ASV vs CPAP - and the winner is...

[Bennnyp]

I lowered my pressures again. Sludge, I will be happy to share demographic data. What would you like to know. Age weight? stuff like that?

[Bennnyp]

http://s743.photobucket.com/user/Bennny ... 1.jpg.html

[Sludge]

Age weight? stuff like that?

And sex (see where they alternately refer to you as her or his), neck size and height.

[Sludge]

http://s743.photobucket.com/user/Bennny ... 1.jpg.html

OK, so let me see if I'm getting this right:

For 9 minutes during the night, you get a little dodgey...

[Pugsy]

As much as I hate to be contrary (HAHAHAHAHAHAHAHAHAHAHA!!!!!), I would respectfully disagree and offer that they are, in fact, "huge".

You contrary??? I would never use that adjective to describe you...well almost never.

Well, the "not huge" was mainly for the person who thought at he was seeing 100 L/min instead of 10 L/min.
It still wasn't huge when compared to what I used to see with Benny's leak rate when he first posted his reports, now those were massively huge.
I do understand your point though and yes I did try to follow the thread you mentioned but some (probably most) of it went right over my head. I have seen reports from Benny with the centrals being ugly and not much if any leak to speak of since he finally got a mask that will seal for him. It's not like the only time he had the centrals was with leaks present and even when they do happen I don't know which came first. I did note the nice flat leak line and nothing going on and the ugliness at the same time as the spikes to 10 L/min. Since I have seen reports with ugly clusters and no big spikes or leaks...I just have to scratch my head a bit and wonder. I wonder about arousal status vs a rebreathing cycle. With the history of centrals prior to any cpap therapy pressures or potential rebreathing in a mask I just have to wonder. I will be the first to admit that I lack your skills and knowledge and just try to do the best I can with what I have. I told Benny lots of times "I don't know".

I don't know how much luck Benny would have getting the raw data from the first doc since he has severed that relationship but if you and he want to go down that road I will sit back and try to learn from it if you share it.

Too bad you couldn't have done his first sleep study.....

[The Latinist]

http://s743.photobucket.com/user/Bennny ... 1.jpg.html

OK, so let me see if I'm getting this right:

For 9 minutes during the night, you get a little dodgey...

If you've seen some of Benny's other reports, though, he sometimes has huge clusters of central apneas lasting much longer than that. I agree that that report is pretty sweet (better than mine from last night, I can tell you that), but I'm not sure it's representative.

[Bennnyp]

I am a 42 year old male. 5'9" neck is 15.6 weight is 214 pounds. I started a diet on april 1st. my weight was 236. I have lost 22 pounds since I started. I quit smoking 17 months ago.
I smoked a pack a day. I quit drinking 7 months ago. I used to drink 12 beers a day.

[The Latinist]

Wow, Benny, that's impressive. You've done a lot of great stuff for your health in a very short time. Hats off to you.

[Bennnyp]

Thanks Latnist. It's been really easy for me to make good decisions when the gun is to my head. Hope I can continue to do that.

[Sludge]

... I'm not sure it's representative.

I do not believe anything is "representative" at this point, but that's academic anyway, because:

• A review of the 48 posted images (although there are some duplicates) show an incredible amount of dial wingin'.
• If he does have CompSAS, it really don't like that.
• There is a lot of Auto Mode usage.
• CompSAS don't like that either.
• If a bilevel treatment approach is used, then EPAP is titrated to get of of obstructives, then attack everything else with IPAP or PS. If we are to believe that BP's initial "Treatment Team" (HAHAHAHAHA!) are a bunch of LSsOS, then I would offer that he might not have had ANY obstructives, and opening EPAP should have been min.
• But it wasn't, it was totally off the wall, and CompSAS REALLY don't like that.
• If he does have CompSAS, and as previously noted, "IMHO" a leaky hybrid mask is particularly prone to near-complete anatomical washout.
• Refrain.
• I would really like to see the role that sleep plays here. Frequently, there are central salvos at the end of the night. One might wonder how one could be doing great for 6 hours, then destabilize (IOWs, perhaps that's a bunch of SWJ).
• The incidence of insomnia (disrupted sleep) following cessation of that much alcohol use is ~50%, and that effect can last a LONG time.
• Meanwhile, there are a bunch of other major life style changes happening, so looking at the stuff from February certainly won't be very useful.

[jnk]

If I may presume to interpret/explain (for the newer thread-followers) a few of the insights being presented in this thread, as I read them and understand them:

1. Trying many different pressures and combinations of pressures in a relatively short time frame (or "dial winging") may not allow the body to settle in and adjust to PAP, especially when someone's body is having trouble sensing and reacting to the gasses in the blood (such as CO2, carbon dioxide) that the body uses to regulate its breathing at night.

2. Someone with simple OSA may not be bothered all that much by the changes in pressures that happen when a PAP machine (CPAP or bilevel) is used in an auto mode, but that mode used for treatment can at times be a problem for people with the above-mentioned blood-gas issues that can cause centrals.

