ASV Machine

[ajack]

That's reassuring that it's just a tremor, that you are calling palsy. Scratch that bit.

I would get the AHI and the minute vent right, then put the ASV aside in your thoughts. Give it time for your body to adjust and recover. If you are still feeling bad, it would need to be looked at elsewhere, for other reasons.

[SarcasticDave94]

Larry:  Yes, an AHI 5 or under is considered normal/treated.  That being said, I would think that with an ASV machine it would generally be easier to get the AHI below 5, but I'm not an expert on this. 

I know when I started ASV, my AHI dropped like a rock and yes, I have seen the AHI hit 0.0.  When my index doesn't, do I panic, no.  I'm actually thinking that I don't want to have an AHI of 0, I want to make sure that my body still wants to have the respiratory drive, but I could be alone on this thinking.

IMO when we arrive at or below 5.0 AHI consistently, it's time to drill the well for "how we feel" instead of "how low an AHI can I get". Again that's my opinion. YMMV

[LarryRapp]

Hojo:  I don't know what you mean by "respiratory drive".  Personally I just want to cut down on the hypopnea.  When I see that happening, I'll probably quit.

[LarryRapp]

Here is last night.  Good, but still show 15 hypopnea.

[SarcasticDave94]

Hojo:  I don't know what you mean by "respiratory drive".  Personally I just want to cut down on the hypopnea.  When I see that happening, I'll probably quit.

Larry,

That recent report looks fine. Some leaks, but overall fine. AHI of 2.01 is very good.

Respiratory drive is the process where your brain receives signals from the lungs that O2 and CO2 are at levels where the brain needs to trigger a breath. Not debating Hojo, just pointing out what I perceive is the background of the respiratory drive concern: there is a medical theory that relying too heavily on your CPAP, or other Apnea treatment device, could cause dependence due to possible reduction of that respiratory drive.

IMO Larry, it's most likely a Non-issue for you. Loose translation is don't stress it, your numbers and results are fine. Don't add to the stress you already face. I liken it to choosing which battles of life you wish to participate in; some are worth your effort to fight and others are not. That's how I handle my current disease/illness situation. I ask myself: what part of my illness can I change if I fight to do or act to make X better? If my answer is I cannot affect a change, I move on. I suggest you should focus on just wearing the mask every night and wake up feeling better for it. Don't volunteer to take on more things to stress over. And in a helpful, friendly manner, I'd also include chasing after squashing hypopneas right now. Let the therapy work for a few days or better, a few weeks, then look at the numbers. Ask: did the AHI improve or not? Where did/didn't it improve? Do I feel better? Certainly, if numbers have gone up in a week, then address the issue.

Just remember, we will have better and worse days for the feel and numbers. Get a few days in and average what you have going on. I think then you can better manage the overall effectiveness and have less stress. All this is my humble opinion. None of us are guaranteed long life; enjoy today by doing things, by surrounding self with loved ones, and just enjoy it. Go on a stress diet, reduce all the stress you volunteer for. Here's a virtual coffee...enjoy

One example of respiratory drive from wikipedia if you would like to read it. CLICK HERE

[LarryRapp]

Dave,

Ok.  Actually, all I'm looking for is lowering of hypopnea.  I feel like if I can do that, everything is fine and I can worry about something else!

[SarcasticDave94]

OK a short reply: check it in 2 days and report about it so we see some sort of trend, but unless I'm totally off base, hypopneas on your most recent report were not real bad at 1.77, well under 5.0 which is treated via machine.

Seriously, a big on where you are now compared to where you started.

[LarryRapp]

Thanks, Dave.

Hypopneas have stayed around 14-15 since I switched to the ASV.  I have raised the min EPAP 1 every night, but it has had no effect.  I will do this about 1 more night and then give up and lower it down some.

[SarcasticDave94]

You're welcome. Keep us posted on progress.

[ajack]

You can stop now if it's stressing you. Do a weekly review on the stats. Your chart is a lot better already and you really are just fine tuning the settings now. You can even do a monthly review and adjust from here on, the numbers are within range.
Resmed says, keep raising the min epap, to create an airsplint till the UA/H clear, you could move to 9 tonight
Also supporting raising the min epap is the median at 8.7 and the 95% at 9.7

(if you read the guide, you can see how BPAP and ASV are titrated differently, with BPAP, you raise epap to clear the UA and raise the PS for H, with ASV you keep raising the EPAP, so in some ways it's easier)

After the UA and H clear that are spread through the night.
I think any remaining H will be from possible SWJ (sleep wake junk) clusters within the 30 min of starting the machine or waking up with the last one? You can see the pressure spikes trying to resolve the 2 main groups. There may also be some positional thing in the 2 main groups. Hopefully these groupings will also settle down. You would need to zoom in on them to see if there is a cause that can be adjusted for. If the machine is working at 25cm and you having UA/H, there isn't much else to do, except try a collar or adjust/change pillows.

I really don't want to get into a debate with Hojo, on the values of choking oneself, just to make sure you aren't too machine dependant. If that can be a thing? I can see the thoughts and my mother shared them when she was on O2. She didn't want her lungs to get too use to O2 and get lazy. I disagreed with her about that too. If it's a belief, it's very hard to counter. You can debate till the cows come home and facts don't matter.