Breathing Pattern Disorder During Day, ASV?

[Try00]

Hello!

I had a sleep study recently and wondered if anyone more educated than myself could help me decipher it more deeply. The doctor I saw for follow-up did not help much and made no suggestions. Recently I have been struggling with constant awakenings during the night which feel like I stop breathing constantly. I ordered a used ASV machine I found a good price on because I had assumed it was central events but I have not used it yet as I wanted to await the results. I did sleep more through the night for the sleep study than I usually do but I also took Ativan & melatonin right before bed as I knew I would have trouble sleeping and wanted to make sure I got results.

Thank you for any help.

[Sleeprider]

Try00, I have merged your new thread asking about ASV with your previous thread, because we really need the Oscar data you posted in order to help with your question. Your sleep study shows that you had obstructive sleep apnea and a high rate of periodic leg movements. Your Oscar data show you have a low incidence of centrals, in a periodic pattern that often coincides with PLM. Some zoomed shots of CA events might be helpful in making a better assessment. With the Oscar results in this combined thread and your sleep study, you won't qualify for ASV through insurance, and I doubt a prescription is likely. I will suggest you try increasing trigger sensitivity to high to see if that helps. We can consider trigger at very-high if you don't get what you're looking for. We may consider moving to PS 4.0 and fixed pressure as another future option to remove the low residual flow limits and make therapy as steady as possible. I don't see any benefit to the increase in EPAP min from 6.0 to 7.0.

[Try00]

Thank you for doing that, I apologize for making an additional thread.

I have attached last night's data with 2 zoomed images on the CA's I had. Last night was a very rough sleep and very fragmented, constant awakenings feeling like I could not breath. Also, to your point, I currently have the trigger set to "high" on both of these OSCAR reports. 

I understand I will not qualify for one with the results. I had ordered one secondhand and have one already in my possession and was wondering if trying it could be beneficial as I have never felt truly rested in the 2 years I have been on BiPaP. 

Currently, my PS is set at 3.6, I will bump it up to 4. The sleep study recommended 8 EPAP 12 IPAP, based on what you see that wouldn't be advisable?

Thank you for your response, time and help!

[SarcasticDave94]

The ASV will likely not benefit and be more disruptive and harder to get used to. This is a different assessment due to extra info such as the Titration data.

With the VAuto and the Central Apnea showing in OSCAR, I would use the Trigger setting at High to avoid some CA. If that doesn't help, go directly to Trigger Very High.

It's odd that trigger and cycle do not show in the left panel of this OSCAR chart. This is an actual VAuto and not a hacked unit?

[Try00]

Thank you for the reply. I will scratch trying the ASV if you believe it will not be effective. My concern was a lot of CA's were not showing because I am waking up before it can be registered, unsure if that's a thing or not.

I currently do have the machine set on "high". Increasing to very high would help what I'm dealing with? I can try this tonight.

I am unsure. I purchased it out of pocket from Lofta using my prescription. I assume it is all legit, but I have been questioning its effectiveness, sometimes when I stop breathing I feel like it is not delivering air to help me breathe.

[SarcasticDave94]

OK yes try very high trigger next if you feel the Central Apnea needs to be lower. Compare both high and very high trigger settings to see which is best compromise between low CA and best comfort.

[Sleeprider]

If you have ASV in-hand, I have no objection to helping you set it up to satisfy your curiosity. It certainly won't do any harm, and as Dave suggests, it may end up being more disruptive. No harm in trying. if you choose. I would go with the Very -High trigger at 6-10 PS 4 and see how the combination of trigger, more PS and fixed pressure works out.

If you go to ASV, your zoomed images show some central anomalies of periodic breathing and the centrals seem to arise from a loop gain which may resolve with ASV at low pressures. I recommend EPAP min 5.0, EPAP max 8.0, PS min 3.0, PS max 8.0. You will be the one deciding what works best.

[SarcasticDave94]

Certainly, I'm not against you trialing ASV. That was my 2 cents from a former ASV user point of view. Note had my COPD not interfered, I'd probably be on ASV today

[Try00]

Merry Christmas!

Thank you for both of your help. I wanted to give the testing a few days before I uploaded anything. I went with your suggestions on both the BiPaP and just last night tried the ASV. I will attach 2 nights of data from the BiPaP and 1 night from the ASV. Just from overall feeling alone, I feel like I got more restorative sleep with the ASV even though it was a little weird adjusting to it and I woke up several times throughout the night.

My only concern going forward is whether there are any complications using an ASV machine if you don't "need" / wasn't prescribed or recommended on ever after my sleep study. I am still somewhat young and don't want to set myself up for future health issues if that's at all a possibility

BIPAP SETTINGS -
6-11
PS 4
Very High Trigger

ASV SETTINGS - 
EPAP MIN 5.0
EPAP MAX 8.0
PS MIN 3.0
PS MAX 8.0


Thanks for all your help!!

[SarcasticDave94]

I would say probably no real harm in using ASV. It's just harder for some to get used to.

It looks OK as is. Is it helping your rest and is reasonable in comfort? Then stick with it.

Merry and safe Christmas
Note on ASV your flow limits chart will likely be somewhat busy. You can't really address it easily, as it appears to be ASV therapy in action artifacts.