New to ASV, new to SleepyHead

[tmoody]

http://www.carolinasleepsociety.org/docu...of_asv.pdf

Could be useful. I don't know if it's been posted here before.

[tmoody]

So, I went ahead and knocked EPAPmin back to 8, dropped EPAPmax a bit, so I could raise PSmin to 3. I think I'll let it ride there for a while. Last night was AHI=2.6, with zero centrals and OAs. I feel a little hungover today, not terrible, probably because I woke up at 3 to use the bathroom and it took a while to get back to sleep, so I lost a chunk of sleep time there. I notice I had relatively few Timed Breaths during the night, until after I got up and went back to bed, at which time there was a mass of them for about 40 minutes. That was probably

I am going to focus more on what, if anything, I can do to improve the quality of sleep.

[vsheline]

Hi tmoody,

Your machine gradually raised EPAP when it was maxed out and also flagged Flow Limitation, so it looks to me like the condition being treated was primarily obstructive.

Last night was my second night with EPAPmin at 9, PSmin still 2. As you can see, my AHI was higher, and two centrals of fairly short duration (15 and 14 seconds). Hypos were up from the previous night.

What catches my attention, however, is a period of about 15 minutes before about 5:26, which is when I actually woke up. As you can see from the zoomed screenshot, my pressures were pretty much maxed out. There were a few hypos during this period, not a lot. The pressure may even have been what woke me up. At least, I recall feeling that the thing was really blowing hard when I woke up. In fact, before I finally hit the button, I lay there for a couple of minutes and tried, without success, to "calm the machine down" by my own breathing. Then I got up and went to the bathroom, went back to bed and started the machine again. I don't know if I actually got any more sleep; I know SH shows a lot of TBs after I restarted the machine, and I do recall lying there being slightly annoyed by this.

But my main question is, what was going on during the zoomed period? Was the machine sensing imminent events and just maxing out preventing them?

[aergun]

Hi, More than a month I've been using Philips ASV machine.
Epap min / max is 7/8.This settings are suitable for me.but I have to choose 0-15 (min-max) values for pressure support.I've tried the following settings for the ps.7/8, 3/15, 2/4,8/15...
Why not just 0-15 turns out to be low in the range of AHI?
When I selected ps min zero, IPAP Automatically starting from seven.Be cause epap min is seven.

[vsheline]

Hi, More than a month I've been using Philips ASV machine.
Epap min / max is 7/8.This settings are suitable for me.but I have to choose 0-15 (min-max) values for pressure support.I've tried the following settings for the ps.7/8, 3/15, 2/4,8/15...
Why not just 0-15 turns out to be low in the range of AHI?
When I selected ps min zero, IPAP Automatically starting from seven.Be cause epap min is seven.

Hi aergun,

ASV machines will not be able to completely compensate for complete central apneas (when we are exerting no breathing effort at all) unless the Max PS is set around 10 cmH2O or higher, and that applies to people with normal healthy lungs and who are not morbidly overweight. Other patients may need Max PS of 15 or higher. A few patients have painful air swallowing problems and find they must very severely compromise their ASV therapy by limiting Max PS to 6 or below.

For most people, a Max PS of 10 is high enough to allow the machine to completely prevent central apneas by doing for us all the work of breathing when we are making no effort at all to breathe.

(With their AirCurve 10 ASV model, ResMed has chosen a Max PS of 15 as their recommended default setting, but I think Max PS of 15 may cause unnecessary air swallowing and awakenings, and I think most people won't require that much.)

Regarding Min PS, I have received the impression from other ASV users that Min PS of 2 or higher is more widely preferred than zero.

Personally, I occasionally wear a recording pulse oximeter overnight and I usually keep my Min PS between 5 and 6 in order to keep my long term average SpO2 (saturation percentage of O2 in our blood) in the range 94% to 96% while sleeping. But I've read articles which say that those who have COPD (a very serious lung condition) should target a lower average SpO2 near 90%, in which case perhaps a Min PS of zero may be best for COPD patients.

