Mostly Centrals

[zzzzk]

your asv charts look just like mine.  did you have this sleep / wake pattern before asv?  edit: I see you said "still" so our condition seem very similar.

Yes, I "still" wake up every 1-2 hours, awake 1/2 hour or so, then sleep 1-2 hours again.  I hope it gets better.  If your chart looks the same, does your doctor consider this "corrected"  ?

[sheepless]

sleeprider may not agree with me but no harm in checking: scroll through your flow rate waveform at a 2-4 minute view scale. see what's happening in all the graphs you show in your post plus the flow limitation graph as you approach the end of each flow rate segment. it might give a clue as to what wakes you. some things to look for: runaway (high) pressure, wide swings in pressure support, leaks, snores, flow limitations.

[sheepless]

my doctor considered me corrected with avg 5-6 ahi on apap. he dxed me with obstructive even though I was originally dxed central 30 years ago and had almost as many centrals as obstructives during the home study he was working from. to my knowledge no one looked closely enough to notice my peridic breathing pattern. I think he'd have worked with me but I had to give him up due to change in insurance coverage. haven't had a doc since (might eventually). been relying on this forum ever since. made the move from apap to asv on my own (with help from folks here).

forgot to say that doc's sole response to fragmentation was cognitive behavioral therapy.

I have intermittent restless legs while awake and periodic leg movements while asleep, which could be a likely rouser. tried gabapentin but subjectively felt that made the legs worse. there are other things to try to ease those conditions that I have yet to follow up on.

lots to be gained through cbt and good sleep hygiene. but I don't see why ragged respiration full of apnea precursors (that I see in my flows) shouldn't be addressed or ruled out too. that's why I suggested scrolling through using a close view to see what's in your flow. and also why sleeprider may disagree <smile>.

[zzzzk]

Here is an interesting article on asv effectiveness. Looks like the older machines do not correct the problem well (the s7?). the new ones, (ex the resmed aircurve 10 asv) appear help fix the problem. Looks like the tech is very complicated...

I'm going to continue because my centrals are so bad...

http://www.sleepreviewmag.com/2018/07/asv-studies/

[Sleeprider]

zzzzk, the charts show that your EPAP min is pretty good, with a median at 6.7 and 95% at 7.5. The pressure support is active, and the maximum PS is probably being used to counter CA events. Obviously you kept breathing and did not experience any pauses that counted as apnea, so obstruction is treated as well. If you're comfortable with this, I don't see any need to change settings, and in time you will adapt to the pressure changes and sleep better. I'm impressed with the tidal volume, and expect that it should reduce to a more normal level for you as you adapt. Great start, and good luck as you continue.

[zzzzk]

zzzzk, the charts show that your EPAP min is pretty good, with a median at 6.7 and 95% at 7.5.  The pressure support is active, and the maximum PS is probably being used to counter CA events.  Obviously you kept breathing and did not experience any pauses that counted as apnea, so obstruction is treated as well.  If you're comfortable with this, I don't see any need to change settings, and in time you will adapt to the pressure changes and sleep better.  I'm impressed with the tidal volume, and expect that it should reduce to a more normal level for you as you adapt.  Great start, and good luck as you continue.

Thank you so much for your help.  Is there a general rule as to when it would be necessary to make settings changes?  Only a rise in AHI?

[sheepless]

while our charts look similar I want to caution us both against making that assumption without some further confirmation.

if you have central or complex apnea and if you have non cheyne-stokes respiration periodic breathing (I saw ca and pb an earlier chart you posted), maybe my experience is pertinent. my experience with a couple months of asv is total elimination of centrals and the pattern I understand to be pb. still playing with pressure settings but think I can eliminate all undefined apnea (they look like obstructive to my untrained eye) and most hypopnea. hoping to trim flow limitations next.

asv does not seem to improve my fragmentation. I feel much less sick with asv than apap but still sleepy due to frequent and longish awakenings. too early to tell how effective, but I'm making a concerted effort to not get out of bed during awakenings. might be simply lying in bed awake longer but the effect is to compress the gaps between segments, which is at least psychologically beneficial (flows look better). hoping in time to train my body/mind to sleep through the raggedy flows.

don't know what'll work for you, just relating my maybe similar experience. I'm also hoping you might find a solution I can piggyback on!

