Worried about periodic breathing / CA patterns

[stevew168]

You said:
It's weird, I tried breathing slowly and calmly for the first few minutes but it really felt like it was trying to overinflate me like a balloon."

My suggestion was to relax and let your breathing settle into a normal or natural rested pattern. When people try to deliberately slow their breathing, they will typically breathe more deeply. This sets the wrong target for the ASV.  You are actually better off with shallower, slightly more frequent breaths.  I'm sure if you look at the flow rate pattern when you put the mask on, you will see a difference from when you fall to sleep.  It's that sleep pattern you want to approximate if possible.

Since minute ventilation = tidal volume x respiratory rate, breathing deeply and more slowly starting out will not increase minute ventilation significantly, since the two parameters work against one another to determine the minute ventilation. Since you tend to breathe more slowly when you begin to fall asleep, it is better to breathe more slowly starting out to set the backup respiratory rate slow enough, so that you don't get blasted by pressure because the ASV thinks you are having a central apnea, due to the slower respiratory rate as you fall asleep.

When I first started using ASV I did not do this, and would get a few blasts of air as I fell asleep, causing arousals.

[Jorgo]

You are all so helpful and I'm so appreciative of all your support, I can't say that enough!

Below is my data from last night.  Really wish I could get the leaks under control, they weren't as bad when I was on APAP.

Also the flow limit spikes are a bit strange?

[stevew168]

It looks really great! At least the leaks are not much over 25 and not very many. The ASV has an algorithm to reduce leaks. You will notice sometimes the IPAP briefly drops to the EPAP level. Maybe just adjusting the mask and centering it on the back sides of your head will help with the leaks. I have the N30i and that has helped a lot. Sometimes the back strap rises up somewhat, and readjusting it downward helps to reduce leaks.

You may notice you may have more REM sleep with the ASV. I read a study that showed ASV gave the most REM sleep, then the VAuto, and lower were APAP and CPAP.

That's a pretty awesome chart!

[Sleeprider]

Looking back at your therapy with CPAP, you always had low AHI, but some really ragged erratic breathing flows from time to time. You have improved things across the board and I suspect your sleep is greatly improved. I was impressed that someone with a complex apnea diagnosis could tolerate CPAP as well as you could, but it seems you found the better solution.

[Jorgo]

Chart from last night - looks pretty good with the exception of a weird 20+ second unclassified event.

Looking at the data in detail it seems like there are fairly regular ragged breaths - typically only one or two at a time but very regular.  Could this just be caused by machine intervention or is it an indication of me being disturbed / moving around in my sleep?

I only ask as I can't really tell any noticeable difference in how I feel between APAP and ASV, if I'm being completely honest.

Finally, any more advice on anything I should look to tweak?  I got pretty close to EPAP max so was thinking maybe putting that up a fraction?

[jcp519]

Those sharp looking breaths are when the PS is high and the machine is helping you breath. I get the exact same thing on my ASV.

You could probably bump up your EPAP range to 6-10. I find that a slightly higher EPAP min helps me breath easier and makes me feel better in the morning. Since your bumping EPAP max a few times in the night, I'd say increase it to 10. The machine will probably never go that high, but if it needs to, it can.

On another note, the leaks that keep jumping up and down will definitely affect your sleep. Notice when the leaks jump around your breathing will get a little more chaotic. I know the N30i can be pretty tough to keep from leaking. I find the nasal pillows of the P30i much easier to keep sealed.

[Jorgo]

Thanks! How do you find the p30i comfort wise? I quite often sleep on my stomach so I was concerned that it would feel unpleasant with that style of mask.

[jcp519]

I love the P30i! Its probably the most comfortable mask I've worn. I often forget that I even have a mask on.

I sleep on my stomach a lot as well. I pretty much jam the mask into the pillow at night and it never leaks. It is a little weird at first getting used to having something right in your nose, but the stability of nasal pillows is great.

Since you have an N30i already, all you would need is just the pillows cushion to convert it. I think they run about $30-$40 USD, so might be worth a try for you.

[Jorgo]

Awesome, thanks! What's the size equivalent? I run a small n30i but it's borderline between small and medium. How does the size compare, do you know?

[jcp519]

I'm a small/medium as well in the N30i. I would say grab a medium P30i, unless you have a really small nose.

I find that the small P30i really restricts my breathing a lot because the nostril holes are way smaller on the small vs. the medium.