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+--- Thread: Just getting into this . . . (/Thread-Just-getting-into-this)
Just getting into this . . . - TSVanwinkle - 05-03-2019
Hello to his forum.
Though I am a “newbie” here, I have been a CPAP user since somewhere in the early nineties. I am also a mild narcoleptic and have been using Provigil for over 20 years. I have been using a Resmed S9 for over five years, until the humidifier failed. I had a new sleep study done in the last month that revealed I have “Moderately severe” complex sleep apnea. During that first study, both CPAP and BIPAP titration was tried, but un-successful and could not get the AHI lower than 10.7. The following week, I had a second titration study using ASV. That titration session was deemed successful and my insurance approved the doctor’s findings and recommendation for the Resmed Aircurve 10 ASV. I was advised by my DME and pulmonologist that there is a “acclimation” curve with an ASV and to be patient. My first night, April 18th was a bit brutal and I had an AHI of 5.7. I have now got it down to below 1 most nights and actually find it comforting when it takes over and “breathes” for me. I have had good success getting used to and adjusting my Respironics DreamWare (hybrid) mask and have been able to minimize air-leaks; I also purchased a side sleeper topper for my bed and also obtained a CPAP pillow – per recommendations from this forum. I’ve made subtle adjustments for water temp and have eliminated the ramp.
Enter Apnea Board website discovery. What a great find and wealth of information. One of the important tasks with any new challenge is learning what one doesn’t know—and I have learned I don’t know plenty! I have downloaded “Oscar” and loading my sessions each morning. I have delayed making my first post until learning enough about what I don’t know to ask some intelligent questions. I have attached two recent nights worth of screen shots along with the zoomed in view of some of the events.
Here are my questions:
- I am most concerned about understanding and trying to best mitigate the Central Apneas as the OAs are pretty well under control now. Between Oscar or perhaps with the Aircurve ASV, there isn’t a specific identifier for CAI. I can tell you that I am very much aware that I sometimes stop breathing, even when awake, and when the machine takes over during sleep, it arouses me enough to know its happening.
- How do I identify the central episodes? Would they be an hyopopnia where no mask issue or Flow limit or other OA events are present?
- Is there a marker or way to see when I’m asleep vs being partially awake or aroused?
That’s enough for starters. I look forward to reading your observations.
- Tim
RE: Just getting into this . . . - ajack - 05-04-2019
There are no markers for CA because the ASV will treat every CA and not flag. It is whether there is enough PS to effectively treat it. The PS15 you have would handle a CA. It would be better to have less charts so that they can be read better. Minute vent, tidal volume and pressure are useful when your AHI is low. Overall, you look ok, there are some dips in the MV and TV that may be tweaked.. I would lift min epap to 7 and min ps to 3. then review.
RE: Just getting into this . . . - jaswilliams - 05-04-2019
Welcome to ApneaBoard
With the ASV machine it treats all CA’s will it’s boost of pressure. The few hypopnoea are likely to be central events that the pressure boost could not get you to take a full breath so it was flagged as hypopnoeas your numbers look great and your machine is doing a great job treating you. We consider any AHI of 2 or less as good your number is well below 1 with only one or two events per night and nothing to worry about. And those events occurred during RAMP I would turn off the RAMP and get into your sleep immediately. If you are still awake and the machine wants to breath for you, a strong blow back at it resets the algorithm and it will take 3 minutes until it tries again
RE: Just getting into this . . . - TSVanwinkle - 05-04-2019
Thanks for your reply. I'll change the settings to what you recommend tonight.
With regards,
Tim
RE: Just getting into this . . . - TSVanwinkle - 05-04-2019
Well, ok! I adjusted settings last evening and experienced my lowest AHI ever. ZERO. Thanks again for your sage advice.
I have attached last night's screenshot.
With regards,
-Tim
RE: Just getting into this . . . - ajack - 05-04-2019
Well that lifted your median tidal volume and lowered your breath rate. You can try and tweak some more. I would increase min epap to 8 and min ps to 4 and review.
