New to ASV, new to SleepyHead

[tmoody]

I've found that the AHI data that I've gotten from "ResMed Air" using the ResMed Aircurve 10 has been inconsistent. With the highest AHI, yet, of 16 on Monday night to an AHI of 3 last night, I have had at least five AHIs above 10 in the last two and half weeks, Do you think it's reasonable to switch from the ResMed Aircurve 10 to the PR System One Bipap Auto SV Advanced? My pulmonologist seems to think so.

Since we have very similar treatment histories, I hope you're sleeping much better these days!

Hiya. I really don't know anything about the ResMed Air or other equipment, so I can't comment. The PRS1 ASV is the only ASV I've used. There are people on the forums who prefer the Aircurve, but I think these preferences are highly individualistic. As far as I can tell, the PRS1 is a good machine, but I'm really not in a position to make comparisons.

Last night's AHI was 4.8, with three centrals, so perhaps I was hasty to think I'd found the best setting, but one semi-bad night doesn't spoil the soup. And the more important point is that treating complex apnea is a much more subtle business than treating purely obstructive apnea, so it's going to take a lot longer to suss it out. I don't consider 4.8 terrible, so I'm going to continue with the current settings for a while longer before thinking about fiddling with PS again.

[shewhorn]

Do you think it's reasonable to switch from the ResMed Aircurve 10 to the PR System One Bipap Auto SV Advanced? My pulmonologist seems to think so.

With 5 AHI's above 10 in the past few weeks...

First... I looked quickly (and not very thoroughly) through your posts and it doesn't look like you've posted a screen capture from SleepyHead. That is what I would do first. Download Sleepyhead and post a screen capture for one of your > 10 AHI nights. SH will let everyone see what your current settings are, and what's going on at night. Somewhere on the forum there's a link that explains how to configure the SH graphs with the data everyone needs to see (in the "Daily" tab order the graphs to show Event Flags, Flow Rate, Mask Pressure, Pressure, Leak Rate, Snore, and Flow Limit... collapse the calendar by clicking on the date as it allows more info to be displayed below).

I've quickly learned that there's a TREMENDOUS amount of combined experience here with people who have already struggled through solving certain problems that you may be experiencing. Also, the data displayed by SleepyHead is FAR FAR FAR more detailed than what ResMed sends to your doctor. I asked my doc what he gets to see and he said it's basically for compliance monitoring, it doesn't show him the detail that SH does, and certainly not enough data to recommend specific changes (he likes that I bring my laptop in to appointments so he can go through the detailed data).

So, that's step 1. Get up and running with SH, get an SD Card reader if you don't already have one (they're cheap), and get a screen shot of a > 10 AHI day posted here.

If nobody has any suggestions, or if they do, and after trying them out for a few weeks there is no improvement, then I'd say it's definitely worth trying a different machine.

[tmoody]

So, that's step 1. Get up and running with SH, get an SD Card reader if you don't already have one (they're cheap), and get a screen shot of a > 10 AHI day posted here.

If nobody has any suggestions, or if they do, and after trying them out for a few weeks there is no improvement, then I'd say it's definitely worth trying a different machine.

I agree with your advice to Jeffo, and I'd only add what I have been slow to do myself: Don't be in a hurry to switch settings around. If you don't let them stay put for a week or so, it's impossible to see what's going on.

I've just finished a ten-night run with EPAPmin=8.5 and PSmin=1. My average AHI for those ten nights is 2.7. That's the lowest average at any settings I've seen yet, and also the longest run I've tried (next being a nine-night run). It may be the best I can do, but I intend to try a few more combinations. Reviewing my data, I'm getting the impression that EPAPmin=8.5 is good for me, but I might be able to do better with PSmin. The trend seems to be that as PSmin goes higher, I get more centrals, though not a lot in any case. So I'm going to try PSmin=.5 for ten nights and see what happens.

These settings have no value for Jeffo, but I think the method of putting results into a table, like this, has merit. It lets me see at a glance where things are, what the consecutive night trend for each setting is, and how them compare.

[tmoody]

I suppose this thread has outlived its title, since I'm no longer new to ASV or SleepyHead. Nonetheless, I'll use it to post the occasional update, as I've been doing.

