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2nd Night with Aircurve 10 ASV
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richb Offline

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Machine: Resmed AirCurve 10 ASV
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage FX
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CPAP Pressure: Epap 6 Ipap 8 Auto ASV
CPAP Software: ResScan SleepyHead

Other Comments: Idiopathic Central Apnea

Sex: Male
Location: Vermont

Post: #11
RE: 2nd Night with Aircurve 10 ASV
Hi Asjb,

I would like to see a roughly 10 minute clip at 4:14 when you had those "events. It would be easier to see the nature of the events if we could see some more detail. Your machine is "working hard" which is what it does when you stop (Central Apnea) or slow down significantly (Periodic Breathing). The clusters of pressure spikes would have been coded as CA or H with a non ASV machine.

Rich
03-26-2016 08:15 PM
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marose1 Offline

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Machine: Resmed Aircurve 10 ASV
Mask Type: Full face mask
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CPAP Pressure: EPAP 10 to 10 PS 0 to 15
CPAP Software: ResScan SleepyHead

Other Comments: Former PR BiPaP @ EPAP 15 IPAP 20

Sex: Male
Location: Las Vegas

Post: #12
RE: 2nd Night with Aircurve 10 ASV
Rich - This is my first effort at linking an image on imgur so we'll see how it goes. 10 minute clip at 4:14

[img][Image: XZhsGNwt.png][/img]
03-26-2016 09:52 PM
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vsheline Offline

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Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #13
RE: 2nd Night with Aircurve 10 ASV
(03-26-2016 09:52 PM)marose1 Wrote:  Rich - This is my first effort at linking an image on imgur so we'll see how it goes. 10 minute clip at 4:14

Hi marose1,

Can you show the same chart, except adjust the vertical scale on the Flow waveform so full scale is -75 to +75?

We don't need to see the peaks of the Flow waveform. More important to be able to see the fine detail, with our normal in/out breathing pattern filling about half the range of the vertical scale.

These apneas and hypopneas are predominantly obstructive.

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
03-26-2016 11:28 PM
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Asjb Offline

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Posts: 173
Joined: Oct 2014

Machine: Aircurve 10 CS Pacewave ASV. Before 11/2015 Airsense 10 Auto
Mask Type: Full face mask
Mask Make & Model: FP Simplus & Remzzzs liner
Humidifier: Integral
CPAP Pressure: Current info in this post
CPAP Software: ResScan SleepyHead

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Sex: Undisclosed
Location: France

Post: #14
RE: 2nd Night with Aircurve 10 ASV
(03-26-2016 08:15 PM)richb Wrote:  Hi Asjb,

I would like to see a roughly 10 minute clip at 4:14 when you had those "events. It would be easier to see the nature of the events if we could see some more detail. Your machine is "working hard" which is what it does when you stop (Central Apnea) or slow down significantly (Periodic Breathing). The clusters of pressure spikes would have been coded as CA or H with a non ASV machine.

Rich

Hello Rich. I'm confused... You didn't mean me, asjb, did you?

As far as I know I was fine at 04:14 hrs!

best wishes

................................................................................​.............
My current pressures: Auto-ASV. EPAP 11-14. PS 3-10
03-27-2016 04:01 AM
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richb Offline

Advisory Members

Posts: 532
Joined: Jun 2015

Machine: Resmed AirCurve 10 ASV
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage FX
Humidifier: Built in
CPAP Pressure: Epap 6 Ipap 8 Auto ASV
CPAP Software: ResScan SleepyHead

Other Comments: Idiopathic Central Apnea

Sex: Male
Location: Vermont

Post: #15
RE: 2nd Night with Aircurve 10 ASV
(03-27-2016 04:01 AM)Asjb Wrote:  
(03-26-2016 08:15 PM)richb Wrote:  Hi Asjb,

I would like to see a roughly 10 minute clip at 4:14 when you had those "events. It would be easier to see the nature of the events if we could see some more detail. Your machine is "working hard" which is what it does when you stop (Central Apnea) or slow down significantly (Periodic Breathing). The clusters of pressure spikes would have been coded as CA or H with a non ASV machine.

Rich

Hello Rich. I'm confused... You didn't mean me, asjb, did you?

As far as I know I was fine at 04:14 hrs!

best wishes

................................................................................​.............
My current pressures: Auto-ASV. EPAP 11-14. PS 3-10
Sorry. I meant marose1.
03-27-2016 06:00 AM
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Asjb Offline

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Machine: Aircurve 10 CS Pacewave ASV. Before 11/2015 Airsense 10 Auto
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Mask Make & Model: FP Simplus & Remzzzs liner
Humidifier: Integral
CPAP Pressure: Current info in this post
CPAP Software: ResScan SleepyHead

Other Comments:

Sex: Undisclosed
Location: France

Post: #16
RE: 2nd Night with Aircurve 10 ASV
Quote DeepBreathing: I don't think your machine reports periodic breathing. I believe that Resmed's position is that the Pacewave algorithm completely eliminates central aneas and PB, hence there is no need to report it.

