18 mths of apap: need help optimizing settings to feel better [ASV]

[jaswilliams]

ajack (and everyone else that's interested), here are the charts with the substitutions you mentioned for the same flow rate segment I posted earlier.

Thanks the asv is not varying it’s pressure support /air volume here so something is going on that the asv is not able to treat. As this is not central in nature and your breathing but in an uneven way if that makes any kind of sense

[sheepless]

"Thanks the asv is not varying it’s pressure support /air volume here so something is going on that the asv is not able to treat. As this is not central in nature and your breathing but in an uneven way if that makes any kind of sense" - jaswilliams

well, it's not entirely clear to me I'm afraid but I agree something is going on cpap won't treat. correct me if I'm wrong: I read your comment as supportive of my contention that the source of this flow rate pattern is periodic leg movement. more generally and perhaps more accurately, supportive of the idea that the source is something other than a cpap treatable source. I still need the independent confirmation to conclude plm.

[sheepless]

[attachment=13125][attachment=13124][attachment=13123][attachment=13122]

'rough' night last night.  0.8 ahi of hypopnea compared to 70+ day avg ahi of 0.21.  thought I'd share several flow rate charts from last night depicting: quiet breathing, short nap without a cervical collar, supine w lip leaks and snoring, and periodic limb movement.  I thought these interesting / instructive; maybe someone else will too.

[ajack]

Are you using the same pressure you were?I know you have air swallow issues.
From your lost lot of charts, I'd suggest these as your goal
min epap 10
max eppa 15
min ps 3
max ps 15

[sheepless]

thanks ajack. I appreciate you taking the time to comment.

I mentioned in a recent post above that I'm happy with my now 74 day ahi of 0.22, even with last night's 0.8, but I apologize for not being clear about that in my last post. also, I don't have aerophagia at current settings.

I put up the graphs because I thought they might help others' see the value of the cervical collar and to learn to recognize mouth leaks, unflagged flow limitations, periodic leg movement and the effect of the supine position (on me). last night at 0.8 ahi was an outlier but if it continues to trend upwards, I will adjust. good for now though.

thanks again for your attention.

[ajack]

I'll try one last time. ASV works differently to CPAP, where everything is about AHI. It's easy to get AHI very low and often 0.0 on an ASV. It also doesn't record any CA and how they are treated in the AHI.
After that, it's mask pressure, tidal volume and minute vent, that are the important charts. Enough epap, with enough PS to vent the lungs, during obstructive and CA.
You raise the min epep to about the 95% for the last 7 or 30 days. or till the AHI is very low. You then use max PS to be able to raise pressure when the machine needs it. It really is a clever algorithm and will use what it needs. Those are the numbers I would use. I would also use resScan for accurate data.

[sheepless]

well, you have my interest. what are we trying to accomplish? what would you like to see? I have SH set up to display flow rate, mask pressure, respiration rate, tidal volume and minute vent. I can give you the same charts as above within a few seconds of those oscar shots. or whatever you suggest...

it's my understanding the resmed asv algorithm handles ca and csr. no ca in ahi because no ca. it doesn't record oa and how they are treated in the ahi either. but if it isn't handling ca, it handles them better than any other machine available afaik, and again afaik, there's nothing to adjust for ca and csr anyway.

otoh, I might be able to do better with flow limitations.

with ahi low, my problem now is fragmentation, which I attribute to plm but it's not 100% certain. sessions have been getting slowly but progressively longer with less time between them since I moved to asv. much better now but still less than ideal. if you can figure out how to use the machine to reduce fragmentation I'd be forever in your debt.

kinda hate to mess with the best results I've ever had but I'm willing to experiment. what's next?

[sheepless]

fyi, here are all the settings I've tried with the asv.  you name it, chances are I've tried it or something close.  still, I have plenty to learn and I can't say I'm feeling 100% yet so I'm open to suggestions.

[ajack]

obstructive are tagged UA, H
CA aren't tagged, it will inflate the lung enough during a CA, "IF" there is enough PS to do it. This is where the tidal volume chart comes in, to confirm. You can mess around increasing max PS as you want to, or just let the machine work it out and set it at minepap+maxPS =25

The chart layout, unpin the events, You want to look at
flow rate
minute vent
tidal volume
mask pressure
breath rate
pressure
right click on the name of the chart and change the Y-axis to display in zoomed in height, it's hard to see anything how it is.
You can also cursor, click and drag the chart larger, to display just one in a page if you need to.

On the statistics page, the top part is what you want to look at. what was the average epap over 30 days? set min-epap at that for a start, that is similar to your median on the daily. Then see how it looks for the 95% epap later, you need to guess your average 95%, or just increase the min epap till the obstructives are resolved. You will see if the machine wants to raise min epap.
max epap 15
min PS 3-4
max PS, whatever min-epap+maxps=25 comes out to.
Put up with the resulting gas and get a good idea of what the machine thinks your pressures should be.

[Sleeprider]

I was looking at the charts you posted in #143 and thinking how well you seem to have this sussed out. You are dealing with unconventional issues like obstruction and PLM, using a C-collar and ASV. The machine seems to be responding appropriately, and for the most part, you seem to be comfortable and gradually achieving less fragmented sleep. I'm not sure I would be supportive of big changes at this point. You seem to have found what works.