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+--- Thread: Just getting into this . . . (/Thread-Just-getting-into-this)
RE: Just getting into this . . . - jaswilliams - 05-08-2019
If you replace the pressure graph with mask pressure you can zoom right in and you can see what your machine is doing on a breath by breath basis and providing pressure support to encourage and maintain your breathing
RE: Just getting into this . . . - TSVanwinkle - 05-08-2019
re the mask graph. Yes, it does clearly show what the ASV is doing, clearly trying to get me to breathe when I stop, at the back-up breath rate. What AJack and I have been trying to figure out is the trigger and my respiration response to rises in pressure and tidal volume, which starts cycles of very low respiration where the ASV is really working, but clearly, my breath rate is negatively impacted by pressure.
Thank you for weighing in! Last night the ASV settings were the same as the previous night. The one change I made was use of a cervical soft collar to insure that there are no positional issues going on. Last night's sleep, despite the carnage going on in the background, was restful. The next thing that I am thinking is that an oxygen sensor would help understand more of what is going on when my breathing rate tanks.
RE: Just getting into this . . . - ajack - 05-08-2019
Having PS4 would make it more comfortable. If you can get your first chart of 6 ps1 up again, I have trouble to see the original. You can compare the two. It seems more PS make the events longer. I couldn't find available what the minimum values are, that the algorithm sets as a backup.
Did you get a copy from the doctor, of your sleep study with the ASV? That will show the o2 readings. The events may settle down a bit over time. You are a new user.
I think there is enough to warrant the outlay for the cms50. The watch one is more comfortable. There is a choice with wifi. I have the normal cms50f. A search of the forum and net will find info on the cms50fw. It would be good if the spo2 meter o2 stayed above 92% during these events. You can also lend it to friends. To see if there are any o2 desaturations, that need further investigations. My sister wore the watch for a night and is on cpap now.
RE: Just getting into this . . . - TSVanwinkle - 05-08-2019
G-day Mate!
I have re-posted the chart of 6 ps1. Looking at that and comparing with the chart where we tried higher ps, its pretty clear that the higher ps and EPAP numbers had a lot more and deeper respiration, minute Vent and TV fluctuations, than the 6 ps 1. re Oxygen. The titration study demonstrated an oxygen saturation level of 94% at the parameters they used to set the ASV. I'll go back to the lower settings tonight. Hoping it will be more stable now that all the positional issues have been settled.
Thanks again for working with me on this. Good on You.
RE: Just getting into this . . . - jaswilliams - 05-09-2019
(05-08-2019, 08:40 PM)ajack Wrote: Having PS4 would make it more comfortable. If you can get your first chart of 6 ps1 up again, I have trouble to see the original. You can compare the two. It seems more PS make the events longer. I couldn't find available what the minimum values are, that the algorithm sets as a backup.
I believe that the resmed sets a minimum breath rate, at 15 but the agorithim can set the backup rate as low as 10 breaths per minute if the minute vent requirements are being met as minute vent over a sliding 3 minute window is what the resmed ASV targets.
RE: Just getting into this . . . - ajack - 05-09-2019
I'm not seeing enough difference between ps1 and 4, to say that's the problem, if you take out that event at 12:30 on PS4. The pattern looks very similar
Even though if you emailed the chart to the doctor, he's probably tell you to see how it goes and we'll look at it at your next appointment. I'd still send it off and ask for an opinion. I'd also ask for the sleep study report on ASV. They are freely given if asked for. It will show if you kept your o2 94% or above during these events and it's not a big concern, Or it may have been an average 94% and there were larger desaturations.
@Jas, it does look like the min RR backup may be kicking in.
RE: Just getting into this . . . - TSVanwinkle - 05-10-2019
Hello to you . .
So.....last night I returned to the EPAP 6 min ps-1 settings. The result was a fairly smooth night with one measurable event.