Quote asjb: Yes, that's interesting. And maybe a little over-confident of Resmed. I have occasional nights …..with runs of apnoeas and hypos that are clearly a form of 'periodic breathing'.

Quote Vsheline: Hi Asjb, Actually, the occasional clusters of apneas and hypopneas in the data you've posted on Apnea Board from your ASV machine have, I think, all been obstructive in type.

I think by definition Periodic Breathing and CSR are breathing patterns which are caused by our central nervous system. Meaning, to be properly identified as being PB or CSR I think these must be central events rather than obstructive events.

It is possible for a central apnea to transition into an obstructive apnea, starting as a central apnea but ending as an obstructive apnea. However, if memory serves, the apneas in the data you've posted appeared to me to be purely obstructive. (end quote)


Hello Vsheline,

Referring to a different thread -
http://www.apneaboard.com/forums/Thread-...ngs-please

- another member answered my query about these bouts of events I have with ASV (and also when I was on CPAP/APAP). He commented:

Quote: <The period you zoom into on the chart is a periodic breathing pattern with hypopnea terminating in recovery breathing with an interval of a minute to 1-1/2 minutes>.

When I used APAP, the Airsense used usually to highlight identical events as <Cheyne Stokes> (or 'Periodic breathing' as many people on the forum refer to them). In this earlier thread you continued to describe them as <clusters of events>.

There are quite a lot of published references that say similar to <It is now known that periodic breathing generally occurs during sleep, that it may occur in healthy persons, and that the apnea is usually central rather than obstructive However, periodic breathing can also be associated with obstructive apnea.>

So, perhaps we should stop using the phrase 'periodic breathing' and use instead your term 'clusters of events' (unless of course the flow waves clearly show true Cheyne-Stokes) ?

best wishes,
asjb
……………………………………………………………………........................................
My current pressures: Auto-ASV. EPAP 11-14. PS 3-10
03-27-2016 06:08 AM
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richb Offline

Advisory Members

Posts: 532
Joined: Jun 2015

Machine: Resmed AirCurve 10 ASV
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage FX
Humidifier: Built in
CPAP Pressure: Epap 6 Ipap 8 Auto ASV
CPAP Software: ResScan SleepyHead

Other Comments: Idiopathic Central Apnea

Sex: Male
Location: Vermont

Post: #17
RE: 2nd Night with Aircurve 10 ASV
(03-26-2016 09:52 PM)marose1 Wrote:  Rich - This is my first effort at linking an image on imgur so we'll see how it goes. 10 minute clip at 4:14

[img][Image: XZhsGNwt.png][/img]

The waveform at 4:15.30 has the rounded shape of periodic breathing. The rest appear to be obstructive events.

Rich
03-27-2016 06:12 AM
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vsheline Offline

Advisory Members

Posts: 1,908
Joined: Jul 2012

Machine: S9 VPAP Adapt (USA Model# 36007, not better 36037 or 36067)
Mask Type: Full face mask
Mask Make & Model: F10 or SimPlus w/ 2Liners. MirageQuatro & Gecko gel pad
Humidifier: H5i
CPAP Pressure: 15 EPAP, PS 5-10
CPAP Software: ResScan

Other Comments: Marfan Syndrome, chronic bradycardia, occasional Cheyne-Stokes Respiration

Sex: Male
Location: California, USA

Post: #18
RE: 2nd Night with Aircurve 10 ASV
(03-27-2016 06:12 AM)richb Wrote:  
(03-26-2016 09:52 PM)marose1 Wrote:  Rich - This is my first effort at linking an image on imgur so we'll see how it goes. 10 minute clip at 4:14

[img][Image: XZhsGNwt.png][/img]

The waveform at 4:15.30 has the rounded shape of periodic breathing. The rest appear to be obstructive events.

Rich

Hi Rich,

I think all the apneas and hypopneas shown are primarily obstructive.

Although the Mask Pressure pattern around 4:15:30 has a mostly rounded envelope, to me it looks like the Flow is not responding to changes in Pressure Support in the way the Flow would be responding during a purely central event.

As the Pressure Support changes (for example, as the IPAP pressure level used during inhalation is boosted higher and higher while the EPAP pressure level used during exhalation remains unchanged) the Flow does not seem to be responding proportionately to the increases and decreases in Pressure Support. This makes me think an interaction between partial obstruction and breathing effort is the dominant influence on the Flow, more than the increases and decreases in Pressure Support.

I suggest it would be a lot easier interpret the Flow waveform if it's vertical scale is adjusted to be more zoomed in, until the peak-to-peak range of the Flow waveform during a normal breath would fill about half of the displayed vertical range.

