Worried about periodic breathing / CA patterns

[jcp519]

Getting an ASV would not be detrimental to apneas and would probably make you nearly event free. ASV machines are significantly more expensive to buy than a standard APAP. There are options such as buying a refurbished or used machine which can help offset the cost.

Your doctor is correct in saying that the clear airway events should get better with time using the APAP. However, there is the possibility that the centrals will not get better over time, which was the case with me. I spent nearly 6 months on APAP and my central events never went away so I just found a used ASV and started using it. I felt significantly better on my ASV, but there are still going to be days where you get a little bit tired during the day. I was in the same boat as you, torn as to whether or not to buy an ASV and I'm glad that I did.

You could try to post some more OSCAR charts to see if there's any tweaks that could be done to help your therapy as well. From the last charts you posted the centrals did not seem too bad, but how you feel is most important.

[Sleeprider]

Generally, ASV won't be recommended unless CAI is greater than 5 per hour and comprise a majority of events. With ASV, you will not have central or very many other events, but it can also be a more distracting sleep. If you have the resources to pursue ASV, it will work, but your doctor's reluctance to go all-in is understandable. In the end, the ASV is just a bilevel device with programming to prevent variable breathing and central apnea, while preventing obstructive events. The only charts we have seen from earlier this month suggest your AHI is around 1.5 to 7.5 per hour with some clusters or CA. What do things look like now?

[Jorgo]

I'll post a couple of charts when I get home tonight, but typically they are around the 2 mark, with some outliers in the 4-5 range, with about 90% being clear airway events.

It's a struggle to get a consistent baseline as my leaking seems to vary wildly with no clear causation. As an example, my leak rate in the last week varied from 2.4 all the way up to 25! Although that being said, there doesn't necessarily seem to be a direct correlation between leak rates and events.

[jcp519]

Leaks can cause CA events or periodic breathing. They can also just be generally disruptive to sleep. Its possible you have some mouth leaks, but a chart would tell the full story for that.

[Jorgo]

Generally, ASV won't be recommended unless CAI is greater than 5 per hour and comprise a majority of events. With ASV, you will not have central or very many other events, but it can also be a more distracting sleep.  If you have the resources to pursue ASV, it will work, but your doctor's reluctance to go all-in is understandable.  In the end, the ASV is just a bilevel device with programming to prevent variable breathing and central apnea, while  preventing obstructive events. The only charts we have seen from earlier this month suggest your AHI is around 1.5 to 7.5 per hour with some clusters or CA. What do things look like now?

Can you please elaborate on your comment regarding an ASV potentially leading to a more distracted sleep?  Thanks!

[stevew168]

I'm not Sleeprider but I will put in my two cents here. I have been using an AirCurve 10 ASV for about six months as well, and I have the best sleep and also time awake ever. It has been much easier to get used to, compared to the AirSense 10 APAP. Even though I have a nearly default, wide range of pressures, I almost always sleep through most of the night and wake up feeling more refreshed and wide awake than ever before.

[Jorgo]

Thanks for your opinion! I keep trying to convince myself to stay the course and tweak my current machine but I keep changing my mind.

I checked with Resmed and I can hire an ASV to try it out but I need a prescription and I'm not sure my current sleep physician would go for it and I don't want to shell out yet more money to get a second opinion from another specialist who may very well say the same thing!

[Jorgo]

My Oscar data from the past 6 nights, I feel like it's fairly representative.  Note last night I was experimenting a bit and upped the min pressure from 7 -10.  Big mistake - big increase in AHI (all centrals) and feel like I've been hit by a truck.

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Second batch of graphs

[jcp519]

A lot of those central events look like they are leak related. If you could improve those leaks it would definitely help a lot. Even a small leak is enough to flush your body of CO2 and suppress your respiratory drive. Even with my ASV if I have lots of leaks/mouth leaks I feel pretty bad when I wake up.

[SarcasticDave94]

Why can ASV be more disruptive? It's down to the way it delivers pressures like PS. I was fine with how mine did its thing, but as I recall, the ASV increased pressure faster than say the VAuto or AutoSet. This is intentional to give a quick hard blow during Centrals to jolt a breath.

Also you need to start out therapy sessions in ASV with calm moderate rate breathing, or the ASV reads that as the breath pattern required, and it'll be faster then you're going to like.