[zzzzk]

while our charts look similar I want to caution us both against making that assumption without some further confirmation.  

if you have central or complex apnea and if you have non cheyne-stokes respiration periodic breathing (I saw ca and pb  an earlier chart you posted), maybe my experience is pertinent.  my experience with a couple months of asv is total elimination of centrals and the pattern I understand to be pb.  still playing with pressure settings but think I can eliminate all undefined apnea (they look like obstructive to my untrained eye) and most hypopnea.  hoping to trim flow limitations next.

asv does not seem to improve my fragmentation.  I feel much less sick with asv than apap but still sleepy due to frequent and longish awakenings.  too early to tell how effective, but I'm making a concerted effort to not get out of bed during awakenings.  might be simply lying in bed awake longer but the effect is to compress the gaps between segments, which is at least psychologically beneficial (flows look better).  hoping in time to train my body/mind to sleep through the raggedy flows.

don't know what'll work for you, just relating my maybe similar experience.  I'm also hoping you might find a solution I can piggyback on!

Ok, I'll let you know if I find anything that helps for longer periods of sleep.  The biggest difference at this point is that I use a full face mask, the Resmed f10.  FYI, I also now ONLY sleep on my side.  I have found that sleeping on my back ramps up my apnea very high.  I also don't get "chipmunk cheeks" with the f10 on my side.  I do on my back.  Thank you.

[Sleeprider]

zzzzk, the charts show that your EPAP min is pretty good, with a median at 6.7 and 95% at 7.5.  The pressure support is active, and the maximum PS is probably being used to counter CA events.  Obviously you kept breathing and did not experience any pauses that counted as apnea, so obstruction is treated as well.  If you're comfortable with this, I don't see any need to change settings, and in time you will adapt to the pressure changes and sleep better.  I'm impressed with the tidal volume, and expect that it should reduce to a more normal level for you as you adapt.  Great start, and good luck as you continue.

Thank you so much for your help.  Is there a general rule as to when it would be necessary to make settings changes?  Only a rise in AHI?

Well, I would be unlikely in any case to suggest changes on a single night or session, but things that suggest a need for changes include a wide variation of EPAP pressure, hypopnea or apnea events,  specific complaints regarding comfort including aerophagia, sleep disruption or  physical discomfort. I think eventually you may tolerate a lower PS max, but I think we will give that issue some time before trying something.  The auto-pressure changes in your case are moving smoothly up and down and you seem to be pretty well dialed in. 

Sheepless has a severe sleep fragmentation issue and frequently experiences seven or more sessions per day with breaks between each one. This pattern has persisted for several years and over several machine types, so it is a persistent issue.  I'm not going to consider your therapy or sleep fragmented until a long-term pattern emerges. My hope is that as you adapt to the ASV therapy, you will become more comfortable and the breaks will merge into a continuous night of sleep and therapy. You are off to a very good start.

[zzzzk]

zzzzk, the charts show that your EPAP min is pretty good, with a median at 6.7 and 95% at 7.5.  The pressure support is active, and the maximum PS is probably being used to counter CA events.  Obviously you kept breathing and did not experience any pauses that counted as apnea, so obstruction is treated as well.  If you're comfortable with this, I don't see any need to change settings, and in time you will adapt to the pressure changes and sleep better.  I'm impressed with the tidal volume, and expect that it should reduce to a more normal level for you as you adapt.  Great start, and good luck as you continue.

Thank you so much for your help.  Is there a general rule as to when it would be necessary to make settings changes?  Only a rise in AHI?

Well, I would be unlikely in any case to suggest changes on a single night or session, but things that suggest a need for changes include a wide variation of EPAP pressure, hypopnea or apnea events,  specific complaints regarding comfort including aerophagia, sleep disruption or  physical discomfort. I think eventually you may tolerate a lower PS max, but I think we will give that issue some time before trying something.  The auto-pressure changes in your case are moving smoothly up and down and you seem to be pretty well dialed in. 

Sheepless has a severe sleep fragmentation issue and frequently experiences seven or more sessions per day with breaks between each one. This pattern has persisted for several years and over several machine types, so it is a persistent issue.  I'm not going to consider your therapy or sleep fragmented until a long-term pattern emerges. My hope is that as you adapt to the ASV therapy, you will become more comfortable and the breaks will merge into a continuous night of sleep and therapy.  You are off to a very good start.

Ok, thank you.  Last night was ahi of .11, it was only 1 hypopnea event, but it appears to be when I first put on the mask, so I think I was awake.  I was able to sleep in one session for longer.  This is the best data I've had in 20 years, so I hope it's working...  Thank you again for your help.