I've continued adding data to my EPAP/PS table, in stretches of ten consecutive days. Since the EPAPmin setting that has been most successful has been 8.5, I've kept it there and varied only PSmin .5 at a time. At the moment, I'm six days into PSmin=0. The difference between the different PSmin settings hasn't been huge, but the best so far as been PSmin=1. I haven't done 1.5 yet; that'll be next.

I have my followup appointment with the pulmonologist on Friday. It'll be my first visit since before the titration study in January. I don't know how he'll react to my self-experimentation, but I intend to print out the table and some SleepyHead screenshots, so he has the sense that I'm not just playing games. Since my AHI average has been below 5 at all settings so far, I don't think he's going to care much what I do to fine-tune, but I could be wrong.

At this point, I'm paying more attention to figuring out how to sleep longer than about 7:15 hours. This amount of sleep is adequate, but another half hour would be better.

[richb]

Thanks for the update. Maybe the sleep Doc would recommend changing your settings .5 cm H2O every 6 mos. so he could review your results. (just kidding)

Rich

[tmoody]

So, I had my visit to the doctor last week and showed him my table of settings and AHIs, which he found interesting. He wasn't even faintly disturbed by my having changed settings on my own. He was also impressed at my 100% compliance, which I found puzzling. After all this time, why would I try to sleep without the machine?

On a vaguely related note, two nights ago I had my first AHI below 1.0, at 0.9. That came at the end of a ten-day series at EPAPmin=8.5 and PSmin=0. The average for the ten nights was 2.8. I'm now starting another ten-night series, keeping EPAPmin at 8.5 but raising PSmin to 1.5. I don't expect it to be much different. As long as EPAPmin=8.5, changing PSmin hasn't had much effect. Changing EPAPmin in either direction seems to have more effect, but not for the better.

[richb]

So, I had my visit to the doctor last week and showed him my table of settings and AHIs, which he found interesting. He wasn't even faintly disturbed by my having changed settings on my own. He was also impressed at my 100% compliance, which I found puzzling. After all this time, why would I try to sleep without the machine?

On a vaguely related note, two nights ago I had my first AHI below 1.0, at 0.9. That came at the end of a ten-day series at EPAPmin=8.5 and PSmin=0. The average for the ten nights was 2.8. I'm now starting another ten-night series, keeping EPAPmin at 8.5 but raising PSmin to 1.5. I don't expect it to be much different. As long as EPAPmin=8.5, changing PSmin hasn't had much effect. Changing EPAPmin in either direction seems to have more effect, but not for the better.

Your long term titration seems to be quite effective. I often think that our sophisticated machines and Sleepyhead can fine tune our settings a lot better than a PSG one night titration.

Rich

[Crimson Nape]

tmoody,
Low AHI's are nice; but how do you feel?

[tmoody]

tmoody,
Low AHI's are nice; but how do you feel?

I feel pretty good, but as a general thing how I feel is far more closely correlated with how many hours of sleep I get than it is with AHI, as long as AHI doesn't get way high. Seven hours is adequate, but 7:30 is noticeably better, and 8 is deluxe.

I've experimented with various supplements. I take magnesium anyway, to help control blood pressure. I've been using 1 mg of melatonin, but can't say that has done anything noticeable. Recently, however, I've tried taking some supplemental potassium, and that has helped to extend my sleep time--or it's just a coincidence.

[tmoody]

Another update: I tried raising PSmin to 1.5, keeping EPAPmin where it's been, at 8.5. With the higher PSmin, AHI went consistently higher, and I decided to abort the experiment after seven days. I didn't see the point of continuing. I think I have enough data now to know what works: EPAPmin=8.5, PSmin=1. So I went back to that, and stopped updating my table. I'll leave it alone unless I see some reason to change it. Meanwhile, AHI continues to drop. My average before at these settings was 2.7; this time it's 2.5 and still falling. I think I'm just adapting to the settings and to ASV generally, and getting better sleep.

Nighttime visits to the bathroom are almost entirely gone (maybe one a week), and sleep duration is slowly improving; but in any case I feel well rested. CAs and OAs are pretty much gone, and the few events left are hypos. Periodic breathing is diminishing--it's at 0 more often than not now. Even my timed breaths are decreasing in number, which would seem to indicate that the machine is needing to do less to keep me on course.

I believe this is the positive result of a gradual adaptation process that is both physiological and psychological. I've learned to trust my sleep again.

There's also an interesting correlation with my vitamin D level, but that's speculative and not strictly relevant, so I'll leave that for another time and another thread.