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+--- Thread: Quick Question - Worth Buying ASV If Tweaking CPAP Isn't Working? (/Thread-Quick-Question-Worth-Buying-ASV-If-Tweaking-CPAP-Isn-t-Working)
Quick Question - Worth Buying ASV If Tweaking CPAP Isn't Working? - Apnea23 - 04-18-2023
Hi folks,
Quick question - if money is no object and one is struggling to tweak their CPAP therapy - is an ASV Auto a magic bullet machine due to reacting to and shaping every breath? It will ensure no obstructions, no centrals - eliminate even shorter events (5 seconds or less) that the usual APAP machines ignore completely?
Do they ensure a consistent flow rate on a breath by breath basis?
Will they stop waxing/waning flow during REM that widens and narrows so much it results in short clusters of mini events but always ignored by my Autoset and Aircurve for example.
Do ASV Autos ensure every damn breath is near perfect and things never get out of control to the point your brain has to fart to keep things like co2 in check?
Thanks,
Pete
RE: Quick Question - Worth Buying ASV If Tweaking CPAP Isn't Working? - Sleeprider - 04-18-2023
Pete, the ASV is used to treat central and complex apnea as well as periodic breathing and CSR. It's not a magic bullet because it uses pressure support to maintain the respiration rate and minute vent targets based on a running 3-minute average. The changes in pressure can be disruptive to sleep and it works best on actual CSA which does not respond to CPAP or BPAP. The machine is nearly breath by breath in its therapy application, but very short "events" are not going to be consistently caught. No normal person has every damn breath near perfect, and ASV is notorious for running away and taking over the ship.
Based on past posts, you have a Vauto. If you'd like to explore optimizing that, post some charts and let us know what is missing. It makes a lot more sense to work with what you have before bailing to ASV. ASV therapy is challenging to adapt to. It really does an amazing job when it is what works, but I have seen a lot of individuals with exactly your idea of using ASV to bulldoze their breathing into submission, have very disappointing results.
RE: Quick Question - Worth Buying ASV If Tweaking CPAP Isn't Working? - Apnea23 - 04-18-2023
Thanks Sleeprider,
I feel like I'm almost there and hopeful but always like to explore possible alternatives.
You have persuaded me ASV is not the way.
I do have a Vauto that I purchased recently after using a Dreamstation for 1 year until the recall, and then the Autoset for another year until recently when I wanted to experiment with more pressure support than EPR3.
After seeing your comments about waxing and waning, I'm just running my VAuto as a fixed CPAP for now as no EPR or PS reduced this and the short clustered events so now I'm nudging my pressure upwards after lowering it increasd the waxing/waning.
My theory is that during REM I require more pressure than the Resmed machines want to give me as the events aren't considered long enough or distruptive enough in the absense of significant flow limits, and the machines don't care about the pattern of waxing/waning.
I'll try to dedicate some time getting some Oscar charts together this week. I only have my mobile at home, PC at the office. Fortunately I still have my Dreamstation SD card from when I first started therapy and the number of these >5 second events during the 20% variable breathing periods was absolutely insane.
After 2 years of therapy which I believed was working as I was awake and not sleepy anymore, my brain fog and memory continued to go to hell as did my blood pressure, and since starting CPAP - only months in to it - I've checked photos historically - my cheeks started to become permanently flushed which has gotten worse and worse which I'm assuming is due to constant vasoconstriction and vasodilation during the night which after having batteries of health tests has turned up nothing but slightly raised FSH levels (they started rising right after therapy and continue to climb marginally each time I test them) but with normal testosterone and free testosterone.
So I'm pointing my finger at the last 2 years of PAP therapy and essentially disordered REM sleep despite extremely low AHI (0 to 1). After finally getting Oscar and digging in to what I'm convinced is my REM cycles, I'm wondering if the continued cycle of waxing/waning with constant clusters of short events throughout these periods has been severely disrupting REM related "work" that my brain ought to be doing, but instead it's spending my REM sleep focusing on respiratory effort and managing my o2/co2.
This is all just a theory and I could be completely off-base, but I know flushing and brain fog etc can be related to sleep disorders due to co2, as can arousals which I have been experiencing since December with no apparent reason.
I now regularly wake at 1am after 2-3 hours sleep and repeatedly in a similar pattern throughout the night.
Anyway I am babbling again.
I'll work on the Oscar data and in the meantime hopefully no EPR/PS and slowly titrating up from 6cm will resolve these short clustered REM events and the waxing/waning that seems to cause them. Lowering fixed pressure from 6cm to 5.5cm increased them and my heart rate was 47% /above/ my resting all night, where as with 6cm it was under resting for 75%. Normally it's under 90% of resting on my old regular settings of 8cm and EPR3 BUT that had the waxing/waning and clusters.. so I'm hoping a fixed pressure that's not too little or too much will resolve all of my issues.
I'll update this thread in the morning after trying 6.4cm fixed pressure anyway.
Apologies for the babble.
RE: Quick Question - Worth Buying ASV If Tweaking CPAP Isn't Working? - Sleeprider - 04-18-2023
Give a PS of 2.4 cm a try with high trigger sensitivity and let's see what it looks like. If you're at 6.0 cm EPAP, then add in 8.4 cm IPAP and high trigger and let's have a go at it. We can't learn much without playing with it a bit.