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+--- Thread: CPAP Failure, ASV Attempter, Still Failure (/Thread-CPAP-Failure-ASV-Attempter-Still-Failure)
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CPAP Failure, ASV Attempter, Still Failure - ophiuchus - 06-27-2023
Hello,
I've perused and used these forums before, but admittedly never had any luck dialing in either of the machines I own (Resmed Autoset 10 and Philips AutoSV Advanced). CPAP Triggered a ton of central Apneas which I saw in Oscar and I just was never able to get the ASV working well for my sleep.
One year after starting this CPAP journey I was finally able to get in to see a good sleep doctor and had a real Titration Study done. Same discoveries really: Treatment Emergent Central Sleep apnea and Obstructive sleep apnea, only thing was that they ended up prescribing me a BiPAP/ST which (in my limited research) seems to like a less advanced version of the ASV I already own. I tried essentially copying the prescription they sent out onto my ASV with the hopes that I could rig a similar treatment to that in my study that had my AHI/RDI down to zero but...I had less than stellar results that kept me from staying asleep.
[attachment=51816]
[attachment=51814]
Any thoughts on what I could be doing wrong here given the sparknotes study results below? I'll end up using the BiPAP on prescription when I get it for insurance purposes, but they've been so incredibly slow with me and I'm getting more and more desperate for a good nights sleep.
[attachment=51815]
RE: CPAP Failure, ASV Attempter, Still Failure - ophiuchus - 06-27-2023
Relatedly unrelated: I don't know exactly how to describe it, but a flap in upper throat kept catching and closing up my airway on exhale that was really distracting when falling asleep.
I had a clean bill of airway health from an ENT post initial sleep study, but it's not the first time I've struggled with this both in and out of PAP. Not sure how much it's been impeding my therapy.
RE: CPAP Failure, ASV Attempter, Still Failure - Rich66 - 06-27-2023
First, you are aware your machine has probably been issued a recall?? There are plenty of threads on this site, if you're not aware. I think your System One is the same exact machine I was first issued -- when it was outdated.
Second,, you have EPAP Min and EPAP Max at the same value -- and PS Min and PS Max at the same value. You're not allowing the machine to do what it is designed to do. Change your EPAP Min to 4.0, change your PS Min to 2.0, and change your PS Max to 7.0. Leave the EPAP Max at 8.0
Give it a try and see how that works. The machine is designed to self adjust for your needs. Your current settings have it locked in.
I'm not familiar enough with the Resmed Autoset 10 to comment, but if you need an ASV, I would go with the Resmed Aircurve 10 ASV.
RE: CPAP Failure, ASV Attempter, Still Failure - Sleeprider - 06-27-2023
The sudden termination or shunting of expiration is often associated with palatal prolapse. We have had members that treated this in several ways. BiPAP ST does not seem promising in my experience. It is a timed backup rate and square wave pressure support that remains the same on every breath. There is no intelligence in the algorithm. I think seeing a complete chart of your ASV results would be much more helpful than the summary of settings. Your current settings on ASV are very unconventional, on the other hand, the BiPAP AutoSV is the only one that could do this. Please post daily details chart for reference.
Before getting into the rest of this, let's go back to your CPAP results. What were the circumstances and frequency of CSA?
RE: CPAP Failure, ASV Attempter, Still Failure - ophiuchus - 06-28-2023
Yeah I know it's on recall...I bought it out of pocket as it was (as you can imagine) the cheapest ASV I could find, CPAP was literally killing me and the soonest I was able to see a 'good' sleep doctor was at the time about a year out. I'd love to get it replaced via the recall, but I don't have an active ASV prescription and I haven't found a way to get them to send me a new one without it.
Heck, I still don't even know if an ASV is what's best for me -it's just what I happen to have around alongside my Autoset which caused CSA nights like seen below.
