[Diagnosis] S. Manz - Therapy Thread

[sheepless]

you may be right it's not plm but it has the hallmarks of it. compare to the attached screenshot of my respiratory response to plm. just keep it in the back of your mind if after optimizing your settings you continue to see this pattern and you continue to feel less than rested.

[S. Manz]

I have these spikes in flow limitations and I am not sure if I understand it correctly. What's with the random spikes?
Also my Oxygen level dropped last night from a long average of 97% to 91% with a lot of times in the 80s range last night.
How can Oxygen level average suddenly drop by 6 point? (I use two Oximeters every night to make sure I am not looking at false data).

[SarcasticDave94]

IMO when on the ASV, the FL chart can look like this for some to most. And unlike other machines and therapy, ignoring the FL might be a necessity, because attacking FL is typically opposite the actions of addressing CA.

I wouldn't know what exactly would create the issue on the dropped SpO2.

I myself would consider editing mode to ASV Auto to give an EPAP range. There seems to be better results that might be gained if giving the ASV more flexibility and power to combat events.

[S. Manz]

The only thing I don't like about Auto ASV mode is that it makes EPAP variable...This wakes me up without fail. 
I tried Auto fro several nights in a row, thinking that I may get used to variable epap, but no luck....BTW Resmed Clinical data, specifically recommends Auto ASV for breaking up Upper Respiratory events in "complex" CA situations when the patient also sufferers from Upper Respiratory apnea. I simply do not have that problem, so Auto ASV is kind of useless for me.

Thanks for the comment on Flow Restrictions, now I know to ignore them as their spikes are very short lived, (in terms of seconds at a time).
As for my O2 levels, this is really weird so I'll be opening up the IPAP on ASV a little higher tonight and see what will happen.

[staceyburke]

Flow limits are apnea just as O and H events. They are not timed. PS is used to control them. I would try increasing PS and see if it helps and you sleep well with an increase in PS.

[sheepless]

your 95%tile flow limitation stat is 0. can't get better than that. ignore the 1.0 'spikes' as the are a consequence of the way asv addresses ca. no harm in setting a fixed epap. I'm not sure which is better for me when I use my asv but have used both a set epap and a range. as I recall one reason I used a fixed epap was to reduce leaks and aerophagia. also, even though I'm usually not aware of varying pressure, it (especially quickly swinging pressure support), wears me out.

[SarcasticDave94]

FWIW I am probably one of the most rare birds on this forum. My combo of CA and COPD, a part of it. Another is that when using ASV Auto, which was fine for me excepting increased COPD ish, I didn't mind that mode. I didn't like non ASV Auto. I'd have liked manual time controls though. Rare case Dave had low amounts of FL to boot in the ResMed ASV, fairly regularly a flat zero FL chart.

[S. Manz]

Thanks everyone for your help which is much appreciated.
God bless.

[Sleeprider]

The spikes in flow limitation on your respiration rate coincide with brief periods where inspiratory flow is very limited, and usually followed by a spike in flow. There are three clusters of this happening between 03:31 and the marked UA at 03:33. This restriction appears obstructive to me as the ASV is delivering nearly the maximum PS during these breaths. Likely positional given the cluster, but you are self-recovering and grabbing recovery breaths. This does not arise from the central apnea component and suggests a need for either corrective position or higher EPAP. Regarding arousals in ASVauto mode, perhaps it is the obstruction that awakens you rather than the increase in pressure?

[S. Manz]

During my "ramp" period of 20 minutes, I take about 7 minutes to fall asleep and then register 11 Hypopnea events on average, before my ASV kicks in full throttle and breaks down the occurances to less than 0.5 an hour.
I love this machine. (see the attachment which I have marked up with detail).