3. Although a hybrid mask (one with both nasal pillows and mouth coverage) can be useful for many, those masks tend to have a high intentional leak rate and are sometimes prone to unintentional leak issues as well. That combination can blow off a lot of CO2, which can be a problem for someone whose body is having trouble using CO2 to regulate its breathing at night.

4. Sometimes the centrals that show up in squiggly lines are really more a matter of a person having a bad night of sleep than anything else. That can be referred to as SWJ (sleep-wake junk, or the results of restless sleep in which the body keeps changing gears between light sleep stages instead of going through full sleep cycles). So a big part of the "solution" for those centrals may be finding ways to improve a person's sleep--ways that may not be directly related to sleep-breathing, even though the way the sleep problem is showing up is in the squiggly lines of sleep reports that track the breathing. In those cases, troubleshooting sleep problems as a whole rather than focusing in on only the breathing may be more helpful to the sleeper than fine-tuning PAP therapy.

5. Alcohol is a major short-term sleep disrupter and causer of longer-term sleep problems as well. For example, if someone consumes some alcohol just before sleep, the first part of the night may be restful, but the last part of the night will be restless, and that bad sleep, although not really caused by breathing, will at times show up in sleep studies and home-machine reports as centrals, since the person is repeatedly waking up and drifting back into sleep. Similarly, a person may have a time (weeks/months, depending) of bad sleep to endure when a person who used to drink a significant amount then stops drinking. In those cases, sleep suffers for a while, but it is well worth enduring that period to get to the eventual payoff of sleep that is no longer directly disrupted by alcohol and the overall health improvements that will eventually follow.

Hopefully I will be corrected if I got too much wrong in the above oversimplifications.

And for the record, I would just like to say that I consider Benny's efforts and approach to be heroic and worthy of great admiration. I am glad he is getting helpful people commenting on his experiences with PAP and on his sleep in general. The likes of Pugsy and Sludge have helped a lot of people over the years on the Internet. Perhaps many, many thousands, when one counts the lurkers and googlers.

[Todzo]

Perhaps it would be good to remember what this thread is about:

The Citation:

Morgenthaler TI, Kuzniar TJ, Wolfe LF, Willes L, McLain WC, Goldberg R. The complex sleep apnea resolution study: a prospective randomized controlled trial of continuous positive airway pressure versus adaptive servoventilation therapy. SLEEP 2014;37(5):927-934 Related article (commentary):833

Things noted while reading the article:

With Complex Sleep Apnea (CompSAS) they seem to be happy to get the AHI below ten (rather than five).

In the study pressures above 15 cm/H2O were excluded (usability?).

In both the ASV and CPAP arms each lost 36% because the participants did not use the machines enough during the three month study. With additional losses (drop outs – 6% on the ASV arm and 3% on the CPAP arm) only 54% completed the study to become part of the “evaluable participants”.

The authors report that their use rates are comparable to those in other studies.

They add “... we were unable to identify any clinical or PSG features that would predict resolution of CompSAS on CPAP. We believe that the analysis of other variables or physiological responses that are not currently collected during typical clinical and PSG evaluation, such as the measurement of apneic threshold, carbon dioxide (CO2) reserve, controller gain, gain margin via measurement of end-tidal CO2, additional dead space, or responses to hyperventilation by conventional bilevel device or proportional assist device may be needed to predict this response[32-34] ”

At 90 days CPAP and ASV had very similar results in terms of usability, total sleep time, sleep efficiency, total arousal index, average daily usage, ESS (daytime sleepiness) index, SAQLI (quality of life) index, and comfort.

However ASV did much better at initially reducing central events and continued to do better regarding these events at 90 days such that total AHI was 9.2 for CPAP and 4.9 for ASV.

[2] Orr J, Javaheri S, Malhotra A. Comparative effectiveness research in complex sleep apnea. SLEEP 2014;37(5):833-834

[32] Salloum A, Rowley JA, Mateika JH, Chowdhuri S. Omran Q, Badr MS, authors. Increased propensity for central apnea in patients with obstructive sleep apnea: effect of nasal continuous positive airway pressure. Am J Respir Crit Care Med, 2010;181:189-93

[33] Younes M, Ostrowski M, Thompson W, Leslie C, Shewckuk W, authors. Chemical control stability in patients with obstructive sleep apnea. Am J Respir Crit Care Med. 2001;163:1181-90

[34] Gilmartin G, McGeehan B, Vigneault K, et al., authors. Treatment of positive airway pressure treatment associated respiratory instability with Enhansed Expiratory Rebreathing Space (EERS). J Clin Sleep Med. 2010;6:529-38

[jnk]

Perhaps it would be good to remember what this thread is about:

Todzo, could you please clarify whether you actually consider your (this) thread hijacked?

Because, if you do, that will have an immediate effect on just how entertained the troll part of me feels at the moment.

Thanks.

[Sludge]

[Bennnyp]

http://s743.photobucket.com/user/Bennny ... b.jpg.html