(03-28-2016, 05:27 PM)12344321 Wrote: I was diagnosed with idiopathic nocturnal seizures in late 2014. There is research literature that details that alleviating sleep apnea can improve seizure control.
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I experience two types of seizures while sleeping - partial and generalized. This means that in one type I wake up with altered consciousness and inability to talk, and in another I have the classic grand mal seizure. The pap therapy has basically eliminated the partial seizures, going from as many as 15 per night to none or 1. I have not been on treatment long enough to evaluate the generals, which occur much less frequently. Seizures increase with any kind of congestion or exposure to allergens, again pointing to obstructive component.
Given the history of seizures, you are dealing with a very non-standard form of sleep problems and that undoubtedly has some potentially serious implications on the treatment of your condition.
In other words, you are going to need to work with your doc(s) far more than a person with run-of-the-mill OSA does. And you are also going to need to take every piece of advice on how to tweak your pressure settings with a HUGE grain of salt. In my own opinion, I think you should NOT be adjusting any of the therapy settings on your machine until you and your docs have a better understanding of how well the ASV is handling the seizures, and you have a really good understanding of exactly how the ASV algorithm works and how each setting affects how the ASV algorithm works.
Quote:With the machine I believed that I was free to sleep on my back, but that night, even with the machine, I experienced some partials and an increased AHI, so we returned to my husband rolling me over whenever he found me on my back.
Given the non-routine background of your sleep disordered breathing condition, I think you should report this to your doctor. He
may suggest increasing the min EPAP a bit. But personally I would NOT increase the min EPAP without a doctor's ok if I were you.
Quote:While I understand that my numbers may look decent, due to the detrimental effects of seizures, I would like to do everything possible to eliminate events, with as much fine tuning as can be done.
I know that you would like to eliminate every single event. But that may not be possible. It is really rare for a PAPer to have an AHI = 0.0 day after day after day. Your AHI for the data you posted was well under 1.0. That is darn near perfect from a statistical point of view, and there may not be any tweaking that will
consistently get your AHI even lower.
A question: Did you have any seizures on the night for which you posted the data? If so, can you correlate the seizures with anything in the ASV data for the night? In particular, did you happen to have a seizure right around the time of the apnea that you zoomed in on?
Quote:This is why I am trying to understand the data and determine if there is anything I can do to get to zero events, to eliminate obstructions ( I am trying to learn of all possible solutions in addition to pap) and to breathe as regularly as possible.
Understanding the data has to come first. Until you fully understand all aspects of your data, you really are not in a position to start trying to tweak things on your own. On an ASV with a nonstandard form of sleep disordered breathing it is possible to make things
worse with a seemingly small change in one or more of the therapy settings. That's another reason that I would strongly encourage you to work closely with your doctors in trying to tweak your settings.
Quote:There seems to be a theme on this board that it may take time to adjust to pap therapy, so I am hoping that things will only improve over time.
Yes, it can take a while to fully adjust to pap therapy. For people with ordinary old OSA it can take anywhere from a week or so (if you are lucky) to a month or so (if you're kind of typical) to as long as 6-12 months or more (if you are very unlucky.)
But anything that is non-standard can also affect how long it takes to really adjust. A lot of that has to do with how quickly a good therapeutic setting can be found that deals with the non-standard problem.
Here is a marked-up version of the same data that you posted.
![[Image: Mu7hbIY.png]](http://i.imgur.com/Mu7hbIY.png)
Notice that I've put a big Red box around the apnea.
To understand what I'm trying to call attention to you need to understand the meaning of the mask pressure graph: The highest points on the peaks of the mask pressure graph are at the current IPAP setting for the breath. The low troughs in the mask pressure graph are at the current EPAP setting for the breath.
In the mask pressure graph you can see exactly what the ASV algorithm is doing
during the apnea: When your breathing stops for a sufficiently long time, the machine starts cycling between EPAP and IPAP even though it is not detecting any inhalations in the flow rate graph. And notice that the the top peaks of the mask pressure graph increase in size as the machine continues to detect no air going into your lungs. That represents the machine jacking up the IPAP pressure really suddenly and pretty significantly over just a handful of "triggered breaths". In other words, in an effort to get you to inhale, the machine increases the IPAP from what looks to be about 10cm before the apnea starts to about 17-18cm on the two "largest" trigger-breaths.
The smaller trigger-breath in between the two really large ones is most likely in response to a small amount of air going into your lungs. (See the dotted blue line going up to the flow rate curve). The last really large trigger-breath corresponds to when you do start breathing again. And notice that just as soon as you are breathing normally again, the IPAP drops back down to about 10cm. That's because the machine is now following your breathing and increasing the pressure to IPAP when it detects the start of your inhalations. The ASV only increases the IPAP drastically when it is trying to trigger an inhalation---i.e. it uses the increased IPAP to act like a ventilator.
Now a really good question is whether this apnea is really an obstructive apnea. My guess is that it probably is: I'm pretty sure that if the airway were clear, the increase in IPAP ought to show up as at least a small bump in the flow rate. But that's just my guess as a knowledgeable
patient. You really need a sleep tech or a sleep doc to look at that to be sure.
Finally you will notice that SH has the apnea labeled as a
Unclassified Apnea (UA). Many ASV machines do not attempt to determine whether the airway is obstructed or clear when an apnea is detected. Rather the ASV algorithm kicks in on
all apneas because the whole point of using an ASV is to prevent a long string of central apneas from occurring.
Strings of CAs typically start with a CO2 overshoot/undershoot cycle: The first CA is the result of "blowing off" too much CO2, and that suppresses the breathing drive. And so the breathing slows down (and the CO2 starts to build up) and an CA occurs. That's the undershoot part of the cycle. After the CA occurs, there's a tendency to hyperventilate, which again blows off too much CO2 and the cycle starts over. The way an ASV treats these strings of CAs is that it prevents the undershoot in the first CA from happening by the "triggered breaths". It forces enough air into the lungs to keep you ventilated and that allows for the proper exchange of CO2 to happen. So even if one CA actually happens, the triggered breaths prevent a whole string of them from happening.
It's also worth noting that the ASV algorithm can kick in if the size of the inhalations is not large enough to keep you properly ventilated and your CO2 levels in check.
