(02-28-2020, 09:18 AM)mper6794 Wrote: Hi, Joey
Situation somewhat similar to mine: too many unbearable arousals! 
After an almost one year of own learnings, i think i am able to discriminate between respiratory-driven and RLS/PLMS- driven arousals. Respiratory was pretty much 100% resolved daily with the Vauto; after back to zero and started ALL over in a self titration.
Then, i have been trying best suitable medication, with bearable side effects: already disregarded pramipexol, pregabalin, and Valerian. These days i am trying propanolol; low hopes. Next texto is going to be zopiclone.
Best solution thus far: clonazepam 0.5/0.6 mg; leads to less arousals, less too early wake ups; and back to sleep quickly; best sleep efficiency ( > 80% in general).

It looks to me you would not have resolved respiratory-driven arousals yet, maybe (bruxism, indication of effort on your charts with asv desistabilizing your sleep, maybe...). 
I could suggest Try to make sure on that discrimination and enentual new titration (mode S was good solution for me).

Good luck

(02-28-2020, 09:31 AM)mper6794 Wrote: .....not able to update untill next week: currently on Vauto, 11.8/7.2/4.6...ipap Max = EPAP + PS......Trigger Med...cycle Med....ti 0.8...2.0.
 It looks i am going to take a Very long while under those numbers.
I have realized How sugnificant would be a systematic titration ( Resmed protocols look work Very Nice).

ALL the best

(02-28-2020, 10:04 AM)mper6794 Wrote: ...... in time: what i meaned to discriminate is between/among respiratory-driven and whatever remain: plms, catathrenia, any other stimilum which might be present...

(02-28-2020, 02:39 PM)Geer1 Wrote: Do the arousals correlate with any of the breathing issues, specifically your moments of slow respiration and falling minute ventilation? It seems like they might be following those times?

(02-28-2020, 05:26 PM)70sSanO Wrote: I'm always leery of posting when there is so much technical discussion because I can take only so much data analysis and then my brain says enough.  The following is not scientific, but it seems to work for me.

During my first sleep study in 2001, complex sleep apnea was present, which was a moot point back then.  I fought a good fight until about 6 months ago.  Did an ASV titration and got an Aircurve 10.

Six years ago I started using a cervical collar, not because I knew anything about chin tucking, but due to a suggestion to help keep the airway open.  I had lost a lot of weight and had, in fact, developed obstructive clusters back then.

I only bring this up because I didn't wear it during my ASV tittration which I aced, although I didn't sleep very well and felt lousy the next morning.

When I got my ASV machine I didn't use it and had an AHI of 0.3 with no apnea events, much less clusters.  I felt lousy the next morning.  Keep in mind I've been doing this stuff for almost 20 years and usually felt good in the morning.  Next night, same thing; until I gave up in the middle of the night and put the collar back on.  Slept great.  My first night flow limitations were about 0.7 and dropped to almost 0.5 after that.

I started tweaking the setting.  Went to ASVAuto.  EPAP 5.0-10.0.  Kept PS at 3.0-15.0.  Did not go well.  I slightly raised the Min and narrowed the EPAP range and and made some slight tweaks to PS and things got better.

But what really helped was trying to find the right bed pillow setup.  I think I've go it to where I pretty happy with it.  Generally my flow limitations are around 0.3 or less.  Occasionally they will go up to 0.4 or so.  The best thing is that I hardly wake up in the middle of the night anymore.  Like everyone else, though, events of the day can throw that out the window.

I have no idea if this is of any help at all.  You can dismiss it.  It was founded on how things were done years ago before all the data.  Data is great and I wouldn't go back.  But there are only so many settings you can dial up.

John

(02-28-2020, 05:45 PM)SarcasticDave94 Wrote: I think John has a point. Numbers can only tell us part of the story. The answer to "how do you feel?" probably needs to guide you along using the numbers to reference. Great numbers mean nothing if you don't feel great for the effort.

(02-28-2020, 08:09 PM)Geer1 Wrote: Agreed about its how you feel. I'm a huge fan of data but it only helps when there is a correlation between the data and results and so far there has never been a clear understanding of what the problem is here. We know it is arousals but are they due to high respiratory effort(flow limitation style)? Lack of respiratory effort(central apnea style)? Spontaneous not related to breathing? 

Have you considered trying to get an ASV PSG/titration study done? Might tell you more of the story and indicate if/what the current treatment is missing.

Quote:The backup rate is automatically calculated to match the patient’s needs so that mandatory breaths are delivered at the patient’s recent spontaneous breath rate