ASV Machine and COVID Symptoms

[richdreher]

After having Christmas with my big Family, 13 out of 30 of us Tested Positive for COVID
My symptoms were no energy and difficult breathing while trying to rest

1st,
I want to credit this Forum for getting me confidently into a ResMed ASV Machine along with suggesting an Oxygen Concentrator to help with my <88% SpO2
After I got the new ASV machine, the doctor made some FIXED settings - My AHI was still quite high
This Forum suggested the "AUTO ASV" settings to allow the machine (vs Doctor) to determine my best therapy
  - why didn't the Pulmonologist suggest this auto setting, as he too agreed the best ASV Machine on the market was the ResMed ASV
After this auto setting and a couple other settings per Forum suggestions
This is a good trace on AUTO ASV setting:
   

During my COVID Symptom days I only felt good when resting with my ASV Machine, it just simply helped me breathe
  - other XPAPs may help as well, but my ASV machine is so much more comfortable and responsive

Last night and the night before, I could feel the ASV Machine working overtime to keep me breathing
This is the first night of what I call the ASV Machine rescue
   

On the second worse night, I decided to add my SpO2 trace to OSCAR
You can see how when I was not wearing my mask, how instantly my SpO2 went down
After 5:30 in the morning, I got up without my mask, but kept wearing my Contec CMS50F SpO2 wrist recorder til around noon.
See my second night of what I call the ASV machine rescue (with SpO2 trace)
   

[Sleeprider]

Tidal volume is higher and respiration rate slower with a minute vent of 6.5 L/min in the trace of good therapy. The other two nights show lower tidal volume, significantly higher respiration rate and the ASV is able to maintain a higher minute vent of 8.12 and 8.37 L/min. EPAP has been higher during COVID, but the range is pretty narrow under the background trace 12/12.

I can't answer why the doctors think they can out-perform the auto ASV algorithm. Probably lack of experience with it. There are times when a fixed EPAP pressure works to provide good therapy and better sleep, and the response is individual. My preference is to see the AutoASV first, then optimize or narrow the range. Thanks for sharing this, and good luck with your recovery. With the doctors, about all you can do is share your perspectives of things that have worked and hope they learn from you. I don't know if they are good listeners, but they failed to move you to the right therapy, so you did it yourself, and maybe they can learn from your personal experience. Their loss if they don't.

[SarcasticDave94]

Kudos for self advocating successfully.

My semi sarcastic reason why Dr. Dolittle didn't use ASV Auto, if it's static they're hoping you come into their office to plead your case why it needs changed. Then they mercifully change your settings while cashing the sailboat payment check. Static PAP settings are spelled $$$$.

Second opinion? Why is course. Dr. Dolittle is not sure how to run an ASV.

[richdreher]

Thanks Dave, Thanks Sleeprider,  
It was the OSCAR Traces that I showed him - that convinced him to write me an ASV Script.  He said so himself. (of course a sleep lab helps HIM with his yacht payments)

I read in a Wiki that during Covid "Iron Lungs" were used to save some patients, mostly because the Iron Lung was available to them. Otherwise a Positive-pressure ventilator was used (Like my ASV?)

I started this new thread to share the results of my ResMed ASV during my Covid breathing-symptoms, so that maybe others that have an XPAP in their closet, to pull it out and use it!

To repeat, it was very obvious to me that my ASV machine was doing the majority of my breathing. (my perspective).

See below, last nights trace(s). I had no Snore and No Leaks so I took those traces out.
No Snore may be an indication that I am almost out of my Covid-labored-breathing symptoms
I added in Tidal Volume and Minute Vent and Resp Rate because Sleeprider mentioned them in his observations. (I cannot interpret them myself)

   


Grateful, Rich

[Geer1]

Glad it sounds like you are improving. I just want to issue a word of warning that although ASV (and most PAP equipment) can be helpful for fighting covid it only has limited efficacy and if you notice issues like dropping oxygen levels you should go to a hospital rather than try and self treat with PAP. If you are unable to go to hospital then by all means use PAP as a last resort but know it has limitations. ASV for example is one of the most capable machines but since it is programmed to rely on spontaneous breathing effort it is not capable of maintaining blood oxygen levels and in moderate to severe covid cases it will not keep you alive. Fortunately it sounds like you had mild to moderate symptoms and the ASV was helpful.

As for ASV vs ASVauto I think a lot of doctors just have a preference based on what they first used or have found success with. In pure central apnea cases it doesn't usually matter and machine operation and results are usually nearly identical. In cases where obstruction is also present ASVauto is the better choice. In some pure central apnea cases where ASV is only partially treating a purely central issue then ASV mode is better because it doesn't needlessly raise the pressure when there are remaining hypopneas/apnea. For example in the data posted the machine raised pressure in reaction to hypopnea/apnea but it isn't clear if these were central or obstructive and the higher pressure only really helps if they were obstructive.

[richdreher]

Thanks Geer1,

Good to issue such a wonderfully worded disclaimer/warning and the time it took to respond!

I agree, my symptoms may have been very likely on the mild side.

Also I use an Oxygen Concentrator 100% of the time.
Recording and plotting my SpO2 level was intentional to allow me to make my own judgement on my lungs "getting" oxygen. 
If my SpO2 level was low, on or off the Oxygen Concentrator, I would have gone to the hospital for observation.

I have severe COMPLEX Apnea where I have central and obstructive apnea. I can agree with you on the higher pressure indicating obstructive.
I think my "flu" created more Obstructive Apnea.

Here is an old OSCAR screenshot of my old BiPap machine indicating the Central Apnea with some other obstructive events (not being sick). So I'm assuming I am a great case for the ASV machine.
   


Thanks again for being there; I'm learning how much I don't know, while trying to do what I think is my best. 
In my day job I am a technical/IT Analyst (not a medical analyst/diagnostician!)
-Rich

[Sleeprider]

Good grief Rich! I forgot where we started with all this. How could your doctors ignore this and the improvement you achieved with ASV.

[SarcasticDave94]

Ah what a colorful Trainwreck. Dunno, you possibly needed 1 more CA flag to make the doctor think this guy might possibly have a wee bit of a complex Apnea issue.

[Geer1]

I imagine you are right about worse obstruction when sick, I would be curious to see what the detailed data looks like though. Say a 3-4 minute zoomed in view of Dec 29th data around 22:25 (after pressure was already raised) or Dec 26th around 21:50. Preferably with flow rate chart taller and mask pressure below it.

[richdreher]

Geer1, thanks for listening and asking for more clarification.

@sleeprider indeed it's been a journey; we have been looking at my Central Apnea since FEB 2021.  The earlier, mostly CA, screenshot was JULY 7!

@sarcasticdave94 I did ask the doctor why he could not use all my OSCAR Proof and tell-tells of Central/Complex Apnea: answer was OSCAR is not "officially" recognized my (his) medical profession ARGH

Geer1,
I have below to two traces you are asking for. I can only a guess I did the zoom correctly enough per your request

Dec 26 slice:
   


Dec 29 Zoom in:
   


Grateful for This Forum/Board