time for ASV?

[SarcasticDave94]

Obviously this is just my own experience, but for what it's worth on the insurance concerns, I'll share what happened to me. Please take note that I cannot make you do any action, this is for educational purposes.

I learned here how to access the clinical setup mode for the DreamStation BiPAP. I had posted pics from Sleepyhead and other AB members gave suggestions on settings. I chose to change the settings as described. The results were somewhat better, but as I learned, I'm a mixed apnea sufferer so BiPAP isn't going to be the right machine for me.

Here's the DME and doctor portion. Somewhere along my ASV path, I had phone conversations with each of those. When they say something like "We'll edit your settings. The BiPAP will receive it x number of minutes, hours, etc." I reply "Can you indicate what settings are changing and to what value? I'll change it now." Every time it's "You know how to do that?" "Yes I do." Every time so far, basically it's "OK. Guess that takes care of it."

I did have one time where the pulmonary tech and I had to go "lawyer talk". "In theory, in cases like mine, what are the changes and values at this stage?" End result? Nothing, but I changed the settings. Oh and I even mentioned it to an insurance customer service agent for some reason. No comment except OK have a nice day.

[lionel197]

It's been 4 months, 2 in-lab sleep studies and a new (ASV) machine since my last post. Thanks for all the previous support and advice. As several of you had predicted, I have complex apnea and am now using an ASV machine (for 20 days). AHI is much lower, but I still have 1-4 periods during the night (last night just 1) that look like the following pattern. Can anyone tell me what's going on during these periods?
https://imgur.com/ZoDNIgT
Thanks!

[Walla Walla]

It looks like cheyne stokes respiration to me. But I'm don't know that much about it.

[Sleeprider]

I would rather see you use ASVauto mode than fixed ASV. I'm not sure why the doctor decided a fixed EPAP is best, but that is usually just not making the technology at hand, available to you. Having no particular expertise at this, I would switch you to ASV auto mode at EPAP min 8.0, EPAP max 11.0 PS min 3.0 PS max 12.0 and see if something more productive comes about. Your PS min is ridiculously high for most complex apnea patients. Once again, I have nothing but the recommended titration protocols to reference here, but that high minimum PS is going to cause problems.

[SarcasticDave94]

I'd have to agree with Sleeprider on this one. Personally, I've never had mine off ASV Auto except to see what changed in the set-up. As can be seen on my sidebar, my ASV can go up to 25 total but it never gets past 18.9.

I may have missed the info, but can you share the settings your ASV is prescribed for? Example: I have EPAP Min 9 max 13 and PS 3 max 12. Those are my current settings on ASV Auto. I run no ramp and FWIW my humidifier is on manual 8 and heated hose at 86°F.

Thanks & best to you on this new machine,

Dave B

[DeepBreathing]

I think you're seeing multiple obstructive apneas (decline or flat-line flow rate followed by a massive recovery breath). Your fixed EPAP is insufficient to keep your airway open, so these apneas occur and each is followed by a gasp for air.

Based on my own experience, I think SleepRider is on the money. ASVAuto mode will give you the best chance of overcoming those obstructive apneas, but I would set EPAP Max higher to 15 or thereabouts (the machine won't go any higher than it needs to). I'd also reduce the PS min to 3.0. The other thing you might consider is to raise the max IPAP to 30, to give the machine a bit of headroom (it's currently up against the limit). Note that IPAP = EPAP + PS so if you have EPAP max = 15 and PS max = 14, then the max possible pressure will be 29.

For ASV machines I like to see the mask pressure graph, which tells us a lot more than the normal pressure graph.

Good luck!

[Sleeprider]

Going back to the chart, I think the main culprit is the PS min of 6. Your tidal volume is hitting 800 mL and you have a respiration rate under 10. I just think you are being blown away by this PS, and thanks to the UA events you are triggering the full PS max of 14. It's my guess that EPAP can be set lower without a problem, but Deepbreathing is right that there is no harm in setting a range to 15 just in case, however I think if the PS min is reduced, these events will be avoided anyway. A significant part of the sleep session has no events, and we need to take that into consideration as well. Still you have a minimum pressure of 17/11 and are hitting 25/11 fairly often. That is considerably more PS than most complex and central apnea forum members have required.