Need help with air leaks

[Jay51]

Something is wrong here.  Your OSCAR charts show a respiratory rate median of 6 in the 1st chart and 7 in the 2nd chart.  Normal should be approximately 12 to 20 or so per minute.  

Your expiration time in the 1st chart is long at 3+ seconds.  Long inspiration and expiration times in the 2nd chart as well (both 3+). 

The ASV doesn't have a set rate to pace your breathing at night.  It only goes by the rate that you provide naturally for it.  

How do you feel in the morning after this therapy?  This might work for you, but a machine that would provide a set back up rate rather than the dynamic respiratory rate provided by your ASV (uses a 3 minute rolling average to calculate the rate) might work better.  

If the ASV experts want to post here about this, please feel free to do so also.

Do you mind posting a close up 3 minute zoom of a time when you know that you are asleep.  Just click on that time, and drag the cursor to the right for 3 minutes of time.  I want to check if your 6 and 7 respiratory rate are legitimate or not.  Thank you.

[ThatGroup7347]

I seem to feel ok.  Does that mean I am only taking about 6 breaths per minute.  When it was leaking bad I would wake up feeling pretty bad. I don't know if this matters or is related to the respiration, but I have a rather low resting pulse.  I am under 60 and I know when I am sleeping it is around 50.  I don't know if this is related, but when I first tested for sleep apnea my oxygen rate was around 80% for half of the night.  I have the wellue oxygen monitor, but the battery died a few months ago and am in the process of getting the battery changed.

[Jay51]

Thank you for explaining all of that.  I have seen a Pulmonologist and Cardiologist (and have an RT, too).  It would probably be good to show your treating physicians and healthcare workers this data.  Getting down to 80% SPO2 during sleep for half of the night is very low.  If a person spends a cumulative 5 minutes or more below 88%, they qualify for supplemental oxygen according to Medicare.  

By uploading a 3 minute close up zoom, it should verify if your respiratory rate is actually 6, 7, or 9 breaths per minute.  I actually had a 6 respiratory rate recorded on my polysomnography.  I had a 5 respiratory rate on a capnography test.  They set off major alarms in the minds my healthcare workers.  

My pulse has gotten down to the low 40's and even high 30's at night sometimes.

[ThatGroup7347]

I think you may have been looking at the wrong chart for respiration.  I made sure I got it on the screen capture below.  I take it this is a little more normal.

[Jay51]

Thank you very much for posting this chart.  Your median respiratory rate for the 3 hours and 35 minutes of sleep was 7.4   That is below average by quite a bit.  

In a nutshell, it is your therapy.  If you feel good enough using the ASV the way it is now, that is your call.  You might feel even better by possibly:  1.  Getting supplemental oxygen to help treat your SPO2 that was 80% for half of the night during your sleep study; and 2.  a machine that has a respiratory rate setting (like the ST (A) that could pace your breathing at night to bring your respiratory rate to a more normal level - which in turn would increase your minute ventilation and should increase your SPO2 as well.  For example, if you set the ST (A) to a back up rate of 12, it would ensure that you take 12 breaths every minute that you are using it.  The ASV only uses your natural respiratory rate and tries to replicate it.  

I wish you well.

[ThatGroup7347]

Thank you for your help.  With my current machine is there a way to set that ST (A) thing to 12 where I could try it to see if I would feel better.  Some days I do feel tired and tend to doze off easily.  I did notice that I got the leaks under control my events are now over 10 on a daily basis.  I would like to try some things as I would love to feel better.  I could dig up some of my charts from my wellue oxygen monitor to show how my oxygen is doing with the therapy.  My brother is replacing the battery and hopefully it will be working again and I can get some new readings.  I've been using the asv for a number of years, but am just realizing how much more involved all this is.  I honestly am a little lost and really appreciate you taking the time to help me.

[Jay51]

You are very welcome.  Uploading some old oximetry data would be very useful for us to look at.  

