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+--- Thread: 18 mths of apap: need help optimizing settings to feel better [ASV] (/Thread-18-mths-of-apap-need-help-optimizing-settings-to-feel-better-ASV)
RE: 18 mths of apap: need help optimizing settings to feel better - sheepless - 06-06-2018
2 nights with asv. I was going to wait another day or two before posting but besides being impatient I'm curious about a few things that stand out to my untrained eye. I've only posted the daily screens. let me know if I should post some zoomed images as well.
duration of sleep sessions is unaffected (so far?); still much too short.
flow rate waveform still looks ragged but I do believe perhaps less so than with apap. e.g., still seeing suggestions of periodic breathing but with reduced amplitude.
most events are unclassified, even when leaks are well below the red line. I saw in another thread that some adjustment in that case resulted in fewer unclassified and more identified events.
flow limitations look to be more frequent and pronounced than historically with apap. however, sleepyhead does not seem to be calculating the flow limitation statistics properly. eyeballing, it's hard to believe med and 95% flow limitation are 0.00. I tried changing the upper limit to 1.0 in file, preferences, waveform, flow limit. med on 6/4 changed from 0.00 to 0.02, which still looks inaccurate, and there was no change on 6/5. the change I made in preferences showed up on just the one day 6/4 so I made the change again while viewing 6/5, shut down and restarted sleepyhead with no change to flow limit statistics.
fyi, I'm kinda sorta trying to close some of the gaps between sleep sessions so I forced the leak spikes at 4:00am and 7:30am on 6/4/18 to indicate being awake without removing mask and turning off machine. not sure but I probably fell back asleep faster than when I stop therapy and do something else for a bit. don't know if it matters but note that the sleep duration depicted by those two flow sessions is incorrectly long; those 2 sessions are actually 4 sessions. for 6/5/18 I forgot & returned to my old habit of stopping therapy during each wake time.
the large leak on 6/5/18 occurred around high pressure and a cluster of hypopnea and unclassified apnea. at other times both nights I handled the high pressure without large leaks. listening to recordings from before cpap, it sounds like hypopnea is a long, sometimes eerily long, slow groaning release of air from my mouth. makes me wonder if that particular large leak was related to the hypopnea.
as I've said elsewhere, I attempt some interpretation hoping to learn how to read these data. it's expected that anyone looking at this will skim over my long winded observations and respond to the posted images. even so, comfirmations and corrections to my observations will help me learn and will be much appreciated.
meanwhile, while still sleepy and brain foggy, I am not anywhere near as 'hungover' feeling as during 1.5 years of apap. I know better to assume anything after only 2 nights and whatever benefit I think I'm noticing may be psychological and/or temporary, but I thought how I think I feel worth noting.
thanks for looking.
RE: 18 mths of apap: need help optimizing settings to feel better - Sleeprider - 06-06-2018
Everything looks great. If you want to change EPAP min to 7.0 and EPAP max to 15.0 I think everything else stays the same for now. Leaks and event rate are considerably improved and the machine is pretty busy with PS mainly between 4-8 but sometimes reaching 12.0. That seems pretty consistent with our objectives here. Your tidal volume and most respiratory stats are completely unchanged.
Your observations are fair, and we don't expect miraculous overnight results however it sounds like you are tolerating the therapy well, and at this stage that is a huge win. For the charts the Mask pressure is useful, and you might replace snores with that for the time being.
RE: 18 mths of apap: need help optimizing settings to feel better - sheepless - 06-06-2018
(06-06-2018, 06:55 PM)Sleeprider Wrote: Everything looks great. If you want to change EPAP min to 7.0 and EPAP max to 15.0 I think everything else stays the same for now. Leaks and event rate are considerably improved and the machine is pretty busy with PS mainly between 4-8 but sometimes reaching 12.0. That seems pretty consistent with our objectives here. Your tidal volume and most respiratory stats are completely unchanged.
Your observations are fair, and we don't expect miraculous overnight results however it sounds like you are tolerating the therapy well, and at this stage that is a huge win. For the charts the Mask pressure is useful, and you might replace snores with that for the time being.
yes, I'd like to move epap min to 7. if I read no objection I'll increase epap max incrementally as I'm concerned about leaks with ipap pressure up to 27cm. re mask pressure graph, you probably meant to add it in future posts but here are they are for current 2 days.
unchanged tidal volume and respiratory stats: is that a good, bad or indifferent thing?
I'm particularly curious about unclassified events and flow limitations. I assume we're in wait and see mode and will revisit these later if necessary.
thanks.
RE: 18 mths of apap: need help optimizing settings to feel better - Reznik - 06-07-2018
IMHO- If you're getting an AHI from 4 to 8, and you're not sleeping well, something else is wrong.
Either you have some other kind of sleep disorder unrelated to sleep apnea OR something about the machine itself is disrupting your sleep.
I have found that the Central Apnea Detection pulses used by ResMed machines was disruptive to my sleep. I'd get AHI <1, but that was because whenever I did have an apnea, the pulses jolted me out of sleep (but didn't fully wake me up). I felt awful the next day. It took me quite some time to figure out that the cause was the pulses, since they didn't fully wake me up, or when they did wake me up, I had started breathing and the pulses had gone away before I was aware that I had woken up.
