HELP WITH SLEEP STUDIES PLEASE

[Deborah K.]

Johnny was using mouth tape under his full face mask, so he could probably use the tape with any pillows mask with better results.

[Johnny Bravo]

Hi. What did you mean when you said this:

"I had to cut pressure support on my Vauto and that is only 4 cm difference, yours is 5.5 to 12"?

Should I lower my pressure support? One night I slept with the mask on I couldnt fall asleep. The next night I couldnt sleep deep. I remembered this is what happened to me before and that's why I dont use pap. I asked about this on another forum and someone told me sensitive people need to start with low pressures. Does this mean lowering the pressure support to the minimums I can? I got psmin 4 and psmax 9. Is this what you mean?

Besides that, the ASV is starting to show a message of the humidifier failing or not working correctly, but it seems to work when I turn it on and use it.

I was gonna post Oscar charts of those 2 nights I've used the ASV but couldn't. In the welcome and daily tabs it says last time I used it was January 2008. I tried to look for yesterdays date in the daily tab and it said no data there. In the profile tab it says last data imported was today. And in the overview tab there are also old dates and I dont know how to use that screen. Im sending attached pdfs of those screenshots. ASV/card is not recording the current data? I went back and changed the date in the asv with the card on and put it back in my computer but same in Oscar. I def need to study how to use Oscar.

Feeling so frustrated. Sorry for asking these basic questions. Thanks for any hep.


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[Sleeprider]

According to your images, you last downloaded data from your S9 VPAP Adapt in 2008, so either the machine is no longer recording data, or that is the last time you used it. It's possible the date on your machine is incorrect due to the battery being spent. The Summary screenshot shows you had no events (zero AHI) on 8/1/2008 with EPAP min 8.0, EPAP max 12.0, PS min 5.6 and PS max 12.0. The data we really want is shown in the Organize Your Oscar Chart linked below in my signature. I do have some suggestions on how you might find this device less disruptive. I recommend the following settings:
Mode: ASVauto
EPAP min 6.0
EPAP max 12.0
PS min: 3.0
PS max 11.0

You clearly need to replace this machine, and the one you need is probably a Resmed Aircurve 10 ASV. It may be possible to refurbish your S9 with a new motor, internal battery and repairs to the humidifier. That would provide a "like-new" machine for about $300 -$400 USD. If you are looking for more comfort to enable you to sleep, give these settings a try. See if you can get some data to load on your SD card and upload it to the forum.

[Johnny Bravo]

Thank you so much for helping me. I keep on having problems but trying stuff, so please bear with me.

I think I only used it once after your last reply when you recommended the last settings (EPAP 6-12 PS 3-11). I think I slept with the mask on but not deeply. I inserted the SD card in the computer to give it another try and it seems like it picked up on the date. It shows I used it on the 27th/28th? of February, last time I used it, with your recommended pressure settings. It showed the daily chart so I took some screenshots and im posting them here if it tells you something. I looked for other dates but it only shows me data for the day.

Trying to use the ASV gave me even more insomnia cause I couldnt sleep with the mask on, so after that I couldnt sleep at all for a week. If I can't fall asleep once I take my sleep meds, I can't fall asleep again till the next day (sleep myoclonus, PLMD, alpha delta sleep, etc).

Im already somewhat stable again, or trying to get there. I watched a video on another forum where someone has my mouth leaks/cheeks/mouth filling up with air and someone recommended Dr Mew´s tongue suction hold exercise. I did it last night with a regular universal bruxism silicon guard and I slept a little better. I had already heard this for tolerating PAP and using less pressure. It sucks the tongue forward and gets rid of it for PAP's air to flow through. So im a little hopeful again.

In case my ASV is def not working well, I dont understand what you said about buying a refurbished machine. Can I do that from here? Im in Colombia, South America. Can you explain this more please? Is my ASV working well according to the screenshots? Im gonna try to use it again and see what happens so I can post more screenshots. Thanks,


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[Sleeprider]

Your S9 VPAP Adapt is continuing to work for you. AHI is 0.00. Your ASV is working fine, but spends a lot of time using the maximum pressure support of 11-cm. I have some thoughts about reducing your pressure support if you would like to try that. My hope is that we can determine what is really going on with this therapy. Current settings are EPAP min 6.0, EPAP max 12.0 and PS 3-11, but your machine delivered an EPAP over 8.0 the whole time, so something doesn't look right, it looks like fixed pressure ASV. That aside, in a 1:45 trial, it was perfect.

I don't know how to overcome all the issues you have just to put on a mask and sleep. I think it would be great if you had a newer machine, but at this point it's not the machine holding you back, it's your inability to sleep with it.

[Johnny Bravo]

Yes I was afraid of that. My inability to sleep with it.

Can it happen that it all looks right in Oscar but the person still feels miserable? That's how I've felt with all my in lab titrations.

I forgot to say that that last night I felt I was back at how I felt a bit with the other machine. At times feeling chocked and with little pressure. But also that combined with the rest (too much pressure, or air at times making me wake up, or feeling leaks or that swallowing air discomfort, etc).

Also what do you mean when you say that its not normal that the ASV is delivering the same pressure all night? That's not normal? Its behaving like it was a fixed pressure like CPAP?

