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+--- Thread: New to ASV, new to SleepyHead (/Thread-New-to-ASV-new-to-SleepyHead)
RE: New to ASV, new to SleepyHead - DeepBreathing - 04-23-2016
AHI = 0 is not a realistic target. Even fully healthy people who do not have sleep apnea will have one or two events a night. If you consistently get a zero on the machine it might be an indication the machine is broken!
RE: New to ASV, new to SleepyHead - vsheline - 04-23-2016
(04-23-2016, 01:45 PM)tmoody Wrote:(04-23-2016, 11:54 AM)Sleeprider Wrote:(04-23-2016, 11:38 AM)tmoody Wrote: Note: Even though PSmin=2 and I can't set it higher, looking at the display on the PRS1 I notice it gives my average PS for the past week and month, both of which are 3.8. So, if I'm understanding this correctly, the gap between PSmin and the average isn't so great that it should cause a problem.
I think PSmin can be set to a higher value on that machine, at least I could with the auto BiPAP. I thought you started with a higher PSmin originally?
Originally, as of the titration study, PSmin was set to 0. I've gone into the clinician's settings and raised it, first to 1, then to 2. And that's all there is in that setting.
Hi tmoody,
The Provider Manual for your machine says PS Min can be set from zero to (Max Pres - Max EPAP). So, the only reason you can't raise Min PS above 2 is because someone set your Max EPAP unreasonably high.
For example, if you lower Max EPAP to 15, your Min PS could be set much higher, if desired.
However, it still looks like your dominant problems are obstructive events. So I again suggest walking Min EPAP higher by 1 cmH2O every week or two.
In parallel, I suggest finding a way to guarantee you will never roll onto your back while asleep.
If you don't successfully overcome the positional sleep apnea, you might walk Min EPAP all the way up to 15 and still occasionally have dangerously-long obstructive apneas. Good luck in finding something which works for you, whether a couple tennis balls in a sock sewn on a teeshirt, or a light but bulky knapsack, or body pillow(s) under the bottom sheet, or whatever. Maybe also try a soft cervical collar as suggested by JSL747.
Take care,
--- Vaughn
RE: New to ASV, new to SleepyHead - tmoody - 04-24-2016
(04-23-2016, 07:30 PM)vsheline Wrote: Hi tmoody,
The Provider Manual for your machine says PS Min can be set from zero to (Max Pres - Max EPAP). So, the only reason you can't raise Min PS above 2 is because someone set your Max EPAP unreasonably high.
For example, if you lower Max EPAP to 15, your Min PS could be set much higher, if desired.
However, it still looks like your dominant problems are obstructive events. So I again suggest walking Min EPAP higher by 1 cmH2O every week or two.
In parallel, I suggest finding a way to guarantee you will never roll onto your back while asleep.
If you don't successfully overcome the positional sleep apnea, you might walk Min EPAP all the way up to 15 and still occasionally have dangerously-long obstructive apneas. Good luck in finding something which works for you, whether a couple tennis balls in a sock sewn on a teeshirt, or a light but bulky knapsack, or body pillow(s) under the bottom sheet, or whatever. Maybe also try a soft cervical collar as suggested by JSL747.
Take care,
--- Vaughn
Thank you.
In lieu of the tennis ball trick or cervical collar (I've tried similar things) I've opted to set the apnea alarm on my machine to sound if I don't initiate a breath for at least 40 seconds. I've combed through my data pretty carefully now and there are only the two long OAs since November. I think it's a rare enough occurrence that the alarm won't become a nuisance.
Re settings: yes EPAP max is way higher than needs to be. But I'm going to leave that alone for now and instead bump EPAP min from 8.5 to 9 for a week and see how that goes, keeping rise time where it is at 1. If I still need to fiddle with PSmin, I'll drop EPAP max and do so at a later date. For now, I'll keep PSmin at 2.
RE: New to ASV, new to SleepyHead - tmoody - 04-25-2016
Last night I bumped EPAPmin from 8.5 to 9, keeping PSmin at 2. AHI was 2.7, which isn't bad at all. No CAs or OAs. A bit more periodic breathing than usual lately.
I thought I'd zoom in on a cluster of hypos, to see if anyone sees anything interesting going on.
![[Image: qGF1975m.png]](http://i.imgur.com/qGF1975m.png)
RE: New to ASV, new to SleepyHead - tmoody - 04-26-2016
Last night was my second night with EPAPmin at 9, PSmin still 2. As you can see, my AHI was higher, and two centrals of fairly short duration (15 and 14 seconds). Hypos were up from the previous night.
What catches my attention, however, is a period of about 15 minutes before about 5:26, which is when I actually woke up. As you can see from the zoomed screenshot, my pressures were pretty much maxed out. There were a few hypos during this period, not a lot. The pressure may even have been what woke me up. At least, I recall feeling that the thing was really blowing hard when I woke up. In fact, before I finally hit the button, I lay there for a couple of minutes and tried, without success, to "calm the machine down" by my own breathing. Then I got up and went to the bathroom, went back to bed and started the machine again. I don't know if I actually got any more sleep; I know SH shows a lot of TBs after I restarted the machine, and I do recall lying there being slightly annoyed by this.
But my main question is, what was going on during the zoomed period? Was the machine sensing imminent events and just maxing out preventing them?
![[Image: FirWidtm.png]](http://i.imgur.com/FirWidtm.png)
RE: New to ASV, new to SleepyHead - tmoody - 04-27-2016
Another night on new EPAPmin setting, which so far seems to result in more hypos, not fewer. And once again, a single central snuck through. Also, my periodic breathing seems to be higher on this setting, though not high in absolute terms. But there was one long interval of periodic breathing, lasting five minutes, which is very unusual. That interval follow directly upon a cluster of eight hypos, as you can see in the linked zoom (I'm using a OneDrive link this time; no thumbnail).
What seems odd to me is that through all this, my pressure response is dead flat. The same thing happens around the single cental, which occurs in the middle of a small group of three hypos. The pressure curve is flat.
zoom
RE: New to ASV, new to SleepyHead - palerider - 04-27-2016
well, I said before, I've always heard that epap is for obstructives (and oxygenation), ps or essentially, ipap, is for hypos.
RE: New to ASV, new to SleepyHead - tmoody - 04-27-2016
(04-27-2016, 02:12 PM)palerider Wrote: well, I said before, I've always heard that epap is for obstructives (and oxygenation), ps or essentially, ipap, is for hypos.
There's been some disagreement in this thread about that, but as I look at the SH graphs, it's clear that the machine isn't responding to hypos by increasing EPAP. And I've seen at least one source that suggests that when EPAP goes too high the result can be centrals.
So my inclination for my next adjustment is: Drop EPAPmin back to 8, since raising it hasn't appeared to do anything. Decrease EPAPmax from 23 to 20, creating the possibility to increase PSmin from 2 to 3. And see what happens.
RE: New to ASV, new to SleepyHead - palerider - 04-27-2016
yes, there is, and I disagree with the disagreement, and stand by what I said before
for what it's worth, I run an ps of 5 on my machine.... not that it's an prs1autosv... but, *shrug*
RE: New to ASV, new to SleepyHead - DeepBreathing - 04-27-2016
Give it a go and see what happens, but give it a week to take effect. We might all learn something, including me.
By the way I found a very interesting paper which discusses the responses of the different ASV machine types. Well worth reading. I have posted links in a couple of threads (possibly including this one) but I'm working with a tablet at the moment and it's too difficult to hunt it down.