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So the PS max of 19 seems like it might be very high and thus allowing way too much pressure in my situation. It looked like the max pressures that were associated with my waking were in the 16-18 range and associated Epaps were running in the 6-8 range.
So the question then is how much to turn down the PS? If one were to just go by the numbers an uninitiated guy like me might want to turn the PSmax down to 10 or lower, but this seems pretty drastic (just because it is a big change). With my goal of not being awakened in mind, what level would you suggest?
As for your question in Post #10, yes you have it right.
You know what you're doing now is not working. And it didn't for me either. I finally made the pendulum swing the other way, and went from there (I turned the pressures way down). I would turn the PS MIN to 3, and PS MAX to 12 -- and the EPAP max to 12 also. That would make your IPAP max 24, instead of 34. You have to experiment and see what works for you. I'm a pretty sensitive sleeper, have been all my life. My radio alarm clock was always set to the radio to turn on and with the lowest volume it would go. Your sleep habits could dictate differently. For me, my thought was large swings in the pressure differences could also be a factor in awakening me.
Take one step at a time. Pay attention to masks and leaks, and try to eliminate any issues. Also pay attention to your sleep environment. I found buying better curtains that block the sun better also helped. YOU are the best one to help yourself. Also, pay attention to Oscar and watch for changes as you make changes to the pressure settings.
You have been remarkably generous and patient. Thanks for that. I will make the changes and see what happens. Thanks for continuing to answer possibly repetitive questions until I "got it right". So helpful!
Labromaniac, I would like to suggest some changes to your settings, and hopefully we can get a look at some additional charts from you. Based on what you have posted so far, I would like to see EPAP min 5.0, EPAP max 8.0, PS min 2.0, PS max 10.0. This is hopefully going to give you a more consistent pressure and feel from the ASV. We can't improve 0.0 AHI but we can make things a little less jolting. Many users of the Resmed ASV on this board talk about the "blow-back" technique. This is when they feel the machine is taking over the pace and volume of breathing, they assertively blow back or exhale into the mask and establish control over respiration. It works to stop the increasing PS and pacing of the ASV algorithm. I think you will find these settings to be more manageable and would appreciate your feedback if you try them.
EERS is the subject of a wiki I wrote here, and is used for CPAP and bilevel users that experience central apnea as a result of the increased ventilation. I don't think it is applicable in your case. http://www.apneaboard.com/wiki/index.php...ace_(EERS)
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Ahhh Sleeprider, thank for this generous advice. This is the first time in 8 years that I have considered changing settings (about time huh?). These suggestions are fascinating to me. The blow-back comment is REALLY helpful as well. When the machine starts doing that, it is exasperating and having to turnover, find the off button, and push it wakes me up further.
These settings are a bit more of a change than Rich66 recommended and I appreciate your confidence building in starting to change things around. May I ask for your thinking on 2 aspects of your recommendations? Why increase the EPAP min from 4 to 5? Wouldn't 4 be more comfortable? Secondly why increase the PS min from 0 to 2? The changes to the max settings make total sense to me.
By the way, I am not questioning your recommendations in any way; I am just curious as to the thinking behind your generous recommendations. AND I am very excited to see what happens and of course will give followup. Should be really interesting and if it will help me stop waking up, I will be delighted!
We don't have but one chart to evaluate so far, however my thoughts on EPAP min 5 is the fact your median EPAP is already 4.7. My habit in looking at these charts is to scan across and visually smooth them to see what might make a better starting point that will result is less variation from the starting pressures, and to my eye, your pressure tends to rise and remain above 4 cm and your PS is clearly higher than zero but not the default minimum 3.0. In your case, therapy seems to be discontinued when EPAP moves above 8.0, so limiting EPAP max is also important. I don't normally focus on flow limitation in an ASV chart, but yours is very high, and I suspect will benefit from a higher minimum PS.
The blow-back method is very effective and has immediate effect. It is much less disruptive than arousing to push buttons and seems to work for members. using ASV. I'd like to have a bit larger sample size than this single chart to work from, and perhaps even zoom in on some places to see why PS and EPAP are being driven higher.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
06-09-2022, 10:58 AM (This post was last modified: 06-09-2022, 11:05 AM by Labromaniac.)
RE: ASV user request for analysis
Thanks so much Sleeprider! I made all the changes for last night. I still was awakened several times. I did do the blow back method and you can see those expiratory spikes on the graph. My groggy impression was it didn't change much, but I didn't have to find the off button. The one interruption seen was a pee break.
Attached is a full chart to see. For zoomed in images, how zoomed in is helpful? See the whole span of a spiky event? Or zoom in further to see individual waveforms?
I habitually wear an upside down 4" soft cervical collar, which when originally started, made a big difference in lowering my AHIs. I initiated this years ago. When testing last night without CPAP on, I did notice that when my neck was flexed down slightly, even with the collar in place, l noticed less airflow. When I extended my neck more (side-lying on the pillow) airflow was clearly more and more free. I wonder with the flow limitations seen, it would be helpful to use a taller soft collar to keep my from flexing my neck as I curl into my pillow? (just a thought)
It may be time to look for a replacement collar that gives you the support and comfort you need. Your results continue to look better and nice that this is not so fragmented. The reduction in PS max seems to avoid most of the events, and we can see where the pressure support levels out at it's maximum. This is a trade off between pressure and comfort. The machine would likely go higher on some of these, but this looks like a good compromise. The flow limit is improved here, and I suspect where it is high over a period of time is related to the chin-tucking you talked about. This looks like a much more stable therapy, and I'd like to see you continue at these settings before making any decisions.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Terrific. I will look for a taller collar. I also will attach here the night before all your recommended changes that was not so terribly fragmented like the original graph I posted. So this one will be with the same mask and the settings just before your recommended changes. It may represent a much better "before" picture to compare to last night's graph with your changes.
Sleeprider, I had asked for advice from my sleep doc as well and somewhat expected to not get an answer, BUT this is what he said:
"Thank you for your message. Dr. reviewed your download and said, "The interesting thing about ASV machines is that they are treating central [apneas] so they don't report the centrals they are treating. It makes evaluating the downloads a little tricky. In his case, you can see that the EPAP [exhale pressure] is rising much, but his IPAP [inhale pressure] is starting to increase. This, plus his perception of the backup rate kicking in, tells me that it is trying to ventilate him through centrals. Unfortunately, this ventilation is waking him up. The only thing we can do is limit out his pressure support to avoid this. Since he waking up when the pressure support reaches about 6 or 7, let's drop the max PS to 6." [/size][size=x-small]I have made the change to your Pressure Support remotely. If you have any questions about this, please feel free to write back. Otherwise, I will follow up with you in one week to see how you're doing with the change."
This seems to match what you are saying as well about reducing the PS and they even knocked it down even further to 6 from your recommended 10!
So I will let that change that they did stand starting tonight and see what happens and of course report back. I thought this Doc feedback might be an interesting addition to your analysis (or perhaps not - LOL). I am just trying to provide as much info as I can. Also 2 new taller soft cervical collars have been ordered from Amazon which will take a week for delivery but are truly 4 ans 4.5 inches tall instead of my barely 3.5 I am currently using. Thanks again for your interest in my case. I am very appreciative.
