Bipap Titration advice needed.

[Rubicon]

I got some n/a on some of the settings. Did you Airbreak the machine?

[Rubicon]

Cause this one is weird.  Seems like the machine should have done something but didn't.  



That said, IMO those aren't OAs anyway, they're CAs, either post-arousal or SWJ.  So the correct response was, in fact, to do nothing.

In ASV Auto the n/a is often (always?) in Max IPAP and PS, and once even in min EPAP.

[amafra]

I did indeed. ASVauto does not show the settings, I generally use 5-10, 2-8, sometimes 7-12, 2-10ps , it can only be seen looking at graphs in OSCAR. Strangely, my may 17 differs. My ASVauto always shows n/a. It's because of airbreak. On ASV auto I never get centrals. It is different from your print. if you import multiple attempts in the same day, like asv and vauto, OSCAR gets confused.

[Rubicon]

Literally every day is a different set of parameters. I think you need to stick to one set, and if you think it fails, figure out why. Like in the above "weird" one, you just woke up and didn't go back to sleep. That AHI is meaningless.

[Rubicon]

Here's another weird one.  No minEPAP noted.  Failing to respond to events.  Slow gradual increase for no apparent reason.  Abrupt halts in PS.



It seems like when minEPAP is noted as n/a, machine response is off the wall.

[Rubicon]

Sustained high pressure despite no events.  Tidal volume at 3000 ml. (although breath rate is 5 MV is still 15.0 which is way too much).  Sustained high pressures at end of night again w/o events.  As ASV ventilates to 90% of MV it should have been tapering down.

That said, during the high IPAP episodes you appear to be sleeping like a log.

Go figure.

[amafra]

Thank you again. Sorry for the delay in response. I was driving to my father's ranch.
ASV auto does not log settings correctly. Many times I wake up, change settings, copy the SD card to a different profile, erase it and try again. I had many profiles, some I deleted to avoid complete mess. For example, if I start Vauto, sleep for 1 hour, wake up and change settings to ASV, SD card will record all graphs but the settings will show as first (Vauto), when device is turned on, settings are written into SD. It does not seem to update it when I change modes during the night, even if it does, OSCAR has problems mixing the same night different operation modes. Sometimes I take the mask off even without realizing it and sleep without it. When I for some reason or apnea wake up again, I see I don't have it so I put it back. These days are the worst, I feel terrible and so sleepy the next day. I believe high IPAP causes me to wake up due to a big leak or need to have a mask so tight. I can say these masks are very very tight. The last image was old firmware patched and was not applied correctly. Thanks to a friend that provided me with aircurve firmware that I patched and allowed more modes. Mostly all, except ivaps and st that do not have backup rate and few other fields that are required to complete functionality. I don't believe I need these modes anyway. Most likely I need Vauto. I don't understand why it does not taper down, not sure if it is not related to big leaks that happen at high pressures. You did an excellent analysis on the graph. I'm going to see if I can figure it out. I will be on Vauto, AVSauto and Autoset for 3 days each and post here, I will try to keep using the mask on when I see it off. It is pretty bad the next day but it is the only way to better understand. 

Have no words to thank you and all what I consider friends here helping me and others here.
Very much appreciated.

[Rubicon]

Another area with 11/7.  There's a long stretch of good sleep, interrupted by a spontaneous arousal, resulting in a post-arousal CA (don't believe the machine).  Rather than leaving it alone, pressure is bumped up.  Fortunately some good sleep followed, but the pressure increase was uncalled for.

[Rubicon]

More weird.  The ASV is simply not working.  No measured mask pressure when it should, no measured flow rate, no change in pressure.  I don't think this is a machine-Oscar transfer problem.  IMO there's a major malfunction.

[Rubicon]

That said, it mostly works. Note mask pressure registering waveforms during events.