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AHIs Good, Waveforms? Not So Much
#21
RE: AHIs Good, Waveforms? Not So Much
I’m leaning toward the ASV camp, but I’m not sure how to go about it. You are a little in no man’s land since you have centrals with EPR, you can’t set the pressure high enough and easily exhale, and you have flow limitations. A Bilevel will give more PS, and make it easier to exhale, but what happens to the centrals is unknown.

With open heart surgery coming up, it is something you need to talk to your doctor about. There may be reasons not to go to a particular machine.

If you need to use Medicare or insurance, you will need to go through a lengthy process. If you buy out of pocket all you need is a prescription.

John
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#22
RE: AHIs Good, Waveforms? Not So Much
Thanks Dave and John,

Yes, I'm definitely in no man's land here. The current machine has definitely helped my energy levels and fixed some nasty O2 desaturations. If this was as good as it could get It would be OK. I would definitely choose an EPR of 3 for breathing comfort and to knock down flow limits just a bit and tolerate the centrals. The worst part about the centrals is when I have a long string of them. Getting awakened every couple minutes is really annoying, but least that doesn't happen every night. I feel like the events that wake me up are keeping me from at least 1 more hour of sleep most nights. But maybe that's just part of being an old SOB. Smile

I get a lot of events that don't fit the machine's algorithm for flagging. they might be "junk", but they disturb my sleep all the same. See clip below from today.

For now I'll play around with EERS and I should have Acetazolamide to try soon.

As far as going with an ASV, the one thing in my favor is that my ejection fraction was just measured at 45 to 50%, so the SERVE-HF  Trial shouldn't prevent me from getting one.

I probably don't have a snowball's chance of getting a more advanced machine through insurance, but I'll pursue that at my sleep Dr. appointment early in April. Cash might be my only option.

Larry


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#23
RE: AHIs Good, Waveforms? Not So Much
Welcome, and FWIW I suggest some form of sleep diary to note all the complaints that are still an issue. Fill in the blank "I still feel ___" meaning all the negatives on sleep therapy; you can note CA events, arousals, tiredness, hard to exhale and such like. This can mean more than numbers to transition to other more powerful machines like an ASV. Complaints was the reason my pulmonary doc and the PA saw my high CA count on the PSG sleep study and placed me on path to the ASV.

Just note an ASV may not be needed, another machine such as VAuto may be fine too.
Dave

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#24
RE: AHIs Good, Waveforms? Not So Much
I cobbled together a mini EERS last night by taping over the mask exhaust vents on a ResMed N30i nasal mask. To get an approximate headgear volume I filled the tubing up with water. It came out to 70 CCs. I would guess the mask volume to be about 20 to 30 CCs, so my guess is 100 CCs rebreathing volume added. When I first put it on, it seemed like I was a little O2 starved, so I peeled back a little of the tape to expose just a couple holes. The tape re-stuck during the night, but breathing felt normal. I don't know if 100 CCs of rebreathing space is anywhere near enough, but it's a start. What are typical numbers for rebreathing space?

The thing that surprised me most was that I tolerated the nasal mask pretty well, with only a couple leaks during the night. Machine pressures ran significantly lower than they have been, and flow limits were also a lot lower. Tidal volume was up, as was 95% minute vent.

I think for now I'm going to stop chasing rainbows and unicorns, keep working with the N30i nasal mask, and play with Acetazolomide once it gets here and see how things go for the next couple weeks.

Thanks for everyone's help. I really appreciate it.

Larry


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#25
RE: AHIs Good, Waveforms? Not So Much
What did you use for a mask vent with your EERS system, it is critical!!!
And I'm not convinced that EERS is your answer, Actually having seen your overview I'm leaning toward ASV.\, not EERS.
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

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#26
RE: AHIs Good, Waveforms? Not So Much
Hi bonjour,

Per my understanding from the Wiki, just the exhaust vents at the top of the mask, since the safety valve can be omitted with a nasal mask. Is that a correct interpretation?

From Wiki: "EERS is accomplished by blocking the mask exhaust vents, and adding a length of tubing to the mask that terminates in a mask exhaust vent. For safety purposes an antiasphyxiation/saftey valve is included in EERS for full-face mask setups to ensure continued airflow in the patient circuit in the event of CPAP failure. This safety valve can be omitted in nasal therapy. "

It didn't seem to really help centrals or the cyclical waveforms, but I didn't know if 70 to 100 CCs was enough rebreathing space. I'll untape the vents and keep trying to adapt to the nasal mask since it went well last night with very few leaks.

Thanks,

Larry
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#27
RE: AHIs Good, Waveforms? Not So Much
It is the exhaust vent that determines the dead space volume.

 "EERS is accomplished by blocking the (existing) mask exhaust vents, and adding a length of tubing to the mask that terminates in a (new) mask exhaust vent."
Gideon - Project Manager and Lead Tester for OSCAR - Open Source CPAP Analysis Reporter

Download OSCAR
New to Apnea? Helpful tips to ensure success
Soft Cervical Collar
Mask Primer
Dealing with a DME
Organize Charts
Optimizing Therapy
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#28
RE: AHIs Good, Waveforms? Not So Much
Right. The N30i nasal mask has 2 vents. one at the nose piece and one at the other end of the tubing/frame that sits at the top of your head. I blocked the nose vent, but the top vent was still open.

I guess I'm misunderstanding something.

Larry
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#29
RE: AHIs Good, Waveforms? Not So Much
And then there are nights like this. :Smilehe APAP flagged  about 30 minutes of Cheyne Stokes, but there's more like an hour of similar breathing.

Flow limits were back up again, and I had a lot of leaks, which isn't too surprising for me with a nasal mask. Caps to follow.


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#30
RE: AHIs Good, Waveforms? Not So Much
Here's the full night plus O2 and heartrate for the Cheyne Stokes time.


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