Once I got a machine that didn't do Central Apnea detection, my AHI actually went up (ranging from as low as 4 to as high as 10 on some nights), but I sleep great and wake up feeling refreshed.
Update: I see that you started with an Autoset machine (which does send the pulses) and switched to an ASV (which does NOT send pulses). If you're sleeping better, it might be the absence of the pulses and not anything else about the ASV machine.
It's a shame that Resmed doesn't allow you to turn the pulses OFF on the cheaper Autoset machines. I think that a lot of people who have trouble with CPAP are experiencing the same problem that I did, but have no idea what's causing it because the pulses only occur when you're asleep and having an apnea. Resmed, of course, is quite happy to have you switch to the ASV, which costs them about the same to make, but sells for 8x as much money.
RE: 18 mths of apap: need help optimizing settings to feel better - JesseLee - 06-08-2018
Sleepless,
It seems as though you may be getting benefit from your new ASV. We know it's going to take time for acclimation and improvement. Previously, you had posted zoomed sections of your flow chart, be so kind as to do that again? I'm interested to see what your periodic breathing looks like compared to your autoset results.
Also, your fragmented sleep is not helping. You know yourself better than anyone else and i think you know you are going to have to address the fragmentation. How you go about getting a solid nights sleep and changing the up and down all night is gonna be tough, but, I think you would benefit from resetting you sleep habits.
You've talked about it in previous posts and i know you dread it, but having a positive attitude will help and hang tough and determined. I would start to prepare yourself and be thinking seriously while you get adjusted to your ASV. Just sayin'.
RE: 18 mths of apap: need help optimizing settings to feel better - sheepless - 06-08-2018
(06-07-2018, 11:20 PM)Reznik Wrote: IMHO- If you're getting an AHI from 4 to 8, and you're not sleeping well, something else is wrong.
Either you have some other kind of sleep disorder unrelated to sleep apnea OR something about the machine itself is disrupting your sleep.
I have found that the Central Apnea Detection pulses used by ResMed machines was disruptive to my sleep. I'd get AHI <1, but that was because whenever I did have an apnea, the pulses jolted me out of sleep (but didn't fully wake me up). I felt awful the next day. It took me quite some time to figure out that the cause was the pulses, since they didn't fully wake me up, or when they did wake me up, I had started breathing and the pulses had gone away before I was aware that I had woken up.
Once I got a machine that didn't do Central Apnea detection, my AHI actually went up (ranging from as low as 4 to as high as 10 on some nights), but I sleep great and wake up feeling refreshed.
Update: I see that you started with an Autoset machine (which does send the pulses) and switched to an ASV (which does NOT send pulses). If you're sleeping better, it might be the absence of the pulses and not anything else about the ASV machine.
It's a shame that Resmed doesn't allow you to turn the pulses OFF on the cheaper Autoset machines. I think that a lot of people who have trouble with CPAP are experiencing the same problem that I did, but have no idea what's causing it because the pulses only occur when you're asleep and having an apnea. Resmed, of course, is quite happy to have you switch to the ASV, which costs them about the same to make, but sells for 8x as much money.
thanks reznik. I agree with your IMHO. that's why after a year and a half with the autoset I'm trying the asv. I'll take relief from wherever it comes. I can't say I understand precisely why (like whether it's the absence of pulses that make the difference) but so far my ahi is under 4 with the asv and more importantly I feel way less crappy. knowledge is power and I'm glad to learn about the pulses. if I go back to the autoset or get my wife on one, it'll be useful to know how you determined the pulses were causing you problems.
edit: I should add that I have csa's and periodic breathing so I need a machine that deals with csa somehow.
RE: 18 mths of apap: need help optimizing settings to feel better - Reznik - 06-08-2018
(06-08-2018, 11:42 AM)sheepless Wrote:(06-07-2018, 11:20 PM)Reznik Wrote: IMHO- If you're getting an AHI from 4 to 8, and you're not sleeping well, something else is wrong.
Either you have some other kind of sleep disorder unrelated to sleep apnea OR something about the machine itself is disrupting your sleep.
I have found that the Central Apnea Detection pulses used by ResMed machines was disruptive to my sleep. I'd get AHI <1, but that was because whenever I did have an apnea, the pulses jolted me out of sleep (but didn't fully wake me up). I felt awful the next day. It took me quite some time to figure out that the cause was the pulses, since they didn't fully wake me up, or when they did wake me up, I had started breathing and the pulses had gone away before I was aware that I had woken up.
Once I got a machine that didn't do Central Apnea detection, my AHI actually went up (ranging from as low as 4 to as high as 10 on some nights), but I sleep great and wake up feeling refreshed.
Update: I see that you started with an Autoset machine (which does send the pulses) and switched to an ASV (which does NOT send pulses). If you're sleeping better, it might be the absence of the pulses and not anything else about the ASV machine.