Yes please give me your thoughts about reducing my pressure support. I guess I can try it again and post something if I can. I still have to see if the ASV keeps recording the data and the dates right.

Thanks

[HalfAsleep]

It sounds like some of your difficulty in using the machine, is a problem with an ill-fitting mask not allowing enough sleep. Most everybody here has gone through some trial and error finding a mask that suits them. Personally, though I needed a full-face mask, I couldn't tolerate the F20 with foam for the reasons you describe (i.e. leaks). I also hated the feeling of the foam. I got a different full-face mask.

I know you might not want to hear this, but it's my experience that it takes some adjustment for everyone to get used to the apparatus of apnea therapy. No surprise there, since most folks have no history wearing a mask on their face, let alone straps and tubes. And then there's the matter of how tight you need it, whether it makes your nose sore, if the headgear bothers the back of your head.... It can be miserable until all this gets fine tuned. Sleep can very easily get lost in the process.

Good luck!

[Johnny Bravo]

which full face mask do you use? thanks

[Johnny Bravo]

Your S9 VPAP Adapt is continuing to work for you. AHI is 0.00. Your ASV is working fine, but spends a lot of time using the maximum pressure support of 11-cm.  I have some thoughts about reducing your pressure support if you would like to try that. My hope is that we can determine what is really going on with this therapy. Current settings are EPAP min 6.0, EPAP max 12.0 and PS 3-11, but your machine delivered an EPAP over 8.0 the whole time, so something doesn't look right, it looks like fixed pressure ASV. That aside, in a 1:45 trial, it was perfect.

I don't know how to overcome all the issues you have just to put on a mask and sleep.  I think it would be great if you had a newer machine, but at this point it's not the machine holding you back, it's your inability to sleep with it.

Hey:

Im sorry to bother you again. I hope you can still help me. I finally was able to sleep with the ASV with the last settings you recommended (Mode ASVAuto, EPAP 6-12, PS 3-11). Also after formatting the SD card which didn't record more than one day. I still have to see if it does (sleeping 2 nights in a row with it tonight).

So if you'll still help me (im sorry for all my troubleshooting and pap intolerance) im posting yesterdays chart here 
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I dont understand anything, though I've already started watching some Oscar videos.

I dont feel better. I only slept a bit better, I think. It was a light sleep like always, but at least I fell asleep. I dreamed a lot, but im experiencing some sort of rebound sleepiness? I dont even know if this is a thing. I feel that when I use pap I go from feeling totally anxious and weak and not sleepy or hungry (cause im long time severe untreated) to feeling a bit better but also bad and worse with the rebound sleepiness? I dont know how else to explain it. Ive slept 2 nights with the asv (first night card didn't record the data so I formatted it) and the 2 days I've had to continue sleeping afterwards, specially after I eat. Does this make sense? Or is it only me cause I have so many health issues?

Also I started reading a post on CPAP talk I think yesterday when they discuss long about this person who uses an ASV for his UARS but feels his pressures fluctuate and go up too much like me. The person who was helping him told him to use CPAP, that he slept better with it, the poster posted charts. Besides being sensitive to pressures (UARS?) he also talked about his air going down his mouth cause of his tongue base collapse (like me). And the helper talked about tongue position on the roof of the mouth as a good posture habit all the time to do it unconsciously during pap therapy to make it work. The poster was using some oral appliance (I use one for this too) but it wasn't working. Im thinking again that there should be one for creating tongue suction and render pap therapy more effective. What we all should be doing out of having good tongue posture habits but we dont do it. Easier said than done.

Can you please explain what you mentioned before about something off with the ASV and the therapy/machine being on a fixed pressure the whole time or the pressure support being too high all the time? If you still see this, if it keeps happening, could you please explain?

Do you think you can help me try straight pap? Or should I see trying asv for a while? I know I have to do this. I mean, with my severe condition and pap intolerance, the challenge is to use it pap therapy.

Thanks for any help.

[Sleeprider]

This graph looks fine. Your EPAP min of 6.0 was pretty much the median and 95% pressure, so if you would like to try a lower EPAP min, we can do that. Let's try EPAP min 4.0, EPAP max 7.0, PS min 3.0, PS max 8.0. You got 4.5 hours of therapy, so don't expect miracles in how you feel with so little sleep.

Since the objective is to treat UARS, the above settings are cutting you back to the minimum spread in PS that the ASV allows. This should treat UARS, but I would not do this for severe obstructive or central apnea. We want to get some feedback on this before deciding which way to go on this therapy. Assuming UARS, this should make a difference, so relax and give it a try. I don't see how CPAP would help UARS if that is your real issue. The idea of using ASV is to provide a mechanical assist to inspiration to overcome airway resistance and provide a normal flow wave form with a nice rounded inspiratory peak. You can zoom in on the flow rate until the flow wave is clearly visible to verify this. This wiki describes exactly what we're trying to do. https://www.apneaboard.com/wiki/index.ph..._and_BiPAP

Excluding air from the mouth, especially when using nasal therapy is an important skill and minimizes sleep disruption. I have heard it described as the tongue-suck technique. The tongue rests behind the front teeth and you can suck, like when you drink from a straw. This locks the tongue in the correct position to block air from your throat.