Switched to ASV - AHI is great, but still feel like I'm not sleeping well

[Sleeprider]

First of all, that segment starts out with about 14 BPM which is your normal spontaneous rate. I would have really liked to have this graph contain the same charts as the other one so we could compare mask pressure, tidal volume, minute vent, flow limitation. Anyway, this is what I would hope to see much more of, rather than the very high pressure support and slow artificial respiration. I see three breaths in this segment that do not achieve peak flow and have double peaks. This is probably a form of obstruction, specifically flow limitation where a tissue occlusion occurs and rapidly releases. This does not seem to be persistent, and is not repeated in any two breaths in a row. If it was more frequent, I might be looking at higher EPAP or the PS min to clear that, but the sample is too small to make such a recommendation. Much better if you will reformat the graph to show the respiratory and pressure graphs I described above. Mask pressure is much better than pressure to analyze what is happening.

[Sassbeek]

Does this help? took it on a vertical monitor to fit more in and rearranged the charts. Let me know if that works!

And in terms of sample, happy to send more as needed for sure. This is pretty 'typical' but obviously I assume you want a bit more than that

[Sleeprider]

That is fine. We can see the breaths I said were flow-limited were met with higher pressure support, however only one of them was actually flagged for flow limitation. The machine is really on top of this segment, and I think this confirms that a PS min of 3.0 is effective, and leaves enough room for the machine to catch any events before they get serious. The segment of machine driven breathing was evidence that the ASV has enough PS to create breaths when needed for central apnea or lack of spontaneous respiration. This latest graph shows you might benefit from using a limited range of EPAP in ASVauto mode. If you tolerate ASVauto, I would suggest a range of EPAP from 6.0 to 8.0. This allows the machine to address flow limits like we see above with a bump in EPAP pressure which is the more appropriate response. I don't know how frequently you see flow limited breaths during spontaneous respiration as we see here, so I'll have to rely on your judgement whether this change to allow EPAP to move in a limited range is appropriate or not.

[Sassbeek]

That is fine. We can see the breaths I said were flow-limited were met with higher pressure support, however only one of them was actually flagged for flow limitation.  The machine is really on top of this segment, and I think this confirms that a PS min of 3.0 is effective, and leaves enough room for the machine to catch any events before they get serious.  The segment of machine driven breathing was evidence that the ASV has enough PS to create breaths when needed for central apnea or lack of spontaneous respiration. This latest graph shows you might benefit from using a limited range of EPAP in ASVauto mode.  If you tolerate ASVauto, I would suggest a range of EPAP from 6.0 to 8.0.  This allows the machine to address flow limits like we see above with a bump in EPAP pressure which is the more appropriate response.  I don't know how frequently you see flow limited breaths during spontaneous respiration as we see here, so I'll have to rely on your judgement whether this change to allow EPAP to move in a limited range is appropriate or not.

Sounds good, switching to epap 6-8 for tonight for sure

Does anything else jump out at all? I'll outline my concerns that I'm not sleeping well in order, and also acknowledge none of these are 100% credible and yes, non respiratory reasons may cause some/all

- Still waking up alot during the night, and spend most of the second half of the night drifting in and out of sleep and being aware I'm awake
- Wake up feeling not well rested
- Partner tells me (I also record myself sometimes) that I still move around in my sleep *alot*
- Definitely dealing with daytime fatique, sometimes pretty bad
- My sleep trackers (I'm putting this last for a reason, I acknowledge these things are boardering on useless) which are a Withings sleep analyzer and Fitbit both tell me I get very poor sleep, in terms of waking up alot and not being in deep and/or rem much at all throughout the night. Again, this is last for a reason, and if all else was good I'd ignore this, but it adds something to the above

Is there anything else you can see that may be worth looking at that you'd want to see more of? Or anything else that may be going wrong?

[Sleeprider]

I don't like to make a lot of changes at once, and will instead try to tackle one issue at a time. I certainly did not like your very high minimum PS, and hope we don't revisit that. Spontaneous awakening, movement and restless sleep is possibly due to factors external to the therapy, and so our focus needs to be on optimization of respiration and making the therapy as nonintrusive as possible. Hopefully everything else follows, but we don't have settings for movements or arousals not related to respiratory events. Give the new EPAP range some time to work and it may reduce some arousals. We can always hope so.

[Sassbeek]

Alright sounds good, let's run with new EPAP and take it from there