I did some more research on Minute Vent and Tital Flo. Some MV guidelines suggest 5-8 for a normal adult at rest with a TV of appx 500.
It would appear my minute Vert falls within the parameters, however my resting average TV 'is appx 400.
As I scanned through the night's data I see an event pattern that repeats every 7-10 minutes, where I take some deeper breaths, without ASV involvement. I would classify that as "hey, my internal system worked! I needed to raise oxygen level and apparently did.
Then there are the bumps, where the internal doesn't respond and ASV has to get my TV up. Lastly there is the ahi event itself, where I had no airflow action for eight seconds. So, my thinking about oxygen would still seem to be a valid trigger.
re the ASV titration report, I do have it. THe lowest level as they were trying various combos of IPA and EPAP settings was 91%, the hightest was 94% at the settings they arrived at as optimum. On the original sleep study, where they tried to titrate using Bi Pap, the lowest oxygen was 83% and they were unable to get AHI any lower than 10.7.
I will probably see the Doc within the next two weeks.
RE: Just getting into this . . . - ajack - 05-10-2019
That chart looks to be the best so far. There are only a couple of sustained drop in minute vent. The other low resp rate events were short lived. As well, there may well be pressure induced, new user CA also impacting. You are very pressure sensitive. The good news there is that part normally resolves for most people over 12 weeks, according to specialists with ASV. So that will give a clearer picture in the long term. As well as citing the above, towards the end of this talk at 48 minutes. This channel has several other good videos on ASV and well worth watching
https://www.youtube.com/watch?v=Nr08K5IfzzY
It's not the median minute vent, that is of the most importance for this issue. It's when there is a sustained drop down to what appears, into the 3-4 over the several charts and whether you maintain your o2 during these events. Have a look at the study, it should have the full night's minute vent chart. That would confirm that there are these events and the o2 didn't drop below 91%
RE: Just getting into this . . . - TSVanwinkle - 05-11-2019
Thanks for sending that youtube link to that seminar. Very interesting. Reminds me to let my cardiologist know that I've started ASV. NO heart issues that i am aware of, but I'm not as young as I once was either.
I made a slight tweak last night increasing the PS from 1 to 1.4, since I seem to be so pressure sensitive, with the goal of slightly increasing Tidal flow. Also lowered the humidity slightly. The results were a little smoother night and an AHI of zero. Can't throw too many rocks at that. One thing I paid more attention to in the chart was the relationship of respiration and Tidal flow. In the quieter periods where mask pressure was fairly low I could see that a decrease in titdal flow resulted in an increase in respiration rate. That makes sense, since the brain center was calling for more 02 - or less carbon dioxide. The area I looked at was where the pressure was relatively constant. As in the other charts, I can have a 30 min period of relative calm, then a blip where airflow isn't happening and then the ASV kicks in. One other factor I hadn't thought about until now is the dream - non dream states. Obviously dreaming can provoke emotional re-action, like the time I got so angry (in my dream) at being threatened that I attacked the person threatening me. I woke up breathing heavily and realized I had heaved a pillow across the room with such force that it knocked over a chair. So, there is that factor. re the O2 levels and Minute Vent rate. The titration study did not contain a by the hour vent rate and O2 graph or data.
RE: Just getting into this . . . - ajack - 05-11-2019
That chart is the best so far, along the minute vent. Don't you think? The purpose of that video, was to show that pressure induced CA can settle down. It's nice to hear it from a specialist. There are others on the channel for normal CA. If you have a cardiologist, you would have had an echogram at some stage and be aware of issues.
I'm ok with the higher breath rates. It's the low ones i don't like. The one at 4:29 seemed to be triggered by some deep breaths, they the machine took over for 2 minutes. It could have been waiting for the co2 to build up again to resume your normal breath rate. They seem short lived now and don't drag on as much as they did.
You may get some more vivid dreams. You may not have had much REM before. Rem goes in about a 90-120min cycle and the chart can go stupid.