There are some areas that are needing high pressure. You may have just been awake and the machine seeing the normal irregular changes and thinking you have apnea, They may be positional, like chin tucking and would benefit by adjusting your pillow to support your neck more and let your head tilt back. See how it goes. Some use a $10 cervical collar or snore aid.
RE: Just getting into this . . . - TSVanwinkle - 05-04-2019
re the positional stuff, I am using a cpap pillow and have angled it in a way that would be the equivalent of tilting the head back if I were laying on my back. I use tennis balls tied together on my back to ensure that I don't roll over and stay there. I also started using nasal strips to help keep my passages as open as possible. I do have a mildly deviated septum. re snoring, nothing scored and I don't have problems keeping my mouth closed while asleep. Last night, as you could see on the graph, I took a 5 min break around 2:30a because it was getting a little too crazy and I was feeling like I was working too hard to breathe and stay ahead of the machine. Overall, when I scan back through the nights, it looks like I average appx 4 periods a night lasting from 10 to 40 minutes where I'm breathing smoothly and the ASV is coasting along at an even 11 cm, then things get erratic and the ASV gets pretty busy. I can't quite say that I am waking up feeling really refreshed yet, because I am very much aware when the ASV is keeping me breathing. I am hoping as time goes on that I will be able to lengthen out the calm periods-but-from what I've read about central apneas and the "disconnect" between brain and lungs, I'm not sure if there is a way to improve that. Per your suggestion, I'll bump up the EPAP min and PS min again and let you know how that goes. Thank you so much for your observations and input!
With regards,
- Tim
RE: Just getting into this . . . - ajack - 05-04-2019
You may have missed the suggestion from Jas about blowing back hard to reset the machine, if it starts to run away, while you are awake. You brain will get use to breathing steady to not upset the machine while awake.
There is a big adjustment curve on the ASV. It is going to take a while to get use to. It's measured in weeks and months. In 3 months time when you are fully adjusted, you will look back on this and realise how hard it was. In 12 months a lot of the damage to the brain has been repaired.
https://aasm.org/brain-damage-caused-by-severe-sleep-apnea-is-reversible/
The thing I'm trying to do is get a solid base setting that the machine can then work from. The idea is to support the breathing, so there are minimal dips in the minute vent and tidal volume. You could look up your height and health factors for what a suggested minute vent and tidal volume would be for you. If needed the min PS can be increased up to 6cm on your machine, to help achieve this.
This is for an AVAPS machine, but the numbers are the same
![[Image: ciLBxT8.jpg?1]](https://i.imgur.com/ciLBxT8.jpg?1)
RE: Just getting into this . . . - TSVanwinkle - 05-04-2019
Hi.
Reading through your most recent post; re blowing back hard, I tried that, but I gather one must have to blow really hard. I attempted that at least twice. It did back off, but only for a few seconds. I'll certainly try again when the need arises.
On to the chart: I am 73" tall and my current weight is 173, right at the weight the chart defined. If I understand correctly, increasing the mim EPAP and PS is the tweak that will raise the median tidal volume and the optimum median target for my weight would be 600 ML. Have I got that right? I should also mention that I am 72, going on 37. I keep active.
That was a very interesting and heartening article about brain damage being reversible. My wife will be pleased to hear that. She believes my brain needs all the help it can get . . . .
So, I'll set epap min to 8 and ps to 4 for tonight's session and we will see how that goes.
With regards,
- Tim
RE: Just getting into this . . . - ajack - 05-05-2019
It's probably too late now, but instead now, I would leave the min epap at 7 and take the min PS up to 5. To get a bit more tidal volume and review.
You could put it in cpap mode at 5cm and sit in a chair and watch tv for an hour. That will give your normal tidal ventilation. minute ventilation and breath rate. Your 95% is 800 and max is 1100, so they aren't dried up bits of leather yet.