[Treatment] Strange breathing waveforms on ASV

[Hrapovik]

Hey everyone, 
I've been on Resmed AirSense 10 Autoset for 8 years with diminishing results and less than a month ago moved on to AirCurve 10 ASV. 
At first, it worked like magic, but the success was short-lived.
Not sure if it's the right therapy for me, or I'm doing something wrong, so I'd appreciate some pointers


For instance, 2 days ago, I woke up extra tired and cranky and with some heavy sensation in the lungs.
On the surface, the charts from that night's SleepHQ paint a great picture: low AHI, no OA's or CA's. But I noticed that there were several periods during the night when my breathing waveform was radically different from the normal sinewave. What is this phenomenon? Is it apnea? Hypopnea? Is this dangerous? What's going on these pictures? 
Thanks in advance!

(settings: autoASV mode, min EPAP 4, max EPAP 6, min PS 3, max PS 10)

Sorry for attachments, I'd rather post links to the pictures and my SleepHQ charts, but I'm not allowed to post links until I have 4 posts.

[Sleeprider]

The odd wave forms are inspiratory flow limitation or resistance. An image showing a closeup of the wave form along with mask pressure would be more useful than just showing pressure. In my experience, when periodic flow resistance like this happens the user is experiencing clusters positional airway resistance or chin tucking. It happens even with ASV and examples with ASV can be seen in our positional apnea and soft cervical collar wikis. Much of your night shows normal respiration ,but when you get into a position where the airway is positionally obstructed, the result can range from severe flow limitation like this to full obstruction of UA events.
https://www.apneaboard.com/wiki/index.ph...onal_Apnea
https://www.apneaboard.com/wiki/index.ph...cal_Collar

[Gideon]

I'm not sure what I'm looking at, ResMed does not have a stat called "Breathing"

It looks like flo\ limited breathing which we generally ignore with an ASV and an ASV reacting to head off events.

[Apnea23]

I generally have 3 similar periods and have ruled out positional issues but you should try ruling it out with a soft cerivcal collar, etc.

The worse periods for me are the two between 3-6am, generally the last period without fail when I will prematurely wake up due to the severity of pressure and chaos.

My ASV has to push really hard *only* during these periods, and often it wakes me due to the immense pressure, blows my cheeks, and often just cannot overcome it to keep the minute ventilation steady. My breathing only normalises when I'm awaken by the ASV.

Me personally, I believe these are periods of REM where everything relaxes and flow limitation is significantly greater. The ASV will just keep pumping as it cannot overcome it until it wakes you up.

Autoset I found was garbage for these suspected REM periods, as is ASV (too aggressive and distruptive). I don't think either is the true answer.

If you look back on your Autoset graphs, do you find your flow limits increase during these periods and your breathing goes from very narrow to very shallow, with arousals, and the rest of your sleep is generally fine outside of these periods?

I went back to the Autoset. At least it didn't shove incredible ammounts of pressure down causing more arousals and issues. However I do need more pressure than APAP wants to provide to keep my breathing more stable during REM, and it still can't do it.

Now I'm working on alleviating the flow limits so the Autoset can work during REM. This means stenting the airway at the soft palate or the toungue base.

Anyway I'm babbling.

Once you confirm or rule out positional apnea, you can take things further.