07-31-2024, 10:06 PM
RE: HELP WITH SLEEP STUDIES PLEASE
Hi:
I was gonna post 3 more charts of Oscar with nights I slept with ASV for you to see, but I already reached my attachment limit and couldnt find where to erase my previous attachments.
Someone online who uses ASV too advised me this:
"The way i understand titration and the way i also did it myself was to begin with an AutoEPAP mode, in your case ASVAuto. Just start with EPAP 4 and let the machine auto titrate for obstructive apnea events. You might want to limit Max PS like i did otherwise it will shoot IPAP too high. That's just an ASV quirk since it adjusts breath by breath.
Once you worked out your EPAP needed for OSA, you can then switch out of ASVAuto back to ASV mode because EPAP is fixed and then there are less things to worry about tweaking.
From there you have to titrate your PS range to fight UARS, since it's the PS that helps for this. I found I need PS approaching 10 in my case but over this amount i get too much aerophagia (i get it anyway even so).
You might also need to bring EPAP higher than it needs to be (for successful treatment of OSA) for this same reason (aerohagia) as i did.
This is just about all that i know for titrating, currently i'm also investigating EERS as a form of stabilizing breathing and CO2 washout but ASV already fights periodic breathing and also incorporates a backup rate for central apnea events".
And from that because I dont know about PAP or Oscar I slept one night with these settings: ASV AUTO EPAP 4-15 PS 0-5.
Then this person advised me to join this Facebook group called "pap reviews" and talked about my story giving a link for this threat and someone advised me with this:
"I need to start by letting you know that, unless anybody indicates otherwise, people in this group are fellow CPAP users without medical qualifications upon which to base advice. For me, specifically, that is certainly true. The knowledge I bring to this group comes fom a background in industrial process control systems engineering.
The other point is that the CPAP Reviews group is associated with Nick Dundai, who has created the SleepHQ platform to view data in a similar way to OSACR. The difference is that it is Internet based with data stored in the cloud. That allows you to share a link for data to be viewed by others instead of static images as is done from OSCAR. By having access to the data in that way, we can scroll around or in and out to see whatever we feel is important. It is possible that the machines you have may not import data properly, but I personally would prefer to look at your data using SleepHQ if it is possible. The link for sleepHQ is https://try.sleephq.com/
Regarding leaks, mouth tape with a pillows or nasal mask is a common solution. I personally prefer to use an Evora Full mask. Another trick that is effective is to sleep wearing a soft cervical collar. That helps to keep your jaw closed (though not necessarily your lips) and it also prevents you from tucking your chin, which a chin strap does not.
It does seem that most of your difficulty stems from your mask, and you do need to resolve that to make progress.
Your sleep studies seem to record hypopneas, but not many central or obstructive apneas. Also, you mention UARS. Both of those things suggest that you may need little EPAP, but some pressure support (PS = IPAP - EPAP). The ASV machine does that with its EPAP setting, but it uses variable PS in order to maintain steady tidal volume. You have no control over what tidal volume it tries to maintain, it is determined based on your own breathing (over the previous 3 minutes, if my memory is correct) It is producing zero AHI, but I wonder if you do really need an algorithm as advanced as an ASV.
What I see from your charts is that your tidal volume seems high (over 650 ml) a lot of the time. Associated with that is a low respiratory rate, which might be suppressed by excessive ventilation of CO2 due to high PS. In the most recent chart that you posted to Apnea Board (your post from 4 July) your tidal volume was lowest when your PS was about 3. It also appears that the machine is not increasing PS as high as 12. Most of the time PS was not higher than 8. You might be able to reduce the max PS setting, possibly with little or any effect.
There is not a lot that you can do to titrate the ASV, there are few settings and the ones you have appear to be doing what you should expect from the machine. I do wonder what results you would get from the Respironics BiLevel using, perhaps, EPAP = 6 and IPAP = 11 or 12. The Respironics may have a Bi-Flex setting that I would suggest switching off since ResMed machines do not have it, so you might be able to better compare the two brands.
Hopefully others will reply as well since I don't think I have addressed all of your questions. I am happy to try to help further,but definitely would prefer you to provide a share link from SleepHQ if you can".
What do you think about what I have been advised? And about the settings I set in the ASV? I can't use the Respironics BIPAP cause its been recalled. Can you please tell me again how do I buy a second hand cheap one online (Respironics AirCurve 10)? Or should I stick with the ASV? I just dont wanna buy a new one to not use it and still wonder if I have more options other than ASV.
Im sorry for being such a crappy PAP user. I struggle with chronic severe insomnia (sleep jerks) and can barely use PAP. Thanks for helping me. I already figured out how to erase my attachments. Ill post the new Oscar charts when I can.
