First night asv. A little confused with Sleepyhead charts

[Sterling147]

I finally got my asv yesterday and used it for the first time. It actually seemed strange not having a constant stream of air blowing at me. I also kept waiting for the blast of air to hit me and wake me up. Luckily that didn't happen (I hope that I didn't just jinx myself).

My settings are straight asv - not auto. EPAP 7 min ps 4, max ps 14. I opened a new Sleepyhead profile so that I didn't mess up my previous CPAP reading I didn't know if that was necessary but didn't want to take any chances. They are saved in case I need to refer to them in the future.

The sleepyhead readings were pretty straight forward for my CPAP use but I am a little confused by all the categories and data listed on the report. One notable difference is that there is no listing for clear airway or central apneas on the asv chart whereas there was one for the CPAP. Do I have to change settings to monitor this? My AHI was 2.69 with no obstructive apneas. My AHI's using the CPAP were mostly in the 1 - 4's occasionally going up to 8's or 9's. I did have combinations of OA, CA  H and UA's using the CPAP. I will have to keep monitoring my asv rates to see how they compare with the straight CPAP.

I have tried to attach 2 Sleepyhead charts from last night (my first attempt).

Thanks for your help and comments.

 

[Sleeprider]

Your results are pretty good for starting a new machine, and it sounds like you are pretty comfortable. The machine seems to be pretty busy providing extra PS, especially during periods of sleep transition, and where no apnea is recorded, I suspect those are CA mitigated by the ASV. The apnea events seem to correlate with FL and snore events so are probably OA. Those particular events may respond better to ASV auto. Eventually you may want to try that mode. but you are doing well enough now, that there is not a compelling reason to change. ASVauto will increase and decrease EPAP based on detected obstruction (FL and snore), and might prevent some of the events. Also experimenting with lower minimum PS may result in fewer machine induced breaths. It appears you may be self-titrating, so be patient and give any settings enough time to establish a baseline.

[C0mbe]

I would follow Sleepriders advice and switch to ASV auto. If you are tolerating the PS at fixed ASV it won't be that different when you introduce a small EPAP range. You will probably notice that when you get it dialed in, your AHI will drop below 1, because the ASV auto algorithm is exceptional at mitigating the vast majority of apneas.

[Sterling147]

Thank you for responding. I just noticed that the events also seem to correspond to leakage. Is there a reason that clear airways/central apneas aren't shown with the asv and are shown with the CPAP? Is there a "Sleepyhead for Dummies " or "Sleep Apnea for Dummies " that would explain what all the statistics, channels, percentages... mean? 

I was hoping to use the ASV auto mode. I already have an appointment with my doctor for July for compliance and to check my progress. I will probably try to see or talk to him in the next week  or two to discuss any changes that I might have to make when I return to Mexico City. I will discuss switching to ASV auto at that time. I am a little hesitant about making changes without discussing it with him. He is open to suggestions and went along with member's suggestions of switching to an asv machine.  Hopefully I will get over this,but I want to keep my doctor in the loop. 

Thanks again for your help.

[Gideon]

Here are a few articles, not too much on ASV, but good general info.
 

Important Info about Sleep Apnea and your Therapy

Understanding sleep apnea   a description of what apnea is from a couple of well written forum articles.

New to CPAP - The Process Defining the process from denial thru getting your machine, a what to expect article.

Prescription - CPAP - APAP - BIPAP Sample Prescriptions, recommended xPAP machines.

CPAP-Machine-Choices-read-this-before-you-accept-a-new-machine do you want a brick? Didn't think so.

Optimizing therapy  

Using SleepyHead - Data is the key to getting good feedback, and SleepyHead is among the best software to see how you and your machine got along last night.

• [url=http://OSCAR Official Download Page ----> CLICK HERE ./]Download SleepyHead[/url] (free) How to
  
• Organize your Sleepyhead charts  Very important, 
  
• Post from Imgur a link from an outside source (easy)
  
• RobySue's Beginner's Guide to SleepyHead an awesome detailed reference to SleepyHead and interpretation of the data
  

Mask Primer pretty much everything about selecting, fitting, and using your mask, including leaks

[Sterling147]

Just started reading RobySue's Beginners Guide to Sleepyhead, which is helping. Thanks.

[DeepBreathing]

Is there a reason that clear airways/central apneas aren't shown with the asv and are shown with the CPAP?

Resmed CPAP and APAP machines detect "clear airway" apneas (ie central) by use of the forced oscillation technique - when an apnea is detected the machine pulses air at low pressure and fairly high frequency (1 cm H2O and 4 Hz if I remember correctly). Depending on the response detected, it can diagnose whether the airway is clear or obstructed. After an obstructive event pressure is raised to try and prevent further obstructives. However if it's a clear airway the pressure is not raised - increased pressure is contra-indicated for central apneas with this type of machine.

The Resmed ASV, on the other hand, doesn't bother about diagnosing the difference, as soon as airflow falls, it gets on and increases pressure support. It does this in a way designed to smooth the rate of change of airflow, which pretty much eliminates the possibility of a central apnea. Therefore if an apnea or hypopnea is detected the machine assumes it's obstructive and raises EPAP while at the same time adjusting PS.

I believe the process is different on the Philips machine, but I don't know the details off hand.

[Sleeprider]

Taking DB's comment one step further and clarifying my own comments, the events you had in your posted chart should be assumed to be obstructive, and would benefit from increased EPAP. ASVauto would do exactly that. I should add your minimum PS of 4 could also be reduced, which may reduce the number of centrals that occur to begin with, and that in turn would allow a lower maximum PS.