frequent awakenings

[SarcasticDave94]

I have to agree with Sleeprider. There's something not being addressed that cannot, in my opinion, be discovered without seeing a data report. I know what the results are of having an ASV working to allow me to sleep better than I've gotten for over 15 years.

Not attempting to get the Captain Obvious award, but I assume there's some medical issue that's not being addressed currently. The thing is, there's not enough info to see whether it's apnea related or not, nor to even indicate what it might be.

Hope there's some more info so we can help with this.

[Dreamless]

Thank you for your replies.  I was getting ready to put a couple of nights of data from this week on here and !!  my card hasn't recorded any data for nine nights.   grrrr  I didn't load the card in the machine correctly.   

I am 70 years of age and being treated for anxiety (for a couple of years), my doc thinks probably developed from sleep deprivation over the years.  I'm going to post some data from a few nights ago.  

[Sleeprider]

Dreamless, how did you arrive an EPAP min of 9.5 and PS min 6.0? The EPAP min is clearly high enough to prevent any OA events, so it makes me wonder if it is too high. Your PS min of 6 is causing an impressive tidal volume and you rarely have any higher pressure support to intervene with centrals or hypopnea. It almost appears the minimum PS is sufficient to do most of your respiratory work. Were you titrated for these pressures? What would be a healthy tidal volume for you assuming 7 mL/kg of ideal body mass?

[Dreamless]

Sleeprider,

I don't really understand what you are asking about the tidal volume and body mass, but my BMI is 27.1

I have been through 3 titrations over the last 5 1/2 years, which never helped my sleep at those settings.  Last summer, with the help of a few very helpful people on this forum, I started sneaking up on new settings to try to get the centrals and hypopneas down.  The last titration (Sept 2016) settings were:  Epap 6, PS 3-15, Auto rate    Once I started changing the settings,  I gave those settings 3 - 4 nights to get a good idea how they were working before changing again.  So, since last June, I've tweaked the settings on my machine based on Sleepyhead results.  Probably way more info than you were asking for but that's how I came to have those settings.  

Thanks again.

[Dreamless]

Sleeprider,

Ok, I just did some snooping around about the tidal volume question.  I should have done that before answering.  Your question about the healthy tidal volume is 934.9  (90.7 * 7).  I'm looking at the charts and see that 95% of the time, mine is way up there.  From what I've read just tonight, this sounds like I definitely need to do some adjusting.  Any suggestions on how to lower that ?

Dreamless

[Sleeprider]

It's all good, and I was just trying to ensure the minimum pressure support was not over-ventilating you. It appears you are pretty close to optimum. My impression of your results is that you're getting pretty darn good results on ASV. We could look a little closer at the hypopnea events, but it appears that your machine is just not responding very quickly to mitigate "relatively shallow" breathing events that are being flagged. With a high Tv and minute vent the occasional hypopnea may not be very impactful to your oxygen saturation or your health. I can't explain what causes arousals, but be assured we all have them.

On your flow rate chart, the vertical hashes are backup breaths where the machine switches over to IPAP when you don't take a spontaneous breath in the expected time. There are a lot of them, but the pressure support rarely rises above 6.0 cm, in fact the highest pressure support you ever see is 9.1 cm. Your original titration settings were pretty conventional at Epap 6, PS 3-15, Auto rate, and it looks like you have made sound decisions in arriving at your current settings. The machine is responding and switching to IPAP, and rarely needs more pressure than your minimum settings. That looks pretty good.

[Dreamless]

Sleeprider,

Thank you for your help.  Last night I lowered the EPAP min to 9.0 and the PS min to 5.0, I didn't seem to wake up when starting to dream last night.  Time will tell.  Sometimes when I wake up I just lay there with the mask on and don't necessarily get up.  

I do have another question for you though, the 95% under the Tidal volume (off to the left side of the charts), what the heck does that tell a person ?  It doesn't mean that you spent 95% of the night at that number, correct ?  I see there is an "avg" number when I hover over Tidal Volume there.

Thank you so much again !  
- Dreamless

[Shin Ryoku]

Sleeprider,

Ok, I just did some snooping around about the tidal volume question.  I should have done that before answering.  Your question about the healthy tidal volume is 934.9  (90.7 * 7).  I'm looking at the charts and see that 95% of the time, mine is way up there.  From what I've read just tonight, this sounds like I definitely need to do some adjusting.  Any suggestions on how to lower that ?

Dreamless

How tall are you?

You can use this calculator: https://www.mdcalc.com/ideal-body-weight

For example, I am 5'11" and male, so my calculation looks like this:

[Sleeprider]

I do have another question for you though, the 95% under the Tidal volume (off to the left side of the charts), what the heck does that tell a person ?   It doesn't mean that you spent 95% of the night at that number, correct ?  I see there is an "avg" number when I hover over Tidal Volume there.

Thank you so much again !  
- Dreamless

When you see us refer to the 90% or 95%, we actually mean percentile.  The way to read this is is you were at or below the 95th percentile value of (pressure, volume, etc) 95-percent of the time, and at or above that for 5-percent of the time.  Percentiles are a statistical term and are useful to understand the distribution of data.  If the mean and 95th percentile are very close, we know the data fall in a narrow range, or if they are widely distributed, the range of data is greater.  We often use the 95 percent pressure, and compare it to the mean or median.  

I don't want to get in to data distribution curves, but the information is helpful to understand so we know how much variation in something like pressure occurs during the night.  While this statistic is useful for pressure, I don't use the 95% tidal volume because it's normal for someone to have occasional large breaths that distort or skew the data, and because there is often some error in that measurement by the machine due to leaks and other causes.  This is what we're talking about with the distribution of data and the 95th percentile.

[Dreamless]

Thank you for the info about the 95% TV.  That definitely makes more sense of the data now.  

And Thank you Shin Ryoku  for the link. 

I really appreciate you both taking time to guide me through that! 

- Dreamless