Suddenly my Centrals got a lot more disruptive

[SarcasticDave94]

The last post I was trying to convey that the ASV will pace your breathing patterns and rates, something like a rolling past 3 minutes or so. If you mask up breathing fast, ASV attempts to mimic that and it'll possibly play havoc with you.

As for the setting edits, I said what I did because I didn't have any chart data, and didn't want to diminish overall IPAP, but was trying to shift the EPAP and PS about. I found that the short bursts that make up PS were easier for me to handle them high EPAP.

Also EPAP deals with your Obstructive based events, while PS is the combat tool for Centrals and somewhat the Hypopnea.

On ASV, please ignore the flow limits graph. The ASV algorithm likely will give you sometime bad looking FL, but it's the result of the Central Apnea based treatment algorithm. The ASV doesn't work against FL.

[SarcasticDave94]

Sorry forgot to add about the pressure, if you need to edit them down, try EPAP Max and PS Max of 10 for each. You doing want to reduce things too much without knowing if it'll hinder therapy though.

[tcinoz]

Thank you Dave.

I did manage to get some sleep, but I seemed to be semi-conscious for much of the night, aware of the PS trying to take my breathing from barly-enough-to-stay-alive to a level that my body or subconscious or whatever was resisting. I changed the settings a few times based on levels of discomfort and eventually got up feeling drained but unable to sustain even the modest setttings I ended up with without the air buidling up in my mouth.

But hey - the Oscar chart looks sensational compared to my recent ones! Up until now whenever someone presented a chart like this to the forum with some sort of complaint that they still didn't feel great on waking, I'd be thinking oh please! get real - I would give my right arm for figures like that! But as my sleep doc said, don't obsess too much over the figures: it's how you feel that counts. I guess that applies equally to whether the figures are good or bad.

I put my WellUe O2 ring on in the middle of the night and was reminded that my erratic heart rate going down into the 30s could be a factor contributing to feeling groggy even after sleep - something I hope to get some action on when I see my cardiologist at the end of this month. Meanwhile, I'll keep going with the ASV.

Finally just a quick question on FL... when you say "the ASV doesn't work against FL" I took that to mean that it doesn't combat them, yet my overall figure is closer to zero on the chart than it's ever been (despite an inexplicable number of spikes - I'm sure I didn't remove my mask that many times!) I wonder if you could please expand on what's going on with the FLs. It does feel like the PS kicks in every time my breathing gets a bit shallow, not just when an 'event' is imminent, so maybe it's obliterating potential FLs in the process? Thanks again.

   

[SarcasticDave94]

I for at least myself would probably consider lower FL on ASV as a by-product at worst. My FL were pretty low as well when on ASV. Anything my body can do to be extremely unique, it seems to find it.

[tcinoz]

I'll take that as reassurance that the therapy is working! Every bit of positive spin helps with this journey. :-)

[alwyns42]

tcinoz, I'm not on ASV yet but I developed a similar problem where I felt awake the whole night. It got better when I improved my pressure, felt good for a while and then at some point regressed. Hope ASV will make it easier to find a sweet spot. Your pressure is already high relative to mine. Hope you get it right at some point, this awake the whole night feeling is awful.

[tcinoz]

Thanks Alwyn. Yep, it's a wonder that eventually I can get up and feel I've had enough sleep. I guess all the little uninterrupted bits add up!

Another fairly restless night for me but I'm already getting acclimatised to the ASV despite lots of 'arousals' from 3 am onwards (which is nothing new). At least now the CAs are being zapped before they take hold, and I can feel the difference in blood pressure and anxiety levels during those periods when they were at their most disruptive.

I wish you well in your own quest for restful sleep.

[tcinoz]

I would like to revisit the subject of Flow Limitations, as in a few days' time I'm supposed to buy an ASV machine that has been ordered for me, following a reasonably successful trial in mid-June.

I have been back on an AirSense11 CPAP machine since that trial. My AHI's have varied a fair bit (stress levels seem a big factor) but one thing that has been consistent is high Flow Limitations.

I am attaching a recent Oscar chart from a relatively good night (AHI-wise) just so as not to distract from my main intent here, which is to drill down on the Flow Limits.

I have also attached a three-month summary with the three most relevant fields. You can identify the period I spent with the ASV (mid-June) from the high pressure spikes.

I have two questions. 

1) how do I interpret the ASV Flow Limitations data when there is only one figure for it every night, whereas the CPAP machine gives Median, 95% and 99.5%? Can anyone tell if the ASV is dealing with my Flow Limits better than the CPAP overall (roughly)?

2) I originally went for an ASV because of persistent CAs, but some nights maybe the Flow Limits are a bigger problem. If I went for a BIPAP machine (Vauto?) instead of an ASV, would it do a better job of zapping the Flow Limits, and if so, might it be at the cost of not dealing so well when the CAs and Hypopneas are playing up? I guess what I'm asking is can anyone tell me which machine might work best for me overall in the long run?

Thanks as always.

         

[SarcasticDave94]

The ASV has no way to help with flow limits directly. Some users get higher FL on ASV while it's in CA combat mode.

A VAuto can be set to help lower FL via EPAP and PS, despite the ASV has EPAP and PS too. Remember the ASV mission is CA. VAuto can lower small amounts of CA via the Trigger setting to high or very high. Consider it more CA avoidance though, only ASV actually treats CA.

If you require CA and FL help, probably the VAuto. I'll have to look back at the CA discussion to be sure though. If you needed to choose to treat CA only, ASV without question. Ditto for VAuto but for FL, OA, H.

OK after revisit... VAuto is going to fit your needs better. You could start with high trigger to address CA concerns, the pressure settings then can focus on overall Apnea treatment, even the FL.

[tcinoz]

Thanks Dave - I appreciate your advice, as always.

As fate would have it, the last two nights provide a perfect example of why I'm conflicted. The first shows an assortment of 'events', including several CAs and a total of a few minutes spent in apnea. The next night (last night) shows my best night to date, with virtually nothing of note other than the usual Flow Limits hovering above 20% for the 95% mark.

Apart from the complications involved in cancelling the ASV that has been specially ordered for me and the need for a fresh assessment from my sleep doc if I decided to go down the Vauto path, I'm not quite clear about what I'd be ordering; when I mentioned Vauto at the Resmed shop a few months ago, they pointed me to a Lumis 150 VPAP ST, the implication being that this model has replaced the old Vauto. Did I interpret that correctly?

The other thing I'm not clear about, which I touched on my previous post, is the different way the ASV records Flow Limits: one figure instead of three. Any idea what that one figure corresponds to on the CPAP? It's too high to be the Median, surely?

I can see myself ending up with three machines eventually, just to be able to spend enough time with each of them to know what works best for my seemingly endlessly variable needs! But in any case, it's good to have as much info to hand as possible, and the subject of Flow Limitations seems to be a black hole when I've raised it with my sleep doc, so I appreciate the clarification from you. It still baffles me that all my main sleep problems (CAs, Hypopneas and Flow Limitations) seem to me to be manifestations of the same problem - shallow breathing - yet require different solutions when it comes to choice of equipment. I'll continue my journey with an open mind and see where it takes me.