BiPAP ASV Settings check possible?

[SarcasticDave94]

Your PS (pressure support) minimum 6 is going to be too high for most other users. This may increase CA (clear airway or Central Apnea) on the chart. You're likely using the ResMed ASV or Philips Respironics SV AUTO due to this CA aspect.

Your EPAP (Expiratory positive airway pressure) is 5, and it would likely be too low, given that Philips Respironics machines need this closer to the median value per user. Your median is 8. Philips Respironics machines are also slow to respond to events, again indicating this Min pressure needs to increase.

Your Philips Respironics missed the events, as in it failed to treat the events shown in OSCAR. The events I refer to are Apnea and Hypopnea.

The chart looks rough. This is an overall view of mine on looking at the jagged OSCAR chart, many transitions up and down on the pressure. It does not need to be perfectly flat, however this one has the look of too many pressure changes. This would be a reason I wouldn't get decent treatment from Philips Respironics.

Clustered Positional Apnea... Look at the events. They are grouped very close together. Here in Apnea Board, Positional Apnea involves a situation of tucking your chin and externally closing off your airway. If this is applicable, you'll find you're probably using several pillows or a thick one. Or otherwise your chin is literally tucking towards you chest, kinking off your airway. If the pillow is thin, them maybe consider a soft cervical collar to prevent this chin tuck situation.

Positional Apnea really has nothing to do with sleeping position, but the alignment of your head and neck, in keeping your airway free from the kinking effect on your airway Positional Apnea involves.

Involved too... Sorry, I'm not going to speak or write perfectly organized sentences. This involved too, it means the OSCAR chart might have the clustered Positional Apnea pattern along with the missing events and rough looking chart. All 3 aspects appear in your OSCAR chart in my opinion.

By the way, the reason we tend to suggest not quoting is based on those that feel they need to quote every time they respond. They would quote their own quotes to themselves as well. This makes for a very long, tedious thread. We are not other forums, and do not under most circumstances encourage quoting. This post can be an example. I knew you were referring to my prior post. Quotes were not required or necessary, even though you supplied them anyway.

[Sleeprider]

I think your pressure settings are fine, but notice the clustered obstructive and hypopnea events suggesting there is positional apnea. https://www.apneaboard.com/wiki/index.ph...onal_Apnea

[AfibApnea]

This experience has been very depressing.
 
I have been diagnosed with both Central and Obstructive sleep apnea. Until now I was never diagnosed with positional problems, In fact the position of my chin was never mentioned. To my knowledge I am not tucking my chin. There are times when I use two thin pillows or one folded. I do so in order to align my chin and neck with the center of my shoulders and my head is not looking down or up. I assume a position that makes breathing as comfortable and unimpeded as possible. Is there anywhere on this forum where proper chin position is described and discussed.
 
Is this forum saying my Philips Respironics Dreamstation is a bad machine? That it misses events, creates bad (jagged) charts with too many pressure changes, and generally does a bad job? I really didn’t have a choice at the time and spent a great deal of money for it.
 
I don’t really care if my PS minimum is going to be too high for most other users. If anyone wants to use my machine, I’ll let them know. What I’m trying to find out is if my machine settings are optimal and my results indicate I’m treating my condition.
 
I was hoping that submitting the results of my sleep would teach me how to better treat my condition and that in order to do so I might need to change some settings and monitor some results with the intention of getting better. I did not expect it would lead to being told that one of the two leading machine manufacturers creates lousy machines. Does anyone else have a different interpretation and maybe some productive advice?
 
Do I need to submit more results or is my situation simply hopeless?

[SarcasticDave94]

The information, as in suggestions about settings, comments on machine brands, the possibility of Positional Apnea, all were to help with your better treatment. That was the purpose of all these comments within posting.

In order to help you learn about the results of therapy, we suggested setting changes. You indicate you wanted assistance, yet explain why your settings are not needing changed. Why ask about suggestions if you're going to dismiss the suggestion you asked for?

The Philips Respironics brand has since been banned for further sales in the US. I have seen lots of charts with user comments that indicate the Philips Respironics machines are slow to respond and are reactionary.

We have given you what you asked for, which includes things not explicitly asked for, like mentioning the shortcomings of this Philips Respironics brand and your PS not being ideal.

2 thin pillow makes it thicker. Folded pillows will also be thicker. This can be the source of the Positional Apnea mentioned.

The above 4 pages of postings were productive advice. This all was targeted to teach you about your therapy, including settings that needed attention, and all the other items discussed. What more do you want?

You ask for help, complain about the offered assistance, explain away why we're not correct, then now ask again what to do to make things better. OK, let's try again. Reread this thread carefully. Begin to take action by changing settings like PS (pressure support) instead of explaining away why it's not the issue. Use the ResMed you say you have, it's a better device than the Philips Respironics brand for most users.

There's one flaw in this thread. You request help, you argue why it's wrong, explain away why it's not right, then without trying the requested suggestions, asking again why things aren't better. My last bit of productive advice? Sure, listen to what was already posted and take initiative by doing what was suggested for a change. We cannot help you if you won't try the things that have worked for many others when they tried the suggested changes, when the data presented were similar to your situation.

I'll simplify the process in case it got lost somewhere in this 4 page thread. You ask for help. You explain what you need help with. Others ask for charts. You post charts. Things are mentioned like event flags, patterns, etc. which includes comments about actions to try to create or entice a change. You read it and try the actions mentioned. You then would find out if the change suggested helped or not. You offer feedback. Whether it helped or not, it may prompt other suggestions supplemental to, or in place of, the first suggestion. Normally, you'd be compelled to TRY THE SUGGESTION. This I think is where the normal process breaks down. Did you try that which was suggested?

Once again, look over this thread. Go through the list of suggested actions presented. Did you try all of these? Yes or no? If you didn't try them, it's not the fault of any of these other members trying to help. Who's left then to blame?

Lastly, the situation is hopeless if you refuse to try the actions others have mentioned you need to act on.

[AfibApnea]

Can I please get feedback on this report?

   

Thanks

[SarcasticDave94]

As a former user of this ResMed AirCurve 10 ASV, I see 3 things to consider and try.

1. Leaks are higher than ideal, specifically for the ASV as it seems sensitive to leaking. From what I know, the leak pattern appears to me as a mix between mouth and mask leaks. Again with my understanding that jagged leaks point to the mask, and wider round leaks point to the mouth style leaking.

2. EPAP seems like you can lower EPAP Max to 12 or 13 at most. Leave EPAP Min there if it's suitable.

3. PS Min might be trialed at 3 or 4.

Of this list, try them in order. Leaks being your worst enemy according to this chart.