[CPAP] Help with ASV OSCAR data? Persisting Daytime Fatigue Despite 0 AHI

[LennySleeps]

Hi there! 
Thanks so much for having me here and any help in advance! 
I am very new to this so apologies if there I have missed any posting protocols - please let me know how to do better if so. 

I am 22 and otherwise fit and healthy but since my diagnosis with obstructive sleep apnea (33 AHI) I have experienced excessive daytime fatigue despite my continued compliance with an ASV machine which was prescribed following residual emergent central events (7) following the use of CPAP in the hopes that these were responsible for my daytime fatigue. I have since stuck with the machine due to the enhanced comfort and the satisfaction of the few specialists I have seen. Furthermore, subsequent self guided experimentation with CPAP settings seem to indicate that the central events have become more pronounced overtime? (as attached).

My doctors have assured me that the ASV machine is doing its job (with an AHI of roughly 0) and therefore other diagnoses are to be explored (Narcolepsy, Idiopathic hypersomnia), however, none of them have broached the subject of RERAs, Flow limitations - things I hear CPAP users/specialists like yourselves referring to, and thus I am keen to explore this possibility before being sent down the path of a separate incurable diagnosis.

Through my own attempts at reading the flow chart, I am having difficulties with identifying these (are they different with ASV OSCAR outputs?) and whether they are prevalent enough to be the cause of my struggles with fatigue. Can anyone help me out with this and put me in the right direction? I would be extremely grateful for any help/suggestions with moving forward. 

Kind regards, Lenny.

[Jay51]

Much better results on ASV.  Your respiratory rate is below average though.  Normal is usually between 12 and 20, but can vary.  Your median is 7.  Your tidal volume is on the high side of normal (but ok).  You take infrequent breaths with a little larger tidal volume using ASV.  
 
ASV is mainly concerned with stopping CA's.   You have about a 13 to 15 EPAP pressure on straight cpap mode.  You have a 4 EPAP and then plus the PS it goes up to about the same - around 13 to 15 or so.  

Most people feel "air-starved" at an EPAP of 4.  We usually advise starting with at least EPAP 7 or so.  You can try raising your EPAP a little and see how you feel in the morning.  The Pressure Support (PS) should decrease a little bit as you raise EPAP (I have an ASV also.)


EPR is usually what treats flow limitations.  EPR is limited to a maximum of 3.  With you ASV you are getting around 10 or so pressure support at your current EPAP of 4.  This high amount of pressure support should treat flow limitations better than a max of 3 EPR also.  

It would be good to show your Dr.'s this exact ASV OSCAR chart and show them your median respiratory rate of around 7 and see what they say about that.  

Anyone can add comments to help if they see anything else.

[SarcasticDave94]

Try this, edit Min EPAP to 6 and min PS to 3. No other edits, normally doing 2 edits at once isn't ideal, but this is an attempt at pressure swapping by increasing EPAP and reducing PS. Regardless you'll at least want a small amount more than this minimum pressure on exhale 4.4, at least I would myself.

[LennySleeps]

Thanks so much for your help, can't understate how much appreciate your advice! I will make these adjustments and see how I get on!