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ASV questions
#21
Okay so I tried turning the machine off and holding the mask off my face and yes I could get back to sleep, but kind of as expected I was still waking up which is the problem.
http://i.imgur.com/vBVpUMT.png
this is last night, waking up 8 times or at least needing to take the mask off 8 times, I may have not actually gotten back to sleep.
Sometimes the pressure was going up and sometimes down.
I had a lot of large leaks last night, none right before waking up and none lasting very long
Note the periodic breathing, that the "professionals" tell my not to worry about
AHI was 1.87 with centrals being 1.29 of that

For those that may not remember I have mild COPD
Any insights would help
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#22
PoollQ,

You say that your mask is your friend but I think that your subconscious feels differently since you say that you wake up to get the mask off. I am beginning to wonder if your mask is the problem. In fact, the more I read over what you have said, the more it seems to me that the mask is your problem but that is only my opinion.
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#23
Could be. I have tried the SimPlus, P10 and now Amara View so far this has been the best
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#24
(05-07-2016, 03:29 PM)PoolQ Wrote: Okay so I tried turning the machine off and holding the mask off my face and yes I could get back to sleep, but kind of as expected I was still waking up which is the problem.
http://i.imgur.com/vBVpUMT.png
this is last night, waking up 8 times or at least needing to take the mask off 8 times, I may have not actually gotten back to sleep.
Sometimes the pressure was going up and sometimes down.
I had a lot of large leaks last night, none right before waking up and none lasting very long
Note the periodic breathing, that the "professionals" tell my not to worry about
AHI was 1.87 with centrals being 1.29 of that

For those that may not remember I have mild COPD
Any insights would help

It looks to me like you need an ASV machine.

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

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#25
The periodic breathing is bracketed between therapy disruptions, and you are not likely asleep here. While ASV may improve results, you're not going to qualify for one with an AHI under 2. Your tidal volume and other respiratory metrics are very good and pressures are very low and use only a small part of the available range.

What happens when you back out PS to 2-3?
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#26
(05-08-2016, 08:01 AM)Sleeprider Wrote: The periodic breathing is bracketed between therapy disruptions, and you are not likely asleep here. While ASV may improve results, you're not going to qualify for one with an AHI under 2. Your tidal volume and other respiratory metrics are very good and pressures are very low and use only a small part of the available range.

What happens when you back out PS to 2-3?

I agree that backing the PS down might be a good idea. Look for the minimum pressures that will prevent OAs.

Rich
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#27
Interesting that you talk about PS. History, I changed to BiLevel because the Doctor thought that EPR of 3 was not enough for me.

Last night I was over 5 for AHI, mostly centrals following OA's. My pressure was higher than "normal". 14.9 and I was getting constant small mask leaks that were keeping me awake, or waking me up. I tightened the mask. without turning the machine off and was able to go back to sleep. Last night I only got out of be 2 times and feel great in the morning. This was one of my good nights. Notably I had almost no periodic breathing at all.

After I got the mask not leaking, I was having difficulty exhaling and was wondering if I need to increase the PS? Or if there was a way to have PS scale with pressure? Or maybe even variable IPAP and fixed EPAP.

Exhaling into pressure seems to be more disruptive for me than the pressure change.
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#28
(05-08-2016, 12:00 PM)PoolQ Wrote: Interesting that you talk about PS. History, I changed to BiLevel because the Doctor thought that EPR of 3 was not enough for me.

Last night I was over 5 for AHI, mostly centrals following OA's. My pressure was higher than "normal". 14.9 and I was getting constant small mask leaks that were keeping me awake, or waking me up. I tightened the mask. without turning the machine off and was able to go back to sleep. Last night I only got out of be 2 times and feel great in the morning. This was one of my good nights. Notably I had almost no periodic breathing at all.

After I got the mask not leaking, I was having difficulty exhaling and was wondering if I need to increase the PS? Or if there was a way to have PS scale with pressure? Or maybe even variable IPAP and fixed EPAP.

Exhaling into pressure seems to be more disruptive for me than the pressure change.

SR pointed out that you may not have been fully asleep during the periods of periodic breathing shown in your screenshot. In any event, you might want to consider a good period of Ramp time to help you get to sleep. It seems that once you are asleep the machine works pretty well. Just a thought.

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

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#29
It could be. I have ramp set to 45 minutes and that is as long as I can set it to.
I have 100% correlation between periodic breathing and waking often. I can 100% tell that if I have woken up often during the night, I will see periodic breathing the entire time. If I get 2-3 stretches of uninterrupted sleep, 100% no periodic breathings during that time.

Does this assure that my short sleep cycles are caused by periodic breathing, no. I cannot find, so far, anything else that correlates. Of course insurance does not seem to care about periodic breathing or waking up often. Even the Doctors say to "just get used to it" or "well, are you better than before", coming up on a year now and I have not gotten used to it. Am I better than before, you bet ya I am . Would I prefer to not just settle with this without at least trying what I can, well I think most would also not want to just settle without trying.
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#30
(05-07-2016, 03:29 PM)PoolQ Wrote: ...
http://i.imgur.com/vBVpUMT.png
...
Note the periodic breathing, that the "professionals" tell me not to worry about
...

Hi PoolQ,

The zoomed-in section shows clear signs of partial obstruction.

Any breathing pattern starting with recovery breaths (strong peak Flow) but with the peak Flow gradually reducing over several breaths to a point (with the envelope of the Flow waveform looking like an arrowhead) and then restarting again with sudden strong recovery breaths, is clearly obstructive.

If your doctor has said not to worry about Periodic Breathing I think he/she would have been trying to communicate that a minor amount of central nervous system caused Periodic Breathing is not a big deal and not to let it worry you, as long as your overall AHI or RDI is less than 5.

The term "Periodic Breathing" is most widely understood as referring to breathing patterns which have central rather than obstructive causes.

I think your doctor would not have meant you should be unconcerned about back-to-back obstructive breathing, which is sometimes occurring in the zoomed-in section of your data and which I think some of us confusingly (and in my view mistakenly) refer to as being Periodic Breathing merely because a pattern is repeating, back-to-back.

In the zoomed-in section you posted, it looks to me like you are sleeping very shallowly with the EPAP significantly too low, leading to sleep/wake central PB as well as the main problem, which in my view is the repetitive obstruction of your airway, causing awakenings or back-to-back arousals into shallower sleep as evidenced by recovery breaths (the arrowhead pattern in the Flow waveform).

I suggest very gradually walking your Min EPAP higher until, for your somewhat unusual case, it is within 1 cmH2O of your 95% EPAP. (I usually recommend raising Min EPAP to anywhere in the range 2 to 4 cmH2O lower than the 90% or 95% EPAP.)

Lowering PS usually reduces the number of CA we have, but I suggest placing the greater emphasis toward reducing the obstructive characteristics in your breathing by raising the Min EPAP.

Good luck and 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.
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