Bilevel ASV - Resuming After Septoplaasty

[Dread]

Here is last nights data. for some reason I woke up in the middle of night. I feel like im getting fragmented sleep similar to the ST

[Dread]

Any suggestions for adjusting? Id like to get good sleep, but feels like i dont dream much. Probably arousals?

[Dread]

Hey Sleeprider. I assume you have more experience with ASV, any ideas whats wrong with my settings?

[Sleeprider]

I'd like to see a zoom on your flow rate to see what's going on. Your median inspiration time is longer than expiration which suggest higher PS min may be needed. It might be possible to reduce EPAP min pressure. I'm kind of moving towards EPAP min 8.0, EPAP max 10.0, PS min 4.2, PS max 9.2.

[Dread]

Does it indicate UARS? I get the symptoms like Orthostatic Hypotension, light sleep, and wake up easily. In January, I am getting a septoplasty done so I hope it helps flow limitations.

[Dread]

Below are flow rates. Let me know if you need more.

[Dread]

Should I still try these settings, or looking at the graph, do you think IPAP may need an increase?

[Sleeprider]

The closeups show the statistics are probably wrong on inspiration time. What I see in these graphs is almost the opposite of what I expected. The ASV is providing high PS when your spontaneous respiration is at a low rate and volume, but not enough to normalize the volume. Then you seem to spontaneously take over with more rapid, higher volume breathing to make up for the deficiency. This actually shows a need for higher PS max not PS min, and EPAP can stay where it is. While I'm thinking about it, I'd like to see the tidal volume graph replaced with minute vent. Rather than confine the PS max, maybe we should allow more. Is there any reason we should not allow PS max to go to 11.0? It might correct those periods where your ventilation rate follows, and prevent the need for the recovery breathing.

[Dread]

Heres the minute vent. What im unsure is ASV tiltration similar to other machines where if i set it to 11, will i go up to 11 or only when needed? I assume it would be fine because ASV will only hit 11 when needed no?

[Sleeprider]

That is correct. In theory, you can set PS max at default 15 and it is only used to maintain the target.