[attachment=51865]
The goal of these strange settings was to attempt imitating the BiPAP/ST they used in my recent titration study that apparently had good results. Unfortunately I think I may be missing something in that regard. I was actually trying to reign in the machine to keep it from doing too much as I'd never had luck with it previously with more typical settings and no professional guidance. Last time I attempted to use the machine was a while ago, the abundance of timed breaths kept waking me up as can be seen here.
[attachment=51864]
Palatal prolapse is something I've never looked into, but it does make a lot of sense. I can 'snore' in both directions when breathing in and out.
And sorry @Sleeprider, what specific data were you looking for? I do have full sets from more typical ASV usage nights; my original posting was admittedly an outlier/experiment based on results they showed me from the titration study.
To be honest I'm having some doubts about my recent titration study in general. Seems very unlikely that I got absolutely zero stage 3 sleep.
[attachment=51866]
RE: CPAP Failure, ASV Attempter, Still Failure - Sleepy Quixote - 06-28-2023
@ophiuchus,
I cant speak to all of the apnea bits as yours is a bit more complicated than mine, but I can speak to why you didn't see any stage 3 sleep, same reason I didn't in two separate studies spanning 16 years and nobody said jack. PLM, periodic limb movements can kill deep sleep. For some people they don't amount to arousals, in others they kick us out of any opportunity of deep sleep, your PLMI is in the mild range but considering you got zero stage 3 sleep and 49 PLM arousals is not in any way insignificant. Treating apnea got me out of the woods and gave me enough clarity to see something else was wrong, treating the PLM has given me my life back. Give those PLM numbers in your study some due diligence. You might find it to be another piece of the ever elusive restorative rest puzzle.
RE: CPAP Failure, ASV Attempter, Still Failure - ophiuchus - 06-28-2023
Noted, thank you.
My original study has zero PLM associated arousals, but actually doesn't give me any data on if there were any movements -just that they supposedly didn't cause any arousals.
How did you end up treating it?
RE: CPAP Failure, ASV Attempter, Still Failure - Sleeprider - 06-28-2023
The charts we are looking for are the daily details organized as shown in this tutorial http://www.apneaboard.com/wiki/index.php?title=OSCAR_Chart_Organization
Based on the titration study you showed above, you did best on a bilevel that appeared to be run in ST mode at IPAP 12, EPAP 8 and backup rate of 12 breaths per minute (bpm). My preference in ASV machines is the Resmed Aircurve 10 ASV which is a very responsive machine. If you would like to try the Auto ASV mode on your machine I'm going to suggest some settings. It would be interesting to see how it works out.
Mode: AutoSV
EPAP min: 6.0
EPAP max: 8.0
Max Pressure: 18.0
PS min 3.0
PS max 10.0
BPM: Auto
Flex-Type: BiFlex
BiFlex: 2
This should provide an automatic backup breath rate and seems consistent with the range suggested in your titration, but using the more sophisticated AutoSV algorithm.
RE: CPAP Failure, ASV Attempter, Still Failure - ophiuchus - 07-01-2023
Sorry for the wait, I've been wearing it off and on while failing to get a full night. I've never struggled with PAP therapy before but now I've yet to be able to keep my eyes closed the entire time. Given the data I understand why, but I don't know the why of the why.
This is with two differing full-face masks: Last chart is with a brand new one from Resmed and the other two are with an older Respironics affair of the same exact style.
[attachment=51953][attachment=51954][attachment=51955]
Bear with me for the screenshots/snippings. I have some weird DPI settings to make Oscar usable and it breaks the screenshotting functionality completely.
RE: CPAP Failure, ASV Attempter, Still Failure - Sleeprider - 07-02-2023
PS 3 to PS 10 worked better than 4-4. To address the hypopnea, we need to increase the EPAP min pressure, so we will move from EPAP min 6.0 to 7.0 and allow EPAP max to run up to 10.0. The Philips machines are very slow to titrate pressure upward and it appears you just need more airway support, so I think this is our first move based on these results.