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AHIs
#21
RE: AHIs
It's really done in a lab, although they are trying to get some cpap machines to flag them.

Respiratory Effort Related Arousal.

An event that causes an arousal or a decrease in oxygen saturation, without qualifying as an apnea or hypopnea.

An arousal is when the sensors measuring your brain activity, called EEG, show that your brain waves change to alpha wave form. This means you’ve woken up even if you don’t realize it. It is the repeated waking of your brain as a result of a respiratory disturbance lasting at least 10 seconds that causes the damage from sleep apnea, regardless of the type of event that is occurring or whether the breathing pause is a full pause or a partial pause. Therefore, many sleep centers and insurance companies are starting to recognize RERA as an indicator of the severity of disease.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#22
RE: AHIs
ajack,
 Thank you for that information.  I will take all that to my doc next time I have an appt.  

Three nights ago I changed the Epap to 10, it was set at 8.0 the previous 7 nights.  I'm not sure if it did any good as I'm also dealing with periodic sleep maintenance insomnia the last three nights too.  

I downloaded the last 2 nights to post here.  See what you make of this mess.

[Image: KzMeeBZ.png]

[Image: eDgWBDg.png]

Thanks,  Dreamless
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#23
RE: AHIs
Yuck...

Well that's not what I was hoping to see. I think just continue at these settings for now. Lets see where these settings get you...If the graphs still look this bad then I'd consider dropping Min epap back to 8. Unless anyone else has any advice for you...
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#24
RE: AHIs
Just something to try, what you're doing now isn't working.
lets get a $10 soft foam cervical collar on and see if you are tucking your chin and obstructing your airway. Then look at stopping yourself from sleeping on your back.

in general, you keep raising epap till the OA/H subside. the PS is for the centrals. I'm guessing here, but if it was a ST, I'd raise the min PS to 6 or 8. Perhaps the respironics ASV are like their cpap and slow to respond? getting the epap and ps up may help.
It would help if you set up the chart as suggested in the link at the top of the page and turn off the pie chart. For now you can just posts what all the pressure settings are on the machine, you want to check that it give the machine room to move

You could also get a trial of a resmed asv and see if that's a dramatic change.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#25
RE: AHIs
Well, the last 2 nights have been really awful. I've not been able to sleep. No sense in posting those graphs...   Sad

I'll try to see what you mean about the pie charts. 

Hopefully I can get some sleep tonight.  I'll see about making those changes to the PS and let you both know something - good or otherwise.

Thanks.
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#26
RE: AHIs
Dreamless,

I understand your frustration with your doctor's reluctance to look at your data. Please understand that SleepyHead is NOT an officially "approved" piece of software for processing PAP data, even though it runs rings around the approved software for your machine.

You may have better luck getting the doctor to be concerned about your data if you printed off an Encore Pro report for him/her. Print off the Encore wave flow data as well for a typical night or two. (Encore Pro only downloads the last night's wave flow (flow rate) data, so you need to download into Encore Pro for each night you want the wave flow available, which is a real PITA.)

You can get Encore Pro by visiting the Private area of the forum.

Quote:Three nights ago I changed the Epap to 10, it was set at 8.0 the previous 7 nights. I'm not sure if it did any good as I'm also dealing with periodic sleep maintenance insomnia the last three nights too.
Did the "periodic sleep maintenance insomnia" start with the change in your EPAP?

If so, you might want to change the min EPAP back to what it was and see if that helps the insomnia problem, even though you know it's not effectively treating your obstructive stuff.

Alternatively, you could start working on the addressing the insomnia problem while continuing to experiment with (slowly) increasing your min EPAP.

Have you ever experienced the same kind of periodic sleep maintenance insomnia before? If so, were you ever able to successfully rein it in?
Questions about SleepyHead?  
See my Guide to SleepyHead
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#27
RE: AHIs
ajack - I purchased a soft foam cervical collar today and will try it tonight.  It'll be interesting wearing the cervical collar, chinstrap and a full face mask. I used to sleep on my side years back when (5 years ago) I started on the bipap ASV machine.  I had to quit sleeping on my side for 2 reasons: 1) Drooling, which wakes me up and subconsciously keep me up and 2)  Large mask leaks, which didn't help my therapy. I've been trying therapy laying on my back ever since.  My wife figured out how to get rid of the pie chart on the graphs, I hadn't realized that that was possible.  

