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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 - JesseLee - 06-16-2018
12 days in right? How long have you been sleeping bad? Time will reveal the outcome, of course, but 12 days is just getting started I think. I'm thinking a month is a fair shake at ASV just to see some significant impact, especially given your tough and complicated situation. I mean, I run and work hard on some weekends and a Friday through Monday long hard haul at work will pretty well shelf me for 2 days solid. Rationally looking at this and comparing my experience to yours puts you in a recovery situation still.
I'm optimistic for you because you are seeing improvement early and you've had a real long trend of poor sleep that's gotta get leveled out.
RE: 18 mths of apap: need help optimizing settings to feel better - sheepless - 06-16-2018
thanks Jesse. I think you are right on.
RE: 18 mths of apap: need help optimizing settings to feel better - sheepless - 07-08-2018
checking in after 34 nights with asv.
I attached the statistics screen so you can see the range of settings tried and some of the overview page so you can see basics about all 34 nights.
I'm never sure what closer views to provide; hoping these are representative of what I think was happening last night at the latest settings: less-obvious periodic breathing (although there are plenty of suggestions of it throughout the night) and I think more-obvious flow limitations.
not clear to me how all this works exactly. seems like treating mixed apnea means threading the needle between centrals and obstructives with some adjustments to some extent working for one and against the other. working from this theory I dropped min pressure support to 2 to help even out periodic breathing. when that seemed to lead to more hypopnea I increased max pressure support to 16 to drive through obstructives. not sure if the theory is correct or if my adjustments in response to the theory are appropriate. please correct me if wrong.
most (not all) of the unclassified apneas I've been getting have occured above 20cm.
the machine seems to limit max ipap to 25cm even though epap + ps can be as high as 33cm. not sure what to make of that.
also not clear if it matters how one reaches ipap, whether by varying epap or ps or a combination, and what the expected effects of each might be. Krakow said titration for uars (flow limitations) requires a back and forth between asv and asv auto in order to finesse the pressure support settings but I don't have any idea how to go about that.
I think I see improvement in my latest charts, certainly over apap, but I also still see too much ragged breathing (none of those nice smooth waveforms we see in the illustrations people draw on a youtube video showing how flow rate evens out in response to the pressure support curves they draw underneath) and those nasty old flow limitations.
the reason I'm concerned about the ragged breathing and flow limitations is because I'm starting to revert to that 'hungover' feeling. funny, 3 weeks ago I felt less hungover and but still very tired. now I'm getting more of that hungover feeling and maybe ever so slightly feeling a hair less tired (but still not anywhere near energetic). not sure about this but I think I can say I feel less body-tired but just as brain-tired as ever (trouble concentrating which in turn makes my eyes droop and I start yearning for a nap).
I think I mentioned it before, but my wife has observed for many years that whatever remedies I've tried for snoring and apnea might seem to work for a short time but my body and brain always seem to find a way to circumvent them to revert to bad behavior. not much science behind that and cause/effect pretty difficult to establish, but because everything tried has failed, I would say it's a valid observation of an apparent pattern (my old logic professor would probably redline that statement!). I don't guess there's any way to figure that out but the return of the hungover feeling is consistent with it.
regarding the hungover feeling, I wonder if I need to find an oximeter to figure out if desats are at work here. latest 2016 at home sleep study had SAO2 dropping to 75%. could flow limitations cause O2 to drop below an acceptable level?
the resmed asvauto titration protocol is pretty simple but leaves much unsaid. nothing about varying min epap or pressure support for example. I recently read someone on this forum say that there must be an assumption centrals and periodic breathing will resolve automatically with no adjustment to machine settings necessary. what do you do if not? (I can't tell a ca from an oa among my unclassified apneas but I'm guessing the machine is nipping the ca's but it's the PB I"m interested in now.)
thanks for any observations and suggestions you-all might have.
more charts to follow (sorry, it's hard to know just what to show you)
RE: 18 mths of apap: need help optimizing settings to feel better - sheepless - 07-08-2018
more from last night
RE: 18 mths of apap: need help optimizing settings to feel better - tedvpap - 07-08-2018
Data looks good - AHI is therapeutic.
