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3rd week of ASV, feeling horrible
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storywizard Offline

Advisory Members

Posts: 350
Joined: Jul 2014

Machine: ResMed VPAP Adapt S9
Mask Type: Nasal pillows
Mask Make & Model: P10 taped to face
Humidifier: included with machine
CPAP Pressure: CPAP 11cm
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Vancouver, BC, Canada

Post: #1
3rd week of ASV, feeling horrible
hi all...

I am in my 3rd week of ASV use, after the initial exciting rush of sleeping all night, no restless legs or snoring I am feeling horrible. In fact this morning I almost caused a traffic accident as I am so wooly headed..below is a screen shot of last night. As you can see great data. But I cannot drive like this, that is for sure, glad I am retired from my machinist job!!!

[img][Image: ZJKYHqFl.jpg?1][/img]

The irony for me is that I had noticed in the last few days, that if I awoke later in the night, say after 1am, it would feel as if the machine was not working properly, not enough air, so it is likely that I had my PS too low, and have been suffering as a result...

I have adjusted my pressures ...
EPAP: 8
Min PS: 4
MaxPS: 12

Storywizard
(This post was last modified: 05-31-2015 06:03 PM by storywizard.)
05-31-2015 04:05 PM
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vsheline Online

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: #2
RE: 3rd week of ASV, feeling horrible
(05-31-2015 04:05 PM)storywizard Wrote:  The irony for me is that I had noticed in the last few days, that if I awoke later in the night, say after 1am, it would feel as if the machine was not working properly, not enough air, so it is likely that I had my PS too low, and have been suffering as a result...

I have adjusted my pressures ...
EPAP: 8
Min PS: 4
MaxPS: 12

Hi Storywizard,

I think those two adjustments (+1 on EPAP, +1 on Min PS) will help, and after another week or so you might want to increase the Min PS a little higher again, unless you are getting painful aerophagia (air-swallowing) from the higher pressures, or are being awakened by high pressures, high pressures are causing some other problem.

Can you post for us a couple zoomed-in views (so that 1 or 2 minutes fills the horizontal scale), one view around 22:29 and another view around 23:26? I think these would be times when you were asleep and the PS was nearly max'ed out.

We would especially like to see the Flow and the Mask Pressure waveforms, while your PS was nearly max'ed out.

I think it will it make easier to see more detail in the Flow waveform if its scale is adjusted to show only +/- 75 or +/- 80. It is okay for the Flow waveform to clip a little, so that we can see small Flow amounts more clearly.

If the Flow during exhale is stop-and-go or jerky this would probably indicate an obstructive condition. Increasing EPAP tends to help avoid obstruction or partial obstruction in our airway.

Flow is the estimated rate of airflow entering (positive) or leaving (negative) our lungs.

Increasing the Min PS setting tends to raise our average Tidal Volume (average volume inhaled or exhaled in each breath), which tends to raise our average blood O2 levels.

Do you by any chance have access to a recording pulse oximeter you can wear, to see how your SpO2 (percentage Saturation, as measured through the skin percutaneously, of Oxygen) is holding up throughout the night?

The wrist-worn type of pulse oximeter with separate finger sensor cup is more comfortable, especially if wearing it several nights a week. It helps avoid soreness to move the sensor to a new finger whenever you happen to wake, and having a finger sensor cup makes it very quick and easy to move to another finger, because no tape is needed to stabilize the finger sensor cup.

A finger clip-on pulse oximeter where everything clips onto the finger tends to cause soreness, and needs some tape along the sides of the finger to stabilize the unit, so it won't move or fall off. (The tape must be only along the sides, to help keep the unit centered on the finger, and must not cause the unit to clip on any tighter - not at all tighter.) Again - no tape is needed when using the wrist-worn type.

Take care,
--- Vaughn

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: 05-31-2015 11:10 PM by vsheline.)
05-31-2015 08:24 PM
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storywizard Offline

Advisory Members

Posts: 350
Joined: Jul 2014

Machine: ResMed VPAP Adapt S9
Mask Type: Nasal pillows
Mask Make & Model: P10 taped to face
Humidifier: included with machine
CPAP Pressure: CPAP 11cm
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Vancouver, BC, Canada

Post: #3
RE: 3rd week of ASV, feeling horrible
Hi there...

Oximeter screen shot from May 25:

[Image: 8c1fuqJl.jpg]


Zoomed flow and Mask pressure last night
[Image: NrN5P1xl.jpg]

[Image: kLkGmRCl.jpg]




Thanks for taking a look...

I will do another oximeter night tomorrow...

Storywizard
(This post was last modified: 05-31-2015 09:45 PM by storywizard.)
05-31-2015 09:14 PM
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vsheline Online

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: #4
RE: 3rd week of ASV, feeling horrible
(05-31-2015 09:14 PM)storywizard Wrote:  Oximeter screen shot from May 25:
...
I will do another oximeter night tomorrow...

From the Oximeter screenshot the dips in the SpO2 waveform were not good, but your average SpO2 throughout the night was mostly between 94% and 96%, which I think is fine as an average.

On the zoomed-in Flow/Pressure waveforms, at 22:27:00 through 22:27:20 the machine was happily keeping the PS at minimum, showing it considered you to be having no problems. But suddenly the Flow shows you have three arousals which are textbook obstructive in shape (outside envelope of the amplitude of the Flow suddenly jumps from zero or small amplitude to large amplitude, and gradually gets smaller and smaller until pattern repeats again).

The Flow waveforms are fairly smooth, not at all stop-and-go but I think do show a little jerkiness or stairsteppyness. I think the Flow looks slightly obstructive, but not sure.

After your three arousals had raised the Minute Volume high enough and long enough to raise the Target Minute Volume, then the machine started applying more PS to keep your Minute Volume up.

It would have been interesting to see what your SpO2 was doing at these times.

If your Min PS setting had been higher that would have tended to keep you better ventilated (would have increased the Minute Volume and Tidal Volume) and I think you might not have had those three arousals.

So I think higher Min PS will be helpful.

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: 06-01-2015 12:32 AM by vsheline.)
06-01-2015 12:15 AM
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storywizard Offline

Advisory Members

Posts: 350
Joined: Jul 2014

Machine: ResMed VPAP Adapt S9
Mask Type: Nasal pillows
Mask Make & Model: P10 taped to face
Humidifier: included with machine
CPAP Pressure: CPAP 11cm
CPAP Software: SleepyHead

Other Comments:

Sex: Male
Location: Vancouver, BC, Canada

Post: #5
RE: 3rd week of ASV, feeling horrible
Uggg, had a horrible night last night with the higher pressures...

Thanks for the help, I really appreciate it....am a little lost at the moment, not sure what to do to make this work...

Will wear the oximeter for the next few nights and see if I am getting good levels...

Storywizard
(This post was last modified: 06-01-2015 10:11 PM by storywizard.)
06-01-2015 05:23 PM
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