Robysue - The periodic sleep maintenance insomnia (PSMI) did start with the recent change in the EPAP, I'm not 100% sure that it was the cause though.  I've had PSMI problems for many, many years.  I've had sleep issues since 1994.  I started the bipap ASV in 2012, 4 sleep labs, 5 sleep doctors and different pressures with no improvements.  I think due to sleep deprivation over the many years has caused me to develop generalized anxiety disorder (GAD) two years ago.  I've been seeing a sleep psychiatrist since last August and through many different meds and CBT, I was finally able to, if nothing else, adjust to the periodic awakenings and get some sleep. So yeah, I'm hoping to get settled back down.  Just to let you know, it is caring people like you that give "hope" to people like me.  
I think I will put the EPAP back to 8.0 for a few nights until my sleep evens back out. 

Thank you all very much !
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#28
RE: AHIs
I hope your collar helps.  I think it probably will.  For about 10 days I have used a buckwheat airplane pillow propped up with a rolled up tee shirt.  I started sleeping on my back, and the results were as good as the previous nights where I was sleeping on my side without the special prop.

I do think the sweet spot for your OA is to have EPAP min up in the 10 to 12 range. I have seen others suggest that PS min be set at 0 so the machine has the liberty to do anything that makes sense.  I see that it is quite rare for you to have PS greater than about 8, so whether the PS max is set at 10 or 15, the PS added is not going to differ much.

If I had the luck of having the ASV and your charts and knew your tidal volume I would try to set in accordance with the titration protocol, I found by web search for "PR ASV titration and settings 1117293" and find page 18 of "PN 1117293".

I would set mine at:

EPAPmin: 10 cm H2O
EPAPmax: 14 cm H2O or IPAPmax: 25 cm H2O
PSmax: 8 cm H2O
PSmin: 0 cm H2O
Max Pressure: 25 cm H2O
Rate: 8 BPM
Bi-flex setting: 2

Good luck with your sleep tonite - can't wait to see what results were.

QAL

ps. I think dmeRT meant to leave as EPAPmin of 10 when suggesting that the settings stay as is for a few more nights.
Dedicated to QALity sleep.
You'll note I am listed as an Advisory Member. I am honored to be listed as such. See the fine print - Advisory Members as a group provide advice and suggestions to Apnea Board administrators and staff concerning Apnea Board operation and administrative policies. 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.
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#29
RE: AHIs
Hopefully the collar will have a good effect
The reason I was thinking min PS:6 was because that is the median PS from your charts. I was hoping that would help the machine to adjust higher, easier. similar to autocpap where we raise the min epap to around the median number, so it is able to adjust easier.
I wouldn't restrict the max numbers, I'd open them up and see where they land.

I would also do a factory reset in the settings, to get any trigger/rise/cycle settings back to default. I think with the DS some are adjustable. Later it would be good to get all your setting numbers up.

The reason I suggested raising the epap till the OA/H subside is because that is what the resmed titration manual suggests for their ASV.
page 41
https://www.resmed.com/us/dam/documents/...lo_eng.pdf
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#30
RE: AHIs
Dreamless,

Just a few more thoughts about the data you've posted.

I'm guessing that you were put on an ASV because of either central sleep apnea or complex sleep apnea. It's possible that many (maybe even most) of the Hs are central Hs and some (maybe even most) of the OAs are actually CAs that have been misscored as OAs.

In that case, it may be that the PS settings are what needs to be tweaked rather than the min EPAP.

I don't know much about PS settings on ASV machines, except that getting them set up right is critical for treating central events. Were you ever titrated on an ASV? And are your min PS = 3.0, max PS = 15.0 derived from an ASV titration? Or are they just defaults or guesses?

Since increasing the min EPAP appears to have made things worse, it may be worth experimenting with changing the min PS setting. You might want to see what increasing the min PS to 4 does. You might also want to see what decreasing the min PS to 2 does. If one or the other of these gives (slightly) better results, then we would have an idea on which way that min PS should be adjusted.
Questions about SleepyHead?  
See my Guide to SleepyHead
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