It's a shame that Resmed doesn't allow you to turn the pulses OFF on the cheaper Autoset machines. I think that a lot of people who have trouble with CPAP are experiencing the same problem that I did, but have no idea what's causing it because the pulses only occur when you're asleep and having an apnea. Resmed, of course, is quite happy to have you switch to the ASV, which costs them about the same to make, but sells for 8x as much money.
thanks reznik. I agree with your IMHO. that's why after a year and a half with the autoset I'm trying the asv. I'll take relief from wherever it comes. I can't say I understand precisely why (like whether it's the absence of pulses that make the difference) but so far my ahi is under 4 with the asv and more importantly I feel way less crappy. knowledge is power and I'm glad to learn about the pulses. if I go back to the autoset or get my wife on one, it'll be useful to know how you determined the pulses were causing you problems.
edit: I should add that I have csa's and periodic breathing so I need a machine that deals with csa somehow.
I spent about 3 weeks in total misery. I would often wake up shortly after I fell asleep, not knowing why, and then have to wait 20-30 minutes before I got back to sleep. Ultimately, I would get 8 hours of sleep, getting a low AHI, and waking up feeling worse than I did when I wasn't using a CPAP.
A few times, I got lucky. I become fully conscious while the machine was pulsing. The pulses are barely noticeable when you're sitting up and awake, but when you're laying down, in a quiet room and a comfortable bed, they are quite noticeable - if you're conscious.
For a few more weeks, I thought nothing of the pulses because I assumed that ResMed MUST have tested this thoroughly before releasing it to the public. Then I Googled it. The only study that I could find was a non-randomized study involving 7 experienced CPAP users from Spain, and it appeared that the pulses were sent at random (and not when the users were experiencing apneas).
There were no studies using new CPAP users. I also checked with my doctor and several area sleep labs, who advised me that the pulses are NOT sent during sleep studies. They use special sleep lab machines that are computer controlled and which don't send the pulses, because they use more direct methods to detect central apneas. As a result, sleep study doctors generally are not looking to see if the pulses are impacting brainwave patterns during sleep.
I also discovered a number of people posting here and on other boards about how the pulses were preventing them from getting to sleep, and how they switched to other machines to resolve their concerns.
I then called ResMed, who advised me that with their machines, the pulses are not used during the Ramp period. I turned on the 45 minute ramp, and suddenly, I was not being woken up as I fell asleep anymore. But, I was still feeling miserable in the morning despite getting 8 hours of sleep and having low AHI numbers.
Eventually, I switched to a ResMed machine that allows you to turn off the pulses. With the very same pressure settings, my AHI went up, but I slept great and woke up feeling better. I've since had my wife randomly change the setting (without telling me), and yet I still know which way she set it the next day, by how awful I feel.
Your ASV machine can also be set to act as a standard CPAP, if you set all the limits to the same number. You might want to try that and see how you feel. If you feel better despite the fact that you're getting exactly the same therapy as before, that's a good indication that the pulses were the problem.
RE: 18 mths of apap: need help optimizing settings to feel better - sheepless - 06-08-2018
good to know reznik. worth finding out or ruling out. and glad removing that variable worked out for you. thanks.
RE: 18 mths of apap: need help optimizing settings to feel better - sheepless - 06-08-2018
(06-08-2018, 08:38 AM)JesseLee Wrote: Sleepless,
It seems as though you may be getting benefit from your new ASV. We know it's going to take time for acclimation and improvement. Previously, you had posted zoomed sections of your flow chart, be so kind as to do that again? I'm interested to see what your periodic breathing looks like compared to your autoset results.
Also, your fragmented sleep is not helping. You know yourself better than anyone else and i think you know you are going to have to address the fragmentation. How you go about getting a solid nights sleep and changing the up and down all night is gonna be tough, but, I think you would benefit from resetting you sleep habits.
You've talked about it in previous posts and i know you dread it, but having a positive attitude will help and hang tough and determined. I would start to prepare yourself and be thinking seriously while you get adjusted to your ASV. Just sayin'.
JesseLee, thanks for your thoughts. fragmentation is problematic to say the least. I haven't given up on the idea that a variety of types of disordered breathing is at least part of the reason for waking up so often, despite finding no support for it anywhere. if awakenings are 'conditioned' by a lifetime of my body and mind reponding to apnea, I'm hopeful the asv leaving me feeling less crappy will help me slowly overcome that conditioned response. I guess you are referring to cognitive behavioral therapy, which I admit to being reluctant to invest time and money into. nevertheless, I can and will make an effort to improve my sleep hygiene. first order is to start whittling down nap time. plenty of other small things are fairly easily implemented. if push comes to shove in time, I'll open up to the cbt.
I've attached some more or less randomly selected charts from last night. if there's anything else you want to see, let me know.
thanks.
RE: 18 mths of apap: need help optimizing settings to feel better - sheepless - 06-08-2018
check out this respiratory rate bar chart. lower with asv (4 bars at extreme right). that's a good thing right?
tidal volume and minute vent might also be trending better but I don't understand these things well enough and maybe not enough time yet to be sure.