03-11-2018, 07:14 AM
(This post was last modified: 03-11-2018, 07:30 AM by foxfire.
Edit Reason: spelling
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RE: AHI consistently 0.0 on ASV, still don't feel any better
(03-10-2018, 09:16 PM)Shin Ryoku Wrote: (03-10-2018, 09:01 PM)foxfire Wrote: The machine itself and ResScan also always report 0.0 AHI as well. My doctor is convinced that the algorithm Resmed uses to determine AHI is flawed, especially for ASV therapy. He recently published a paper that discusses this (among other issues with ASV treatment): "Estimation of adaptive ventilation success and failure using polysomnogram and outpatient therapy biomarkers" google it if your interested, not sure if I'm allowed to post a link.
Looks like an interesting paper. Thanks for sharing it. Has your doctor looked at the mentioned biomarkers of reduced ASV efficacy as they relate to your treatment?
Yes, he looked at the amount of pressure cycling in my data and concluded it could be a problem. Won't know for sure until I get my next sleep study done. If you have access to the full text he has examples of SH data showing pressure cycling examples for effective ASV therapy and poorly effective ASV therapy.
RE: AHI consistently 0.0 on ASV, still don't feel any better
(03-11-2018, 05:13 AM)crowtor Wrote: Please tell your doc office where you did your last study to mail you the whole study result with the whole EEG(this is what you want). I had 1-5 apnea events per night at 10 - 8 pressure and my saturation didnt go below 97% and it only helped that I didn't faint every week anymore. I still felt sh*t. When comparing the EEG, it turned out i was not getting any stage 3/4 sleep. I switched(myself) to Bipap 17 - 12 and went again, this time i had almost an hour of stage 3/4 sleep and since then i feel way better, my doctor still doesn't approve this change by the way.
Get the EEG.
I have the EEG, it shows me cycling between wake and N2 every couple of minutes, as my doc said it looks like pure misery.
03-11-2018, 07:28 AM
(This post was last modified: 03-11-2018, 07:56 AM by Shin Ryoku.)
RE: AHI consistently 0.0 on ASV, still don't feel any better
It sounds like your doctor is very knowledgeable and engaged. If only we had an affordable home EEG that could import into SleepyHead!
-Amin
Nothing I say on the forum should be taken as medical advice.
RE: AHI consistently 0.0 on ASV, still don't feel any better
Here is last night's data with EPAP set to 7.0. Sorry for the overlapping data, daylight savings time got me. The large leaks seem to be because my mouth opened, something I've never had happen before. But overall I actually feel better this morning. 
RE: AHI consistently 0.0 on ASV, still don't feel any better
One night doesn't make a trend, but I'm glad you're feeling better. Given the extent of the leaks it may not be a very meaningful comparison, but I suspect a further increase in your EPAP will make you feel even better. Your previous pressure of 4 is as low as it gets and many people feel starved of air at that pressure. I think you'll probably end up with an EPAP much closer to your median IPAP - that will reduce the size of the pressure swings you're getting.
It's a shame your doc's paper is behind a paywall. I'd love to read it, but I'm not prepared to pay $44 for 24 hours access! 
RE: AHI consistently 0.0 on ASV, still don't feel any better
(03-11-2018, 10:08 AM)DeepBreathing Wrote: One night doesn't make a trend, but I'm glad you're feeling better. Given the extent of the leaks it may not be a very meaningful comparison, but I suspect a further increase in your EPAP will make you feel even better. Your previous pressure of 4 is as low as it gets and many people feel starved of air at that pressure. I think you'll probably end up with an EPAP much closer to your median IPAP - that will reduce the size of the pressure swings you're getting.
It's a shame your doc's paper is behind a paywall. I'd love to read it, but I'm not prepared to pay $44 for 24 hours access!
Agree one night is not a trend, but hey, I'll take the one for now.
Although it doesn't have as many details this editorial written by Dr. Thomas covers much of the same ground as in that paper and is free.
http://jcsm.aasm.org/ViewAbstract.aspx?pid=31006
RE: AHI consistently 0.0 on ASV, still don't feel any better
Interesting studies. I think the increase of EPAP may be helpful to you based on feeling better. That is a big step. The presence of hypopnea might actually be a good thing in this case as you are breathing with enough volume that the machine detects a drop. It might be interesting to zoom in on some sections of the Flow Rate chart where the individual wave form of respiration is easily visible and see what is there. These would be segments of approximately 2-minutes in time.
RE: AHI consistently 0.0 on ASV, still don't feel any better
Well I managed to get my sleep study pushed up a full month.
The result is that I will need to stick with an ASV machine. EERS, acetazolamide and CPAP were not sufficient to stabilize my breathing. Doc thinks I may just have been on ASV too long for my body to adjust to breathing without it.
So new prescription will be 150ml of EERS, acetazolamide, and an ASV set to EPAP of 5, minPS of 1, and maxPS of 6. My existing ResMed S9 ASV cannot do PS settings that low. Doc thinks that the A10 ASV can, but wasn't entirely sure, so I guess I'll have to wait and see. I'm now waiting for the DME to get insurance approval before I can get the new machine.
03-29-2018, 03:26 PM
(This post was last modified: 03-29-2018, 03:28 PM by Sleeprider.)
RE: AHI consistently 0.0 on ASV, still don't feel any better
Aircurve 10 ASV allows variable EPAP pressure and minimum PS of 0.0 to max PS 15. I think 6.0 may be the lowest IPAP pressure support. JesseLee posted what it was recently and that is my recollection.
RE: AHI consistently 0.0 on ASV, still don't feel any better
It looks like max PS will be equal to the sum of min EPAP + PS max of X = 25
Example
Min EPAP 9.8 + PS 15.2 = 25
Ranges:
Min EPAP 4.0 - 15.0
Max EPAP = EPAP Min - 15.0
Min PS 0 - 6.0
Max PS 8.0 - Variable that equals sum of EPAP Min + X valued PS = 25
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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