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Auto to manual BPM experiment
#1
Auto to manual BPM experiment
I have mixed apnea, which I became aware of after nine years of CPAP therapy. It showed up when I was switched to APAP: Quite a bit of periodic breathing with clusters of CAs. Another sleep study confirmed it and I was switched to ASV. After a few months of fiddling with settings, with the help of the good people here, my average AHI was 1.4 and all was well. In the last few months my average has gone up, to 2.1, but at least some of that is due to a few clusters of really bad nights, due to travel and other stresses.

Looking at SleepyHead data, I've noticed that although the CAs are mostly gone, when one does slip through the ASV net it tends to be in the hour or so before I wake up in the morning. Sometimes I feel like the machine itself wakes me up, but of course I don't really know. About two weeks ago, I decided to experiment a bit. I took the machine's BPM setting off "auto" and set it to 8. Results have been mixed. I've had five nights with AHI below 1, which is fairly unusual for me, though not unheard of. I also had a couple of nights at around 5, although in each of those cases there were external factors affecting my sleep, i.e., physical overexhaustion. That is, I've noticed before that if I get really overexerted/overexhausted, instead of being tired and ready to sleep I'll go to bed feeling "wired" and I'll have a high AHI. Throwing out both the high and low AHI outliers, my average is pretty much unchanged from when the machine was set to "auto", with maybe a few more stray CAs in the mix. It's hard to generalize much in two weeks.

I'm going to try reducing BPM to 7 and see what happens. My expectation is that a few more CAs will slip through, but you never know. I didn't expect to see AHIs below 1 when I went from auto to 8 so anything's possible. And I should add that none of this has made any difference to how I feel, except for those two nights around AHI 5. This is as much out of curiosity as any expectation that these changes will make a therapeutic difference.
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#2
RE: Auto to manual BPM experiment
(08-24-2017, 09:43 AM)tmoody Wrote: I'm going to try reducing BPM to 7 and see what happens. My expectation is that a few more CAs will slip through, but you never know. I didn't expect to see AHIs below 1 when I went from auto to 8 so anything's possible. And I should add that none of this has made any difference to how I feel, except for those two nights around AHI 5. This is as much out of curiosity as any expectation that these changes will make a therapeutic difference.

Update after a week of BPM=7 (PSmin= .5): It's interesting. My AHI is dropping, and I'm starting to sleep a bit longer, and I'm definitely feeling more energy during the day, even though I wasn't aware of being tired previously. The last several nights my AHI has been .6 to .8 and before that it was around 1.2. I'm getting one CA per night, most nights, in that last hour before waking. The first night I went from 8 to 7 BPM I had two CAs, and AHI 3.2. But after that it's been low AHI and either one or zero CAs.

As a reminder of why I'm doing this experiment: For the previous 16 months or so on ASV my AHI stayed low, around 1.4, and CAs were rare: one or two a month. In terms of numbers, nothing needed fixing, although my AHI had been creeping up to around 2 over the summer. But I subjectively felt like sometimes the auto algorithm was too aggressive, and in suppressing CAs it was disturbing my sleep. That could be utter nonsense but I thought there could be no harm in trying something different, since if it didn't work I could always go back to auto. So far, though, it seems to be working okay. I don't mind allowing one or two CAs per night in exchange for generally better sleep. So I'll leave it alone for a while and report in again in another week or two.
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#3
RE: Auto to manual BPM experiment
Interesting stuff, and can't argue with the results. It would be interesting someday to do another trial on auto mode and see if the problem persists. Don't change anything to satisfy my curiosity, you seem to be doing all the right stuff.
Sleeprider
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#4
RE: Auto to manual BPM experiment
(08-31-2017, 09:28 AM)Sleeprider Wrote: Interesting stuff, and can't argue with the results.  It would be interesting someday to do another trial on auto mode and see if the problem persists.  Don't change anything to satisfy my curiosity, you seem to be doing all the right stuff.

Yes, I intend to do just that at some point. Before I do, however, my plan is to keep dropping the BPM and observe what happens. In theory, more CAs should start appearing, but you never know. As long as I'm getting decent sleep overall, I enjoy making this my science project. It just occurred to me, however, that I've already spoiled it by introducing another variable: taking an herbal supplement at bedtime. But I'll start another thread about that.
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#5
RE: Auto to manual BPM experiment
Update: I'm still on BPM=7 instead of auto. I haven't made any more changes except to raise EPAPmin from 8.5 to 9, a few weeks ago. The reason for not making any other changes is because I was also experimenting with herbal supplements to help control cortisol, so I didn't want to have too many variables in play.

At any rate, my average AHI since my last post in this thread is 1.1, which is lower than my average for the previous year, which was 1.4. At the very least I can say that going from "auto" to BPM=7 hasn't made anything worse, in terms of either AHI or how I feel. I expected to see more centrals, because the BPM setting would be a little less aggressive than auto, but that hasn't been the case. I had one night with 2 CAs and 1 OA, at AHI=1.5, and a couple of other nights with one CA, and that's about it. This isn't much different from what I was seeing on auto, i.e., a few CAs a month.

Next week I'll try BPM=6 and see what happens.
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#6
RE: Auto to manual BPM experiment
Looks like very positive results and encourages spontaneous breathing. With BPM set at 7, what is your actual median respiration rate now? Has it changed much from when you used AutoASV?
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#7
RE: Auto to manual BPM experiment
(09-22-2017, 08:39 AM)Sleeprider Wrote: Looks like very positive results and encourages spontaneous breathing.  With BPM set at 7, what is your actual median respiration rate now?  Has it changed much from when you used AutoASV?

No, it hasn't changed at all. It's still at about 14.5, rarely going below 14 or above 15.
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#8
RE: Auto to manual BPM experiment
A quick update after several nights at BPM=6.
AHI remains unchanged, still averaging about 1.0, but my duration of sleep has increased from 7:20 hours to 8:00. This could be a fluke but I have to say I almost never sleep eight hours anymore and now I have three nights in a row. I'll continue the experiment and see if I continue to get that extra sleep time, which feels very good.
There have been no centrals.
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#9
RE: Auto to manual BPM experiment
Yet another update: I'm still on BPM=6, for 13 consecutive nights now. Averave AHI for those nights is 1.0, which is just slightly lower than what I was seeing with BPM=7, and probably not a meaningful difference. There have been five centrals in the 13 nights, never more than one per night. All of them have been in the final hour before waking up.

The purpose of this prolonged experiment has been to see whether I could get longer, more restful sleep without seeing much or any increase in AHI, by setting the ASV to be less aggressive. So far, I am seeing somewhat longer sleep duration, and a modest reduction in AHI. As for restedness, it's not so clear. There are still days when I've had eight hours of sleep and AHI below 1, but I feel poorly rested. Since my titration study reported significant PLMs and spontaneous arousals, I suspect these are degrading the quality of sleep, at least sometimes. And since the SAs were clustered around one particular EPAP pressure, I have to wonder how spontaneous they really are.

I'll probably drop BPM to 5 this weekend and see what happens. I suspect, however, that my sleep architecture is suboptimal for reasons that are independent of apnea.
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#10
RE: Auto to manual BPM experiment
@tmoody

I'm following your thread with great interest, increased by the likelihood I'll be getting an ASV myself soon.

Thanks for sharing your experiment.

Bill
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