Worried about periodic breathing / CA patterns

[Jorgo]

Hi all,

Not sure if I should start a new thread or continue here.  I managed to convince my specialist to give me a prescription for an ASV with a recommended range for EPAP and PS.  The ranges look a little odd to me (EPAP min and max seem a tad high and PS max seems way too low), so I just wanted to check here to see if they appear to be a reasonable starting point for a first time ASV user.

EPAP min: 7
EPAP max: 14
PS min: 2
PS max: 5

Additionally, are there any other settings I should look to tweak?  I will turn ramp off (hate it on my APAP), but anything else?

Thanks as always!

[SarcasticDave94]

Best to keep it here for context.

I agree the EPAP and PS ranges are lopsided. That PS will not go into the ResMed ASV, as it's not a range of 5. And being a low range like that, your ASV is handcuffed to not really be able to blow during Centrals.

Try this, EPAP 5-12 PS 3-15

PS will then be at default. You might never touch PS Max 15.

All the settings I recall on ASV are:
Mode CPAP, ASV, and ASV Auto
EPAP single number in ASV, range like now in ASV Auto, CPAP single pressure

PS is always a range like you have, must have a differential of 5 between Min and Max

IPAP is hidden, can't edit direct, indirect manipulation by edits to EPAP and PS, example you have EPAP 7-14 PS 2-5, IPAP would be the sum of those, IPAP 9-19

Heated hose control, humidifier, Ramp, Smart start and stop, reminders, about it I think

[Jorgo]

Superstar, thank you!

[Jorgo]

As an aside, I found this in an American Thoracic Society paper on ASV therapy. Has anyone heard of this as a risk before??

"There may be direct effects of ASV which could affect breathing patterns or heart function. The ASV settings can sometimes lead to hyperventilation (breathing too much) which can lead to respiratory alkalosis (low carbon dioxide, high pH in the body) and electrolyte abnormalities. These changes, if present, could trigger arrhythmias (irregular heart beating) which could lead to sudden cardiac death."

[SarcasticDave94]

It may be, or be based on, a flawed SERV-HF study about ASV being related to heart failure. The study findings were flawed, incorrectly linking ASV to heart failure. I myself have PVC's, this stands for Pulmonary Ventricular Contractions, a rhythm, timing issue of the heart, and used an ASV.

Do you have a heart condition already diagnosed? The things like heart failure means your health is very poor, and it will be obvious to you and doctors. Later stages of heart failure this is becoming terminal. You won't have to guess about this state. My father died from heart failure, but not related to ASV.

I was on ASV for a few years myself. I graduated above needing that, meaning a different therapy that I've not gotten yet. To get ASV I had to get an echocardiogram, a heart ultrasound test mainly focused on the LVEF of 45%, which is where one fails the criteria for ASV, at least here in the US. My LVEF (left ventricle ejection fraction) was originally 55%, after in ASV 2 years during a heart stress test LVEF was 62%.

There was to be a new study to replace this flawed test, haven't found out if it has or not yet.

[Sleeprider]

Jorgo, regarding your question on risk of ASV with heart failure, read our wiki here https://www.apneaboard.com/wiki/index.ph...nd_Summary  This risk applies to severely ill people with relatively advanced heart failure and left ventricular ejection fraction less than 45%.  I would be surprised if you are in that cohort, and subsequent research has failed to reproduce the risk cited in SERV-HF.

Your doctor suggested initial settings of
EPAP min: 7
EPAP max: 14
PS min: 2
PS max: 5

The Aircurve 10 ASV requires that the difference between PS min and PS max is at least 5 cm, so those settings are not possible.  You would need PS min 2, PS max 7 to setup the machine.  I actually like these alternative low pressure settings, and based on your history, I don't think you need to start with default ASV settings.  Once you are able to try the ASV, we can assess its performance very quickly and make recommendations.

[Jorgo]

Thank you so much both. I did know about that study but this seemed to be discussing the risks independent of that study, although who knows for sure as there were no citations. I was just surprised as I hadn't heard of any such risks for patients with no heart conditions.

Given my sleep study showed significant central apnea events I did have a heart ultrasound done which didn't find anything.

[Jorgo]

Just picked up a ResMed Aircurve 10 CS Pascewave ASV. I will keep it on the prescribed settings for now as a baseline and will post my data tomorrow.

EPAP min: 7
EPAP max: 14
PS min: 2
PS max: 7 (up from the original 5)

[Sleeprider]

The settings you outline are not default, but will often be suitable for individuals with mild to moderate central apnea that respond with spontaneous effort when the stimulus of pressure support is felt with ASV therapy. The PS range of 2-7 is often not sufficient to cause a breath without that spontaneous effort, but we often use these settings with members. A more common PS range is 3.0 to 8.0 if the individual prefers better ventilation provided by a higher minimum pressure support. Anyway, your use of the CS Pacewave is something we're very familiar with.

[Jorgo]

Here's my data from last night, I'm not quite sure how to interpret to be honest.  I would be keen to hear any thoughts and any recommendations for tweaks!

I changed the EPAP settings early on in the night - it felt really weird and strong the inhalation pressure when I was trying to get to sleep so I dropped the EPAP to 5-12.

I know it's early days but I must say I don't feel noticeably better than when I was on APAP, but I'm sure I'm expecting too much too soon.