I must say that it is good to make adjustments not more often than weekly or monthly, so we can obtain a repeatable long term average AHI before we readjust the settings again.

Good luck in fine tuning your ASV therapy.

Feel free to start a new thread to post SleeyHead displays of your machine's sleep data, for comments and suggestions for fine tuning the settings.

Take care,
--- Vaughn

[aergun]

Thanks.

[tmoody]

I was sure whether to start a new thread, but this is fairly specific to my situation, so I'm keeping it here.

I was looking at my ASV Titration study again. I had attached it to an earlier post in this thread, but was advised to remove it, since it exposed some personal information. This time, I'm just going to post a link to a cropped portion of it, the main table of results:

click me

and these recommendations, the basis for my prescription:

click me too

Here's what I notice. In the table, the lowest AHI is at EPAP=8, but that also happens to have the highest SAI (spontaneous arousal index), by a wide margin. At EPAP=7, the SAI is almost nothing, but the AHI is 5. So there's something of a trade-off between those two settings.

Obviously, the doc thought the AHI trumped the SAI, and so recommended EPAP=8. This corresponds to EPAPmin, I assume. But at EPAP=9, the AHI is only 4, the second lowest in the table, and the AHI is only 2, which isn't bad. That looks like the "goldilocks" setting to me.

Now it also says there was some hypoxemia at lower EPAP settings, but "mostly resolved" at 7, and normal at 8 or 9.

This makes me wonder whether they tried 7.5, to see if that might get the sweet spot between AHI and SAI, perhaps even better than 9. But there's no indication of non-whole-number settings.

The other thing I wonder about is how they arrived at a recommended PSmin of 0, when there's no further mention of PS in the entire report.

I'm wondering about the SAI because I've noticed that there's no very tight correlation between AHI and how refreshed I feel in the morning. And there is mention of spontaneous arousals in the summary. If the EPAP setting is somehow triggering large numbers of arousals, as the table suggests, it seems to me that's a good reason to experiment with other EPAP settings. Trouble is, I have to way to monitor spontaneous arousals, except by subjective feel the next day.

[palerider]

I think you've falling into one of the common fallacies about sleep studies... some thoughts:

as to sleep studies... they may be "The GOLD Standard", but they are, in many ways, woefully inadequate if you think about it.

you're in an artificial environment, all wired up and less comfortable than normal.
it's *one night* and likely only part of that night. reading any titration report, you'll see that "oh, your good pressure was 12cm, you slept for 45 minutes at that pressure!"

it's a simple fact that sleep varies from night to night, you'll have better and worse days with the same exact settings. yet the "gold standard" is a small number of minutes tested on one night.... a brief photograph taken during the marathon run that is your sleep.

it's not surprising that sleep studies are somethings quite wrong, what's surprising is that they're ever right!

and, specifically for you, tmoody, you could likely take a night, at any constant pressure, and find an hour or two that shows great ahi and another hour that shows great sai and another that shows terrible ahi, and sai, and whatever other metric you want to find.

[tmoody]

it's not surprising that sleep studies are somethings quite wrong, what's surprising is that they're ever right!

and, specifically for you, tmoody, you could likely take a night, at any constant pressure, and find an hour or two that shows great ahi and another hour that shows great sai and another that shows terrible ahi, and sai, and whatever other metric you want to find.

Regrettably true...that sleep studies are a shot in the dark, I mean. And also true that in any given night there can be long stretches where everything is peaceful, not even a Timed Breath, for hours. Then all hell breaks loose.

One of these nights, I'm going to put my machine in CPAP mode at 11 and see what happens. That's the setting I had for nine years, before I had any idea what AHI was. I sometimes wonder if nine years of constant pressure trains the brain so strongly that it can't adjust to anything else.

It's funny that I was exhaling against 11 for all those years and thought nothing of it, and now my ASV seldom raises EPAP to 11.

[Jeffo1]

[url]

Could be useful. I don't know if it's been posted here before.

Wow, tmoody! This is awesome!!
THANKS!!
Jeffo1