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Machine: Needing iVAPS but QUACKS refusing to help but they love testing Mask Type: Not using mask Mask Make & Model: F&P Vitera on shelf Humidifier: None/nada CPAP Pressure: 0-0 pressure set CPAP Software: Not using software
Other Comments: SCS PVC K9D** Untreated CA Asthma Dr. Donothings
07-22-2021, 01:16 AM (This post was last modified: 07-22-2021, 01:19 AM by SarcasticDave94.
Edit Reason: clarify
)
RE: AirCurve 10 in ASV mode
Not to be contrary, but with ASV treatment, flow limits more or less were ignored by me with my ASV, which is identical to your ASV model here. What I mean is, I didn't factor FL in titration decisions. Feel and basic results of AHI, leaks, and pressure were about all I looked at. However it turned out, when I dialed in my ASV via my own Titration, flow limits were oddly low. Just a bonus I'm guessing.
When you're ready to go up to bat again with ASV Auto, let me know and we'll walk through it. Myself, I tackled EPAP first then PS. I didn't read ResMed titration directions until afterwards. Oh well, I still had good therapy with it, scoring some 0.0 AHI nights.
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.
This chart does not show any positional apnea problems or patterns of flow limitation that would be related to chin-tucking. Usually with ASV, we see flow limitation that is related to the user relying on pressure support to provide a breath. These are the isolated spikes of FL we see in your chart. From 22:40 to 23:20 we see a period of fairly low pressure support indicating spontaneous breathing, but relatively high flow limitation. This is real obstructive flow limitation and is associated with increasing EPAP pressure. Based on this, I recommend increasing EPAP min to 5.0. Everything else looks great.
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.
Thanks again for all your observations and suggestions. I'll pause this thread and start working on the things you all have advised. I'll do my best to document changes and conditions for each step and do them one at a time. I'll hope to report back with improvements. This is a great community! I have also made my brother aware of you. He is working without a doctor and can benefit from you a lot. I gifted him an O2 ring to aid him in understanding his progress.
I have a question since I am trying to learn. In the plot of ASV Auto mode, waitedwaytoolong's SpO2 levels were much lower than in the plot provided at the top of the post.
Are these lower levels likely from the positional issues?
Also, does anyone have hints on a camera setup for detecting these things? I am thinking of some sort of camera that films my father overnight, perhaps with a clock moved next to his bed, so I can later correlate any obvious positional issues with OSCAR apnea results. Or is this overthinking? Is the better approach to try a collar and see if things improve?
I don't see any issues with SpO2, however, in the first post the EPAP was set at 10.0 cm and in the most recent, EPAP ranged from 4.0 to 8.0. It is a basic principle of PAP and mechanical ventilation that higher EPAP results in better oxygenation, while higher PS results in higher ventilation and lower CO2. I would suggest that the original settngs were too high for comfort and resulted in much higher tidal volume and a slightly more suppressed respiration rate. The over-ventilation suppressed respiratory drive and made the user more reliant on the ASV pressure support to correct the hypocapnea induced centrals. In the end, we would rely on subjective "how did you feel" to evaluate the results. I can tell from the much smoother respiration flow rate graph, this was closer to the mark than the original settings.
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.
SleepRider, at 07-22-2021, 06:44 AM you responded saying there was low pressure support: "From 22:40 to 23:20 we see a period of fairly low pressure support". My graph shows higher pressure and higher mask pressure during that time frame. Can you please explain why you say there was low pressure support? My perspective says that there was higher pressure support when looking at the graphs. Please excuse my ignorance!
From 22:40 to 23:20 should probably have been from 21:30 to 23:10. That entire period shows very even flow rate from respiration and not much intervention from the ASV.
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.
It has been 2 months since I queried the team. I have been lowering my settings and looking at results. I have also been wearing a collar that has helped a lot with positional events. Attached are two screenshots showing my current settings with a typical night with and without wearing my collar. I am posting these to help others see the efficacy of wearing a collar. I now have pressure settings that do not wake me up and also I have reduced aerophagia. If anyone sees any issues with my chart using the collar, please advise. I have not tried the Auto ASV mode yet as was suggested.