I apologize if my explanations have been too vague.  The Aircurve 10 ST (A) is a different machine than your ASV.  But it can be set to a back up (respiratory) rate of any number you like.  You could program it to cause you to breath 12 times a minute, 15 times a minute, 10 times a minute, etc.  It would guarantee that you breath that many times also.  I have used ASV, ST (A), an Astral ventilator, and now this Trilogy Evo ventilator.  The ASV, in contrast, uses a rolling average of your normal respiratory rate - this is why it is so low.  

IMO, you appear to be hypoventilating even when using the ASV.  Why?  You have posted OSCAR charts with median respiratory rates of 6 and 7.  Your minute ventilation is below normal in both charts also.  Minute ventilation is respiratory rate x tidal volume (amount of air breathed in one single breath on average).  Your tidal volume is ok though.

You might actually be able to get by with using ASV and supplemental oxygen (to increase your SPO2 levels at night).   But probably the ST (A) and supplemental oxygen combination should help you the most IMO.  

I have been diagnosed with hypoventilation.  Also, Sleeprider, Sarcastic Dave and other members here at ApneaBoard have helped me with learning this stuff (along with the medical professionals that I mentioned in an earlier post).  

Keep the questions coming if you are curious about anything.  Glad to try to help.

[ThatGroup7347]

This is really good info to know.  Kind of a dumb question, but why are the doctors not concerned about these numbers.  When I called the office they never even heard of Oscar.  If this info is available from the machine I would think it would have some meaning to make sure everything is working ideally to provide the best therapy.  I have 3 charts that I picked for my oxygen data.  They are old because the battery has been dead, but maybe this can help you better understand what is happening.

Back to the ST machine.  If I wanted to try to improve those respiration numbers I would need to get the ST machine.  In order to do this I take it the doctor would have to order it for me.  I have medicare, do you know how they are about paying for that machine.  I am still on my first machine which I have had for about 6 years.  They had to swap me a new one just before the warranty ended because it was making strange noises. I know these machines are really expensive.  Even when I called the doctor and I was having the massive leaks he was like everything looks good just get the leak under control.  They didn't know the machine shut off when it leaks so bad.  

On the charts even when my oxygen drops it is only for a very short time.  I think over the course of the night it is less than 10 minutes vs 2 and a half hours before I was being treated.

[Jay51]

Possibly, your Dr.'s may not have been aware of these statistics.  

Looking at your 3 different SPO2 charts, the 1st one looks ok.  The 2nd not very good (needs work), and the 3rd not the greatest, but not terrible - a few brief spikes below 90.  

The plan I would personally use if I were in your shoes would be this (I have already been down this road before):  Definitely show your Dr.(s) a couple of OSCAR charts that show your median nightly respiration rates of 6, 7, and 9.  Average should be around 12 to 20 or so during sleep.  

Also, show them your minute ventilation median statistics:  yours are below normal because your respiration rate is so low.  You tidal volume it ok, but the average minute ventilation for an average size male is lower than normal:  1 Minute Ventilation Volume in Health and Disease (normalbreathing.com)  

And lastly, show them your SPO2 charts.  Time spent below 90 should be concerning, investigated, and remediated if possible.

Regarding the ST:  there are 2 different machines.  The ST and the ST (A) - A stands for advanced I think.  The ST is more crude and only offers a spontaneous mode (which would not help you) and a timed mode (you could set a back up respiratory rate, but it uses a square wave algorithm - it can be difficult to tolerate though.  Basically, the pressure comes at you very quickly and subsides very quickly.  I could not get used to this in trial.  

The ST (A) has both of the above described features plus IVAPS.  IVAPS is basically to increase tidal volume, so you might not need this either.  

Let your Dr.s see all of the information and decide what they think would be the best move.  Also ask about supplemental oxygen.  If you get supplemental oxygen, you very well might be able to continue to use your ASV and get adequate results in SPO2.

[ThatGroup7347]

Thank you again for the help. I had showed some of the oxygen charts that were bad, but he was not concerned as it would drop, but would come back quickly.  Probably because the ASV is doing something.  Although I never had the new data before so maybe the combo will help.  I will have to wait until I get my oxygen monitor working so I can get some current readings. Thank you for taking the time to help me.