, but not as much as a true ventilator. They cost about $5000 in Canada, so possibly $3800 US or less... Google it for more info. If you can talk your doc into it, and your insurance company will pay, then it may cover all bases. 

One caution though. ASV machines are not for everyone. A quote from the link below:

"On May 13th, 2015, ResMed issued a press release and related Urgent Field Safety Notice, “An update on Phase IV SERVE-HF Study of Adaptive Servo-Ventilation (ASV) Therapy in Central Sleep Apnea and Chronic Heart Failure.”  ResMed and regulatory authorities cautioned against the use of ASV therapy in patients with symptomatic chronic heart failure (NYHA 2-4) and reduced LVEF</=45%, AND moderate to severe predominant central sleep apnea. 

ASV for Complex and Central Sleep Apnea

[bcorlando]

Thanks.  And Thanks for the "warning" since I am being treated for CHF with a cardiologist.

[SarcasticDave94]

Thanks.  And Thanks for the "warning" since I am being treated for CHF with a cardiologist.

FWIW this is a standard/required test to qualify for ASV. LVEF ≤ 45% being the threshold of determining if ASV is "safe". It's handled as a pass/fail scenario as I understand it, and I had to deal with it myself as I'm on ASV. Mine BTW was at LVEF 55.

[dmeRT]

"Now 5 years and eligible for new machine."

I think it might be a little more difficult to get a new bipap than this statement implies. Insurances just don't buy you a new machine every 5 years. If you're medicare, there has to be a malfunction and be a model that no longer is repaired. insurance will pay for repairs rather than buy a new one. If your trying to change to a bipap s/t or bipap asv to treat the centrals, insurance will require an in lab titration study that shows you need this type of bipap. With an AHI of 3, not sure insurance would authorize one.