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+--- Thread: How do you tweak? (/Thread-How-do-you-tweak)
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How do you tweak? - tmoody - 04-27-2016
I have a general methodological question. As I review changes in settings over the month or so that I've been on ASV, I don't really see any trend of improvement in AHI or hypops, which is what most of my AHI is.
My original EPAPmin, from the titration study, was 8. The PSmin was 0. I increased PSmin to 1 for a while, then to 2. No clearly observable change in anything. Then I increased EPAPmin from 8 to 8.5, then to 9. Still no change, except for possibly a few centrals sneaking in.
I'm going to wait a full week before trying anything else, but in the meantime I'm considering raising PSmin again, but I'm wondering if, when I do so, I should drop EPAPmin back to 8.5 or 8 again, or just leave it as is at 9.
Logically, my inclination is to roll back the EPAPmin changes, since the only discernible result has been a few more centrals and more periodic breathing. Then fiddle with PSmin for a few weeks and see what happens. Then try combining changes.
My AHI is usually <5, but often not by much. I've been keeping a sleep log and I notice I feel best when AHI is <3, so that's my target.
How do others do these things? Let the changes accumulate or try one thing, roll it back if unsuccessful then try something else?
RE: How do you tweak? - PoolQ - 04-27-2016
As one who has done LOTS of tweaking I can tell you how I did it as I am pretty happy with the outcome.
Some tweaks I will know right away if it was bad or not and then I do not give it days, weeks or even one night. I have zero interest in learning to tolerate something that I just made worse. But that's me.
I kept a log-what changed, what my AHI did or did not do, did I sleep better? Wake up less? feel better in the morning?
I changed only one thing at a time and if it turned out "bad" I changed it the other direction until that direction was also bad and then back it back up into the good.
I found that sometimes when I got a better setting on one thing, that I then had to go back and readjust earlier settings to find the "new" better for them. These IMHO tend to be interconnected, re-tweak everything
I suggest being careful with obsession for low AHI, I suggest that you want reasonable AHI and the best quality of sleep you can get. Just because you have an AHI of 5 does not mean that this is disturbing your sleep, it may be something else that is disturbing you and that many not even effect your AHI at all.
I suggest getting your AHI near or below 5 and then if your still not sleeping well, start to look for other settings that deal more with patient comfort and tolerance. Then once you are sleeping the best you can and if you still want to drive the AHI down, then go for it.
The goal for CPAP is not to just have low AHI, it is to minimize or negate any harmful effects that sleep apnea may be having on you and help you get a good nights sleep while doing that. For many the AHI is all that is required, for others, there is more involved that just one number.
RE: How do you tweak? - tmoody - 04-27-2016
Thank you. I have been logging for a little while now. As I mentioned above, I seem to feel best when AHI is below 3. But my small tweaks, so far, haven't shown any clear results. My AHI is almost always below 5, but often just barely so, like last night's 4.6. I have another thread on the details, but I started this one just to get a sense of how people go about this.
If I've learned nothing else, I've learned how wildly variable sleep apnea can be from one night to the next. When I was on APAP for four months, my AHI swung between a low of 6 to a high somewhere north of 30.
RE: How do you tweak? - justMongo - 04-27-2016
You're sort of walking the thin end of the wedge with mixed apnea.
A person with with obstructive apnea may get those less than 1 AHI results.
With mixed, you may trade off one type of apnea for another.
I'm no expert on the ASV, i'll just give an opinion that you are probably in the "good enough" zone.
RE: How do you tweak? - tmoody - 04-27-2016
(04-27-2016, 03:05 PM)justMongo Wrote: You're sort of walking the thin end of the wedge with mixed apnea.
A person with with obstructive apnea may get those less than 1 AHI results.
With mixed, you may trade off one type of apnea for another.
I'm no expert on the ASV, i'll just give an opinion that you are probably in the "good enough" zone.
I've wondered about that too. I have the idea that I ought to be able to reduce hypos without increasing anything else, but that may not be possible. And if it's not, I'll take hypos over centrals at the same AHI level.
But I guess it remains to be seen.
RE: How do you tweak? - robysue - 04-27-2016
I'm going to throw this out as an idea for you to consider as well: You may also want to see if the higher AHI's are correlated with different sleep behavior or different non-sleep related things going on in your life.
In other words, if the higher AHIs correlate with nights that it took you a long time to get to sleep or a night where you have frequent, long wakes, some of the elevated AHI may be explained by misscored "sleep-wake-junk" breathing, and the real problem is that you're just feeling the effects of the plain old insomnia kicking in. Or if the higher AHIs correlate with severe seasonal allergy problems or serious nasal congestion issues, then perhaps the thing you need to tweak is how you deal with the nasal congestion instead of the settings on your machine.
RE: How do you tweak? - PoolQ - 04-27-2016
I was not sleeping well, with AHI between 2 and 10ish and my Doctor kept telling me to not worry about my centrals, turns out he was right. The problem was in another area, Dyssynchrony, most searches will bring up ventilator because this is most commonly an issue with them, but many of the settings are available with CPAP's at least my BiLevel and perhaps your ASV. I don't know what settings you have available, but I would guess that if my machine has these then yours should also have them. I found them to be quite important and very disturbing for me until I tweaked them. Timin, Timax, trigger and cycle sensitivity are the VPAP settings. Might find it interesting to check them out
RE: How do you tweak? - PaytonA - 04-27-2016
From looking at the clinician's manual for the PR System 1 BPAP AutoSV, I do not find any of the settings for Ti and trigger or cycle. In fact the manual claims that these functions are adjusted dynamically by the machine operating algorithm.
Best Regards,
PaytonA
RE: How do you tweak? - palerider - 04-27-2016
(04-27-2016, 06:17 PM)PaytonA Wrote: From looking at the clinician's manual for the PR System 1 BPAP AutoSV, I do not find any of the settings for Ti and trigger or cycle. In fact the manual claims that these functions are adjusted dynamically by the machine operating algorithm.
you are, as usual, completely right.
RE: How do you tweak? - DeepBreathing - 04-27-2016
(04-27-2016, 03:05 PM)justMongo Wrote: You're sort of walking the thin end of the wedge with mixed apnea.
A person with with obstructive apnea may get those less than 1 AHI results.
With mixed, you may trade off one type of apnea for another.
I'm no expert on the ASV, i'll just give an opinion that you are probably in the "good enough" zone.
From my own experience it is possible to get low AHI with mixed apnea. Mine is consistently below 2, usually below 1. Provided the PS is high enough the machine will eliminate central apneas, just leaving obstructive events to be dealt with.
I think tmoody does have significant opportunity for improvement. It's a matter of tweaking the machine and also eliminating any non-machine issues, as RobySue said.