If you are worried about O2, then you should measure it. Then you will know if there is an issue or not.
RE: 18 mths of apap: need help optimizing settings to feel better - Sleeprider - 07-08-2018
There is no right or wrong answer, but what makes you sleep the best. The numbers change, but all within a range considered acceptable. You have the most days at 7.0-27 PS 3.0-12.0 with very good results. Summary stats don't really tell us much and you have made changes within a pretty small margin, and compared to CPAP your event rate has dropped from 4.0 to between 1-2 events per hour. Your subjective statements have been positive on comfort and how you feel.
You were never a clear-cut candidate for ASV, but it seems to be working well for you. What do you think?
RE: 18 mths of apap: need help optimizing settings to feel better - sheepless - 07-08-2018
nothing seems to be jumping out at you-all so I guess the answer to what do I think, besides pages and pages of reporting on just that in this thread :-) , is time will tell. trying to stay optimistic, particularly because with asv I guess I've gone as far as pap will take me. I've been pretty non functional for many years. apap helped a lot but not enough. just a month with asv and still playing around with settings. if I can get back to the point where I can get up in the morning and put in a decent age-appropriate days work I'll declare victory. still feels like that's pretty far off yet. but who knows, maybe I'll wake up tomorrow just raring to go.
there was a noticeable difference between apap and asv but I don't think I had much if any trouble adapting to asv. breathing is easier and it feels much more natural. I napped the other day with apap again and I can say without equivocation that I like asv much better.
biggest issue is still fragmentation and what's causing it. maybe time will tell about that too.
thanks tedvpap and sleeprider for taking a look and for the encouragement.
RE: 18 mths of apap: need help optimizing settings to feel better - Sleeprider - 07-09-2018
We tried dealing with the fragmentation of your sleep and therapy earlier, so far to no avail. I still think this is your biggest challenge and perhaps one that merits professional help. In spite of that, your subjective experience on ASV seems better, and it has smoothed out some uneven respirator patterns and eliminated the centrals. I don't think that was a waste of your time or money. You're pretty good at figuring out your own needs, making changes, analyzing results and applying that knowledge to therapy. About all we can do is encourage you to continue on that path.
RE: 18 mths of apap: need help optimizing settings to feel better - sheepless - 07-11-2018
Q1. what is the resmed aircurve 10 asv max ipap? is it the same for asv and asv auto?
max ipap reported in SH for asv auto is 25cm. epap and pressure support can combine to 33cm. so which is it?
I've been reducing unclassified apnea by increasing pressure support. last night at epap 7 - 16, ps 5 - 15, my three residual hypopnea occured at just under 25cm. the night before with min ps 2.6 and all else the same, half my 19 residual apnea and hypopnea occured between 24cm and 24.8cm.
Q2. what do we do about events bumping up against 25cm?
Q3. whether or not it's possible to resolve the last few high pressure events, what adjustments would help overcome what looks to me like way too many remaining flow limitations? raise min ps? or?
I'm thinking about raising min ps and reducing min epap because higher min ps alone seems to be increasing leaks (which intuitively seems a little odd).
Q4. SH rarely reports min, max and 95% flow limitations with my asv. eyeballing the flow limitation graph makes me suspect these 0 values are not correct. does the machine report these? is SH calculating them properly (looks are deceiving and 0 value is actually correct) or is this a SH bug or machine issue or what?
RE: 18 mths of apap: need help optimizing settings to feel better - sheepless - 07-21-2018
still hoping for replies to questions in my previous post (#89 above) and in another thread called "apap resolving central events?".
meanwhile, here's another question.
pressure (support) is supposed to increase in response flow limitations. in addition, I would expect setting min pressures to limit how low pressure can go. so what's happening when ipap drops to near epap and pressure support drops to less than 1cm around flow limitations, even though min epap is set to 6 and min ps is set to 6 for min ipap 12 (or 7 & 5 for 12)?