When to call it quits?

[PoolQ]

That's a great chart to look at, truly a restful site!

[richb]

You have the correct machine now.

Rich

[DeepBreathing]

Congratulations on the new machine and the excellent results.

[vsheline]

The next trick will be to get all that sleep in one contiguous block without waking up.

Hi shewhorn,

Great restart, great new machine.

Any apnea scored by your machine will be Unclassified because it does not try to detect whether an apnea is obstructive or central; it just immediately raises the pressure to attempt to overcome it.

You would likely be doing better in ASVAuto therapy mode rather than in ASV therapy mode.

The difference is the machine needs EPAP manually set if in ASV therapy mode. Your time on the AutoSet showed you sometimes need much higher EPAP than 4. If staying in ASV mode I suggest the EPAP should be set around your long term average 95 percentile EPAP found while on AutoSet, which may have been close to 15, which is the highest EPAP can be set on your machine.

The 95% EPAP pressure is the EPAP the mask was at or below for at least 95% of the time. It is also the EPAP pressure the mask was at or above at least 5 percent of the time.

In the picture you posted SleepyHead is showing the "95% Pressure", which is the 95% IPAP pressure.

If it is changed to ASVAuto mode, I would suggest a Min EPAP around 10, as a start, or not less than 5 lower than the long term average 95 percentile pressure for EPAP measured while you were using the AutoSet. The lower the Min EPAP the faster EPAP drops too low after it has been raised to the level needed, because it treats the Min EPAP as a pressure target it is always gradually trying to get back to.

Also, looks like your Pressure Support (PS) has been set to near its highest allowed Min PS setting of 6.

I suggest using a recording pulse oximeter overnight at least occasionally if using a high Min PS like 6. If you have normal healthy lungs I think a good target for SpO2 (percentage saturation of O2 as measured through the skin, percutaneously) would be between 94 to 96. If someone has COPD it may be dangerous to have SpO2 that high, and 90 to 92 may be a safer range for average SpO2.

Raising or lowering the Min PS tends to raise or lower the average SpO2.

Take care,
--- Vaughn

[Asjb]

Hello Shewhorn and welcome to the Resmed Aircurve ASV Users Group! (no, there isn't really a group... Perhaps we should start one)

Congratulations for persisting with your doctor and getting the machine you needed. Your graph this week looks terrific. I have been delighted, symptoms and AHI, with my use of the ASV and hope you will be too.

I echo Vsheline's comments - but then I would do! as he (with other members) has helped me enormously with my ASV settings and teaching me about the machine's capabilities. I found auto-ASV better than fixed ASV, but I am still gently fine-tuning my settings after 5 months of ASV use.

As regards 'unknown apnoeas' - I asked Mark of Sleepyhead a few months ago if 'obstructive' and 'central' apnoeas could be removed from the Aircurve ASV reporting in SH as they will always be zero (you have to look at the wave form of the 'unknowns' to see what type it was), and thus to add a note too that 'unknowns' may be O's or Cs, etc. The new Sleepyhead beta 2 hasn't corrected that yet, maybe something for the next update.

best wishes
...............................................................................................

All my opinions are only as a xPAP user trying to help another xPAP user.
No suggestions I may make should be taken as medical advice.
If you have medical concerns you should see a doctor

My current pressures: Auto-ASV. EPAP 12-15. PS 3-9

[shewhorn]

Vaughn,

Wow, thanks for all the information! Last night the 95% EPAP was 14.98% I think I'll leave the current settings until the insurance company monitoring period is over (one, or three months?). I don't know what data they're collecting but... I do not trust Anthem BCBS, everything about the way they operate is optimized to deny coverage. Wouldn't surprise me if they'd try to deny coverage if the machine settings didn't match the script. After that I'll try your settings (and with at least a month's worth of data I'll have a better sense of what everything looks like when averaged across a month of use). I just got up to speed on some of the terminology here:

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

One interesting point they made was that Auto may be a better option for patients who have centrals associated with REM which is definitely me. From past observation of my AS S10 Autoset I'd have giant clusters of centrals in the AM when REM cycles are longer. I'm also going to give my doc a ring and ask what his prescription indicated just to make sure the machine setup and his script match (I have a sneaking hunch it may not be).

That said... the settings "feel" good whilst falling asleep. I remember distinctly when they enabled ASV mode during my last sleep study, it was somewhat uncomfortable as the pressure would drop off before I was done with the inspiration... kinda feels like having the floor pulled out from under you.

[shewhorn]

I suggest using a recording pulse oximeter overnight at least occasionally if using a high Min PS like 6. If you have normal healthy lungs I think a good target for SpO2 (percentage saturation of O2 as measured through the skin, percutaneously) would be between 94 to 96. If someone has COPD it may be dangerous to have SpO2 that high, and 90 to 92 may be a safer range for average SpO2.

I have asthma but... the lungs are strong! Lots of cardio... on the weekends I often do 20+ miles of hiking with 10,000+ vertical feet of climbing. I usually blow 110% to 120% of estimated volume on spirometry and nearly always peg the peak flow meter. I do have a recording pulse ox monitor though so maybe I'll give that a try (although I find it a little annoying... the spring tension is a bit much and it's heavy).

[shewhorn]

Another followup... No changes to the settings yet but, it doesn't look like I'll need to. I've had an AHI of 0 for the past 4 days of use (skipped one night as I was away from home).

Also... my 95% pressure is the 15cmH20 range. With the higher pressures of the ASV I noticed that after about 4 to 6 hours, my full face mask would start... farting. After the oils/sweat under the seal built up, it would compromise the seal and then... PFFFTTTTTT. I have a Respironics Dreamware mask which I didn't think I'd be able to use (as I'm normally somewhat congested) but with the higher pressures of the ASV (and given how the algorithm works) I figured I'd give it a try. It blows right through the congestion (and often what happens is I'll wake up with one nostril completely clear and the other congested). Unfortunately, after about 6 hours with the Dreamware, the tip of my nose gets very sore. I went back to the DME for yet another mask fitting and ended up with an F&P Eson nasal mask. 95% leaks are now down to 0. Still figuring out how to make the chin strap a bit more comfortable.

[Shastzi]

That's what being persistant gets you. Congrats!