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ASV data interpretation?
#1
ASV data interpretation?
Can someone with ASV experience help me interpret this? Not really any problem per se; just trying to understand what I'm seeing.

I am testing out AutoASV mode, which I intend to do for the next week or two before drawing any firm conclusions.

Quick background: diagnosed with mild OSA/UARS last Summer with an RDI of ~24, generally been doing pretty well on a VAuto with PS of just short of 6 and min EPAP around 7. 

At these settings, my AHI is almost always below 0.5, and often 0.

But I am still not always feeling as rested as I'd like. I recognize this may not have anything to do with SBD.

I had previously read about Krakow's advocacy of ASV for UARS, and have skeptically wondered whether I might benefit from the higher, and variable (but CA-free) PS it provides. Unlike Phillips, Resmed doesn't provide variable PS on their standard bilevels.

Hence, this experiment.

Here's an overview from last night, which includes the Dreem sleep stage data just for comparison (I had wondered, for example, if higher PS correlated with REM; seems not).

   

Generally, the machine is operating at a baseline PS just above 4 (the min), for periods throughout the night it goes to PS of around 10 for some time, and then there are a few peaks later on of about 12 (current max).

Note: unlike some people report, these pressure swings don't appear to bother me. I did wake up for a short time (you can see on the sleep stage graph), but I don't think because of the machine.

I find the feel, while different than vauto, comfortable.

With that background, here's one of those "peak" examples.

   

My guess: I'm clearing my throat or something similar, and/or shifting positions (I can confirm this as my Dreem tracks position data), and the machine responds with a big increase in PS.

As in, examples like this are where the ASV actually isn't helpful and I can ignore them.

What, more generally, can I conclude about how the machine is behaving as reflected here? Sleeprider mentioned, for example, something about the relationship between PS and RR being "interesting," I'm not sure what to make of that myself.

My settings:
  • min PS = 4
  • max PS =12
  • min EPAP = 6 
  • max EPAP = 9
I set these EPAP settings based on my titration study and vauto experience. I was titrated at PS of 6, but speculated I'd be fine to lower the minimum.
Caveats: I'm just a patient, with no medical training.
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#2
RE: ASV data interpretation?
Can you add left panel info from the OSCAR chart? I like seeing the EPAP median, 95% etc. By the numbers seen it seems pretty good. How would you summarize how you felt? I do think with your EPAP and PS range groups you have room to slide them around for comfort as needed. What I mean is that you might be capable of subtracting PS and adding it back to EPAP if it becomes necessary.

I feel for me that EPAP Min is the lowest therapy I must have AKA I can't go lower than 8 for myself or I get OA events. FL was almost 0 for me. On EPAP Max, I chose to go 5 over EPAP Min after some self titration, from EPAP Max 15 to 12 and bumping to 13 as final. PS Min 3 or 4 should do for most I think. And PS Max added to EPAP Max will give whatever you need for IPAP Max.

EPAP vs PS: EPAP is more constant and smoother flowing where PS is more abrupt IMO.
If in ASV modes you get the serious blow from the machine while drifting off, initiate a blow back. Literally, blow back through the mask and it'll back off.

Just some ASV thoughts...
Dave

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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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#3
RE: ASV data interpretation?
one possible interpretation of your flow rate is that it reflects physical movement
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#4
RE: ASV data interpretation?
(04-29-2020, 11:48 AM)SarcasticDave94 Wrote: Can you add left panel info from the OSCAR chart? I like seeing the EPAP median, 95% etc. By the numbers seen it seems pretty good.

The EPAP should be right, as the median and 95% is just a tad above the min I set. I will check on posting that later.

Quote:How would you summarize how you felt?

Pretty good.

Quote:I do think with your EPAP and PS range groups you have room to slide them around for comfort as needed. What I mean is that you might be capable of subtracting PS and adding it back to EPAP if it becomes necessary.

By PS you mean max? E.g. for sake of argument, bump min EPAP by 1 and drop max PS by equivalent?

That kind of thing?

That's a strategy I was using to titrate vauto as well.

Quote:I feel for me that EPAP Min is the lowest therapy I must have AKA I can't go lower than 8 for myself or I get OA events. FL was almost 0 for me.

At min EPAP of 6 and max of 9, I don't get any OAs, and AHI is 0; EPAP (as you can see; actually, I see I cut that off of the screenshot; but the max EPAP over the night is just over 7) stays closer to 6. So I'm assuming that's right.
Caveats: I'm just a patient, with no medical training.
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#5
RE: ASV data interpretation?
In order:

Copy on median and 95% makes sense and what I'd do also.

OK on feel so it passes that so far.

Correct, it was PS Max. Note that you can add/subtract either way as in PS to EPAP or EPAP to PS. Gauge it by feel and numbers more or less equally.

And copy on EPAP Min. Sounds set there.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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#6
RE: ASV data interpretation?
(04-29-2020, 11:56 AM)sheepless Wrote: one possible interpretation of your flow rate is that it reflects physical movement

Yes. But in any case, something spurious to standard SBD patterns; right?
Caveats: I'm just a patient, with no medical training.
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#7
RE: ASV data interpretation?
I think my response is yes but I don't know what all falls under the sbd category. movements might produce sbd, sbd might produce movements but probably within your meaning to agree maybe it's not 'standard' sbd pattern. if it's movement, pressure isn't likely to resolve it, which suggests a way to help make a determination. otherwise, it's tough to call without some independent confirmation, like with video.
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#8
RE: ASV data interpretation?
Elsewhere I mentioned that there was an interesting relationship between pressure support an respiration rate. What we see is that seem to cruise along at about 16 bpm and low pressure support, and as shown in your closeup above, your respiration seems to destabilize without events, and drops in frequency to about 9 bpm with the machine pacing your respiration with high PS. The example from 00:14 to 00:22 was a fairly brief episode, but interesting. Wish i could offer some insight on the cause, but I don't see anything I can put a finger on. The therory that there is movement at 00:16 to 00:19 is plausible, but I just don't know.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#9
RE: ASV data interpretation?
I see only about 5 periodic cycles in that 0016 to 0019 screenshot but they are very similar to my periodic limb movement pattern. I think I've mentioned this to you some time past & my vague recollection is you don't think plm is an issue for you. still, if you see longer and more frequent instances of this pattern and if fatigue &/or fragmentation are bothering you (which I don't think you said were problems in this thread), I'd be looking for some kind of twitching going on. otoh, if it's not bothering your sleep, it's interesting but by itself no big deal.
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#10
RE: ASV data interpretation?
Thanks SR.

I have an idea.

The feel of this mode is definitely different. It doesn't bother me, but I do notice sometimes I feel slightly out of sync with it.

So the idea is that movement (turning on my side, for example) causes me to take a bigger breath, which makes me more aware of that different rhythm.

I recorded myself last night to see if there's evidence for that, and there is, in the sense that turning does correlate to that kind of pattern.

That suggests to me that, and at least while adjusting, it may be be counterproductive to have max PS higher than 9 or 10.

It's not even clear ATM whether more than 6 is beneficial for me; if that turns out to be the case, there would be no point in using asv for me.

I need to look again more carefully sheepless, but I still don't see evidence for plm.
Caveats: I'm just a patient, with no medical training.
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