Membership in the Advisory Member group should not be understood as in any way implying medical expertise or qualification for advising Sleep Apnea patients concerning their treatment. The Advisory Member group provides advice and suggestions to Apnea Board administrators and staff on matters concerning Apnea Board operation and administrative policies - not on matters concerning treatment for Sleep Apnea. I think it is now too late to change the name of the group but I think Voting Member group would perhaps have been a more descriptive name for the group.
(This post was last modified: 03-27-2016 01:33 PM by vsheline.)
03-27-2016 01:04 PM
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richb Offline

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Posts: 532
Joined: Jun 2015

Machine: Resmed AirCurve 10 ASV
Mask Type: Nasal mask
Mask Make & Model: ResMed Mirage FX
Humidifier: Built in
CPAP Pressure: Epap 6 Ipap 8 Auto ASV
CPAP Software: ResScan SleepyHead

Other Comments: Idiopathic Central Apnea

Sex: Male
Location: Vermont

Post: #19
RE: 2nd Night with Aircurve 10 ASV
(03-27-2016 06:08 AM)Asjb Wrote:  Quote DeepBreathing: I don't think your machine reports periodic breathing. I believe that Resmed's position is that the Pacewave algorithm completely eliminates central aneas and PB, hence there is no need to report it.

Quote asjb: Yes, that's interesting. And maybe a little over-confident of Resmed. I have occasional nights …..with runs of apnoeas and hypos that are clearly a form of 'periodic breathing'.

Quote Vsheline: Hi Asjb, Actually, the occasional clusters of apneas and hypopneas in the data you've posted on Apnea Board from your ASV machine have, I think, all been obstructive in type.

I think by definition Periodic Breathing and CSR are breathing patterns which are caused by our central nervous system. Meaning, to be properly identified as being PB or CSR I think these must be central events rather than obstructive events.

It is possible for a central apnea to transition into an obstructive apnea, starting as a central apnea but ending as an obstructive apnea. However, if memory serves, the apneas in the data you've posted appeared to me to be purely obstructive. (end quote)


Hello Vsheline,

Referring to a different thread -
http://www.apneaboard.com/forums/Thread-...ngs-please

- another member answered my query about these bouts of events I have with ASV (and also when I was on CPAP/APAP). He commented:

Quote: <The period you zoom into on the chart is a periodic breathing pattern with hypopnea terminating in recovery breathing with an interval of a minute to 1-1/2 minutes>.

When I used APAP, the Airsense used usually to highlight identical events as <Cheyne Stokes> (or 'Periodic breathing' as many people on the forum refer to them). In this earlier thread you continued to describe them as <clusters of events>.

There are quite a lot of published references that say similar to <It is now known that periodic breathing generally occurs during sleep, that it may occur in healthy persons, and that the apnea is usually central rather than obstructive However, periodic breathing can also be associated with obstructive apnea.>

So, perhaps we should stop using the phrase 'periodic breathing' and use instead your term 'clusters of events' (unless of course the flow waves clearly show true Cheyne-Stokes) ?

best wishes,
asjb
……………………………………………………………………........................................
My current pressures: Auto-ASV. EPAP 11-14. PS 3-10

Periodic breathing is a real phenomena. It is characterized by a falling then rising wave pattern. Periodic Breathing is one of the most common features of Idiopathic Central Apnea. It is also found in those suffering from High Altitude Sickness. Traditional CPAP machines can convert episodes of Periodic Breathing into full blown Central Apnea events. It is often difficult to differentiate between the causes of Hypopneas. Most are Obstructive in nature. Some, however, are Periodic Breathing. Traditional CPAP machines deal poorly with Periodic Breathing often converting to what looks like Chain-Stokes breathing. This failure of traditional CPAP machines is actually diagnostic for Central Apnea. For those with Complex Apnea finding a pressure setting that controls Obstructive events while not making the Periodic Breathing worse is an issue. Sometimes settings that are high enough to convert Periodic Breathing into Central Events is unavoidable. The good news is that ASV machines can deal with just about all Central and Periodic Breathing events.

Rich
03-27-2016 05:45 PM
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Vanya Offline

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Post: #20
RE: 2nd Night with Aircurve 10 ASV
Here's my story: Severe Sleep Apnea OSA/CSA/CSR Epworth Sleepiness Scale: 24
Arousal Index: 92.4 per hour, AHI Index: 80.5 per hour, Periodic Limb Movement Index: 43.8 per hour... I lived this way for more than 20 years and suffered a heart attack due to non-compliance when I unknowingly removed the full face mask while sleeping and stopped breathing long enough to suffer a Vaso-Spasm.  I battled my Pneumologist for years prior to the heart attack because having tried everything on the book I still was unable to sleep.  I actually stopped treatment with him and started from scratch with a new doctor; his approach was brilliant instead of the patient struggling to adapt to the machine why not try a machine that adapts to the patients needs?. The ResMed AirCurve 10 ASV Auto Mode was his suggestion to tackle as aggressively as possible my ordeal and the results after my first weeks of treatment speak for themselves: a MyAir score of over 90 steady for the past two weeks with the lowest being 1.3 events per hour no Periodic Limb Movement and almost no Snoring. I have noticed regarding your settings that the device in Auto Mode encourages your own breathing to take place and your lowest pressure being 0 is a problem as far as keeping upper airway patent if you can tweak your settings it is what I would suggest. The maximum lowest pressure the machine allows is 6.0 cm2 H20 so it's very hard to go wrong changing the pressure in Auto ASV. You're on the right track... God Bless Sleep Apnea Patients!!!
03-28-2016 10:27 AM
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