Trying CPAP one last time... AHI looks really bad

[gsilver]

Thursday's 95% of 19 was an anomaly.
The 95% pressures have been:
Day 1 (EPAP 4, PS 3.0 - 15.0) - 13.4
Day 2 (EPAP 4, PS 2.0 - 15.0) - 13.88
Day 3 (same until noted) - 14.2
Day 4 15.32
Day 5 15.18
Day 6 (aka, the rough day; no change in settings) 19.06
Day 7 (EPAP 4, PS 3.0 - 15.0; tried using cervical collar and running mask fit) 14.8
Day 8 (same settings, but no collar or re-running mask fit) 16.8

So on that metric, that was worse than the first three days and only slightly better than the next two.

[ajack]

Fair enough, It was just a bad night before. You can see the advantage of working with 7 or 30 day averages. To make sense of what is happening. Have you zoomed in and had a look at mask pressure, tidal volume and minute vent? The ASV gets the AHI low, so these can help sus stuff out.

[gsilver]

I didn't catch any data on Sunday night, since I removed the card from the machine late in the day and didn't remember to put it back, but here's the data from last night. 
I've been feeling pretty rough since Friday, so I can't directly say if the settings made things better or worse, but AHI and 95% pressure are higher than normal, with the AHI being the second-highest since I started using the ASV machine. Last night (and last Thursday) were also the only nights where I saw multiple unclassified apneas appear.

This is with the settings Min EPAP 4.8 Max IPAP 35.0 PS 3.0-20.0 (cmH2O)

[ajack]

Thanks for putting up the tidal volume and minute vent. Aren't they interesting. The respiration would be worth looking at too. Normally the tidal volume wouldn't stay high and would quickly oscillate from deep and shallow to keep some sort of level.
The machine is seeing obstructive and raising min epap. while there is a jump in the tidal volume and minute vent, looking at the respiration during this would also give info.

As you know I thought something was up with those pressure rises. It still isn't clear to me what it is. Would you really be needing to increase your minute vent and tidal volume over such a long time? Or is it inhale defusion under the mask, messing up the machine and adding it to the tidal volume and minute vent?
I don't think it is positional in any way, now. I'm don't know enough, to say what it is. Someone else here may, or it's one to take to your doctor.
It might be worth going out of asvauto and just asv, to see if the increase in epap is triggering it? keep the epap around 5, minps3 maxps15 or 20 and titrate from there.

Zoom in on 1:45 to 2:00, it may help to see. With the added resp. rate chart to replace the flow limit.
You can see there was an instant increase in TV and the target MV followed

[gsilver]

I’ll update the charts in the morning, but one thing that I’ll add is that I know that I was at one point diagnosed (when I was a child) with a partial brain stem disconnect. I can’t find a lot of information on this, but it does seem to be related to sleep apnea. Maybe someone here knows something about this?


My weight has been as low as 165 in recent years (I’m 6’2”), and I still had trouble with EDS... actually, I think that it *was* at around 165 when I originally signed up for this forum 
I’m up to 195 now, which isn’t great, but still at the bottom of the overweight range for my height.

[ajack]

With the added info I looked at your charts again. With your height, the low MV areas, also need checking. It looks minute vent is going down to 4. that's low. It could be that it the bad stuff and the spikes are the good stuff. That will be a funny situation. If the resp rate is 8, that will show that the machine is running on min backup. Just need to check the min and max areas on the minute vent to the resp and tidal volume. If it's the case, swapping from asvauto to asv mode and low epap may be worth a try. I have seen this a couple of times before, it just presented differently this time. Time will tell.

Do you still have the appointment with the doctor who does centrals?

[jaswilliams]

I didn't catch any data on Sunday night, since I removed the card from the machine late in the day and didn't remember to put it back, but here's the data from last night. 
I've been feeling pretty rough since Friday, so I can't directly say if the settings made things better or worse, but AHI and 95% pressure are higher than normal, with the AHI being the second-highest since I started using the ASV machine. Last night (and last Thursday) were also the only nights where I saw multiple unclassified apneas appear.

This is with the settings Min EPAP 4.8 Max IPAP 35.0 PS 3.0-20.0 (cmH2O)

Any AHI less than 1 is excellent you will get a few events from time to time, unclassified apnoea may be obstructive or may be central in nature if you zoom in on one of them we might be able to advise. But at a high level your ASV is doing its job and well. The next thing is for you to get used to sleeping with the ASV to improve your sleep quality. The Resmed ASV if pretty much fully automatic with not many changes you as an end user can do. But I would give it more time before doing any more dial wiggling and changing settings. As our ahi changes from night to night due to any number of things including colds, disturbed sleep, humidity, family members etc...

[gsilver]

Second 0.0. I found the increased EPAP of 4.8 to be a bit uncomfortable, so I tried changing it back to 4.0. Now I just need to master actually sleeping through the thing and spend less time lying in bed awake. 

My appointment with the new doctor will be on the 23rd.

[Sleeprider]

That is a really good screenshot of the ASV working hard to resolve periodic breathing and potential CA, finally settling into normal sleep rhythm.

[gsilver]

How long should I expect before I at least feel better than not using it? I'm about 3 and a half weeks into using the ASV. I was managing to go to the gym about 3 times a week before I started, but haven't managed it a single time since. I'm also tracking my naps, and I'm seeing between 1-3 hours most days (average 70 minutes).

It was really hot last night and my AC broke, so I ended up sleeping in the basement without hauling the machine downstairs, and I feel better today than any day since starting using the machine, even with waking up for about 2 hours at around 3:30 last night (early night awakenings have been a problem since I started the machine).

This is with seeing quite a few 0.0 nights on the machine.