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The treatment of UARS with ASV is both off-label and experimental. The ASV machine is also considerably more expensive normally. The main problem is that in ASV mode the minimum possible difference between inhale and exhale pressure is 5-cm. If you want to give it a try, we can suggest some settings however the Vauto or VPAP auto is a more solution. From what I can tell from your chart, the ASV is working very well with no apnea events, low flow limitation, so the only remaining question is, are you comfortable, or do you find the pressure changes disruptive to sleep?
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
Yep, definitely an off label thing here. But I suppose you can't argue with 0 AHI. Do let us know how things go the next sleep session.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
(05-13-2021, 12:42 PM)Sleeprider Wrote: The treatment of UARS with ASV is both off-label and experimental. The ASV machine is also considerably more expensive normally. The main problem is that in ASV mode the minimum possible difference between inhale and exhale pressure is 5-cm. If you want to give it a try, we can suggest some settings however the Vauto or VPAP auto is a more solution. From what I can tell from your chart, the ASV is working very well with no apnea events, low flow limitation, so the only remaining question is, are you comfortable, or do you find the pressure changes disruptive to sleep?
Minor correction, the 5 cm difference is between minimum PS and maximum PS, not inhale/exhale pressure (which would be PS). You can have min PS as low as 0 I believe.
I see the OP already has max PS at its minimum 5 cm above min PS which is what I was going to recommend for this UARS scenario.
I personally would try a lower min PS than 6 (I would start with 3 and work up as needed). The one benefit of ASV is that it does a lot of the work for you to combat restricted breaths by increasing PS when necessary. Having a min PS of 6 could be causing some issues, it might be necessary but does seem on the high end to me.
My recommendation would be EPAP = 4 cm, min PS = 3 cm, max PS = 8 cm. Then depending on how that looks I may increase min/max PS slowly (1 cm every week or two).
As for determining RERA's, you can kind of do so from flow rate chart. It becomes difficult with ASV due to the increasing/changing PS though. If you see continually reduced amplitude breaths followed by a spike (arousal breathing) that is a sign of a RERA. ASV makes this difficult because as soon as you have one reduced amplitude breath it increases PS to try and compensate.
If this is similar to my ASV then correct on minimum PS can be 0. The spread between PS as a range must be a minimum of 5 as in Min PS 0 Max 5.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
(05-13-2021, 12:42 PM)Sleeprider Wrote: The treatment of UARS with ASV is both off-label and experimental. The ASV machine is also considerably more expensive normally.
Since they gave him an S9, is it possible that this is a used machine, and it IS an experiment, and they are testing whether the ASV functionality works but using a machine which might be essentially free?
(It kind of sounds like the sort of experimenting we would do! )
Experiment? Maybe. But nothing like the experiment of a belt drive electric vacuum blower the Sullivan PAP.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
05-14-2021, 10:01 PM (This post was last modified: 05-14-2021, 10:11 PM by KingKongBingBong.)
RE: UARS how to interpret data!!
Yes it's somewhat of an experiment! I try out different machines until I find something that works. They didn't have a better version available at the moment so I am using this one until a later date. If I did purchase a machine this week for example, I would get the most recent version.
Here is my latest data - I felt better waking up this morning than usual, but I did not feel dramatically different to how I wake up sometimes. I have woken up like this many times in the last 6-9 months without any machine. I also tracked the night before this; the data looks quite similar, AHI index 0 but it was only 3 hours of sleep.
My data looks weird between 7-8 and I believe this is because I was awake trying to fall back to sleep (in the past I've just taken it off! )
Could somebody comment if flow limitation is RERAs? Or explain how exactly to identify them if not? Low AHI is great and all but I already had low AHI in my sleep study - which was likely inflated due to sleeping on my back rather than my usual side sleeping. Hence I'm trying to eliminate RERAs right now.
(05-14-2021, 10:12 PM)KingKongBingBong Wrote: Could somebody comment if flow limitation is RERAs? Or explain how exactly to identify them if not? Low AHI is great and all but I already had low AHI in my sleep study - which was likely inflated due to sleeping on my back rather than my usual side sleeping. Hence I'm trying to eliminate RERAs right now.
No, flow limitations are different -- it has to do with the shape of the waveform. A flow limit can certainly lead to an arousal.
I have one of the first A10s to come off the assembly line in 2014, and it doesn't do RERA detection. The S9 that you are using is even older...
I find it odd how different your flow limits look from mine. In your summary, your 95% FL is shown as zero, but max is 0.42.
compare this to mine,
[attachment=32248]
where my max is 0.39, but my 95% is 0.27
And my flow limits just rumble right along, over minutes, while yours are spikes:
[attachment=32247]
I thought that the S9 did things the same way?
Anyway, if you look at that second graph between 5:30-6:00, you see that the flow rate curve noticeably "squeezes" and then there's an apnea and then the spikey up-and-down of an arousal. In my case the apnea is unusual -- normally there's flow limits followed by arousals and awakenings all freaking night but I rarely have events.
)