Thanks.
I was gonna post 3 more charts of Oscar with nights I slept with ASV for you to see, but I already reached my attachment limit and couldnt find where to erase my previous attachments.
Someone online who uses ASV too advised me this:
"The way i understand titration and the way i also did it myself was to begin with an AutoEPAP mode, in your case ASVAuto. Just start with EPAP 4 and let the machine auto titrate for obstructive apnea events. You might want to limit Max PS like i did otherwise it will shoot IPAP too high. That's just an ASV quirk since it adjusts breath by breath.
Once you worked out your EPAP needed for OSA, you can then switch out of ASVAuto back to ASV mode because EPAP is fixed and then there are less things to worry about tweaking.
From there you have to titrate your PS range to fight UARS, since it's the PS that helps for this. I found I need PS approaching 10 in my case but over this amount i get too much aerophagia (i get it anyway even so).
You might also need to bring EPAP higher than it needs to be (for successful treatment of OSA) for this same reason (aerohagia) as i did.
This is just about all that i know for titrating, currently i'm also investigating EERS as a form of stabilizing breathing and CO2 washout but ASV already fights periodic breathing and also incorporates a backup rate for central apnea events".
And from that because I dont know about PAP or Oscar I slept one night with these settings: ASV AUTO EPAP 4-15 PS 0-5.
Then this person advised me to join this Facebook group called "pap reviews" and talked about my story giving a link for this threat and someone advised me with this:
"I need to start by letting you know that, unless anybody indicates otherwise, people in this group are fellow CPAP users without medical qualifications upon which to base advice. For me, specifically, that is certainly true. The knowledge I bring to this group comes fom a background in industrial process control systems engineering.
The other point is that the CPAP Reviews group is associated with Nick Dundai, who has created the SleepHQ platform to view data in a similar way to OSACR. The difference is that it is Internet based with data stored in the cloud. That allows you to share a link for data to be viewed by others instead of static images as is done from OSCAR. By having access to the data in that way, we can scroll around or in and out to see whatever we feel is important. It is possible that the machines you have may not import data properly, but I personally would prefer to look at your data using SleepHQ if it is possible. The link for sleepHQ is https://try.sleephq.com/
Regarding leaks, mouth tape with a pillows or nasal mask is a common solution. I personally prefer to use an Evora Full mask. Another trick that is effective is to sleep wearing a soft cervical collar. That helps to keep your jaw closed (though not necessarily your lips) and it also prevents you from tucking your chin, which a chin strap does not.
It does seem that most of your difficulty stems from your mask, and you do need to resolve that to make progress.
Your sleep studies seem to record hypopneas, but not many central or obstructive apneas. Also, you mention UARS. Both of those things suggest that you may need little EPAP, but some pressure support (PS = IPAP - EPAP). The ASV machine does that with its EPAP setting, but it uses variable PS in order to maintain steady tidal volume. You have no control over what tidal volume it tries to maintain, it is determined based on your own breathing (over the previous 3 minutes, if my memory is correct) It is producing zero AHI, but I wonder if you do really need an algorithm as advanced as an ASV.
What I see from your charts is that your tidal volume seems high (over 650 ml) a lot of the time. Associated with that is a low respiratory rate, which might be suppressed by excessive ventilation of CO2 due to high PS. In the most recent chart that you posted to Apnea Board (your post from 4 July) your tidal volume was lowest when your PS was about 3. It also appears that the machine is not increasing PS as high as 12. Most of the time PS was not higher than 8. You might be able to reduce the max PS setting, possibly with little or any effect.
There is not a lot that you can do to titrate the ASV, there are few settings and the ones you have appear to be doing what you should expect from the machine. I do wonder what results you would get from the Respironics BiLevel using, perhaps, EPAP = 6 and IPAP = 11 or 12. The Respironics may have a Bi-Flex setting that I would suggest switching off since ResMed machines do not have it, so you might be able to better compare the two brands.
Hopefully others will reply as well since I don't think I have addressed all of your questions. I am happy to try to help further,but definitely would prefer you to provide a share link from SleepHQ if you can".
What do you think about what I have been advised? And about the settings I set in the ASV? I can't use the Respironics BIPAP cause its been recalled. Can you please tell me again how do I buy a second hand cheap one online (Respironics AirCurve 10)? Or should I stick with the ASV? I just dont wanna buy a new one to not use it and still wonder if I have more options other than ASV.
Im sorry for being such a crappy PAP user. I struggle with chronic severe insomnia (sleep jerks) and can barely use PAP. Thanks for helping me. I already figured out how to erase my attachments. Ill post the new Oscar charts when I can.
Thanks.
