[CPAP] Beyond ASV with Overlap Syndrome!

[SarcasticDave94]

Probably Alexa told on me...

I'd be doing my own settings whether or not she showed me.

[Gideon]

But Dave, if you do that you might DIE!  
Returning the sarcastic moniker to its rightful owner.

[SarcasticDave94]

No worries bonjour. We all have an inalienable right to sarcasm some time each day.

With a NIV I might even inflate a lung or something.

[SarcasticDave94]

FWIW sleep study upcoming 10/16/20 and doc follow-up 11/6/20. This seems slow, but if I were still under the other pulmonary care office, we'd be talking a few months out to discuss and then more time to plan, get the sleep study, and then to detour and avoid helping the patient.

[SarcasticDave94]

Cap'n Obvious; log entry 10/17/2020 0807 Eastern Time.

I've been back from the newest of the sleep studies. I know zero results, but tech said she was running a Respironics machine that she'd go through CPAP, BPAP, ASV...not sure of other modes but it does not sound like any mode like AVAPS was on the plate. But I have info from the Nurse that set this appointment that AVAPS is the direction she's headed with an ASV failure on person with Complex Apnea and COPD. So I'm certain we're headed that way.

I had to use 1 Ambien just after the wires and belt hook-up and just before the eye exercises, etc upon lights out. I think I was out in about 10 minutes, fast for me.
A few brief awakenings of a few seconds, but nothing much to blip the radar. I was awakened by the tech via audio intercom at 6 ish. Lights out was 2130-2200 as best as I remember. Now I wait to get to see the doc slated for 11/6/2020 0915.

The tech was curiously suspicious on how I knew what settings my ASV has and why I'd know timing controls are missing. I mentioned I had to find and set the ASV myself as the RT at Apria told me she had to guess at the settings.

I used an F&P Simplus M for the first time ever. It's a nice full face, and I got to keep it. COVID means that they throw the whole mask away or give it to the patient who used it.

Twas cold this AM at 34 degrees a bit earlier. First place Dave stops at after the study, Sheetz for coffee. Good AM all.

[SarcasticDave94]

FWIW here's summary of sleep study, and I will request full copy next Friday 10/28 when I have doctor follow-up. The summary does show the sleep tech as choosing only 3 combinations of pressure settings, settling on one that netted 7 AHI and said that's the best her Philips could get. My ResMed ASV was getting me to ZERO AHI, or 1-3 consistently on my settings. Anyway, there's some issues I'll be combatting. Feel free to comment.

Some things I see that are issues are not treated at pressures, no N3 sleep, lots of arousals but not PLM based, there's probably more stuff. I will be taking the ASV with me to show that I know what settings I can and cannot access. The tech was disturbed that I set my own machines and questioned that I knew what I was talking about. Meh, so what. I did have 1 5mg Ambien as one and done for the tes; explains the quick transition to sleep and may be why I slept OK, otherwise it's hours as it was pre-ASV.

Certainly I will not accept this poor result as anywhere near acceptable nor treated.

My ASV settings that has been used with great results:
EPAP 8-13
PS 3-15
IPAP then is 11-28
Backup rate algorithm configured automatically, as are all other timing controls; trigger, cycle, etc.


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[Sleeprider]

You don't have the backup rate and Ti Min with Resmed, so this must be a Philips testing device. If you get comparable or better results with Resmed ASV, then that issue is moot, and you can see AHI ranged from 7.0 to 32.0 which is pretty bad. Higher PS max was associated with better results for this test.

As usual, the test used standardized titration protocols and any questions about overlap syndrome or the efficacy of iVAPS remains undetermined. I would not consider AHI 7.0 to be a good result.

[RayBee]

I will be taking the ASV with me to show that I know what settings I can and cannot access. The tech was disturbed that I set my own machines and questioned that I knew what I was talking about.

Backup your SD card of the ASV before they delete or corrupt the data for you... Free of charge service of course.

[SarcasticDave94]

Thanks for chiming in folks.

Agreed, I can beat their best with my settings, a consistent below 4 AHI but the lack of timing control is where my Overlap issue lies. I am not too surprised but am very disappointed they only tried 3 combos of settings, and all results are bad.

Don't worry RayBee, they probably won't even get the chance to touch my SD or ASV. I'm just taking it along to show what settings do exist, none of which are timing.

If anything, they proved I can self titrate better than they can. And yes the tech said hers was a Philips, so assumed to be Respironics. The main reason I slept OK was the Ambien, as I have bad insomnia, sleep onset is hours now as it was in 2017.

I may have to take Friday off and not comment here, I may be in a mood to Nuke someone. I knew there would be snags, and it was definitely the right move to change pulmonary offices, so no regret or second guessing. I was not getting any further with the last one with constant new answers that tended to involve what I must have been doing wrong. As is, I was going to change medical teams when I began to fight for the ASV in '17, so this battle is not unexpected.

AHI 7 and lots of arousals are not close to acceptable. CPAP/APAP won't cut it. BPAP without backup no way, it will increase CA. ST nope. So which AVAPS are we going with? ResMed is it, I will refuse Respironics.

[SarcasticDave94]

small interesting-ish blip, new DME calls today to say they received a doc order for a new ASV. The RT will call when I can show up so we can set it up. I did mention that the nurse in charge of my case said we needed AVAPS not ASV anything. Doc has yet to agree however. I did mention if the ASV is rented, I see it being returned soon to get AVAPS. She could not verify brand. OK Dave needs to drive around for a ride anyway. As is, I got 90 minutes use last night on subpar new doctor settings, and the old workhorse ASV says AHI 0. I need to load it onto OSCAR and see the stats. Starting EPAP 4 PS 0 Dave was starving for air.

I did a CT scan today for pulmonary diagnostics to see if lungs recovered from pneumonia last July. Scarring noted, some areas look odd they say, there's definite evidence of airway resistance.

The 90-ish minutes of OSCAR. I don't see anything to mention really. Of course therapy time is too short. All the pressure numbers are off the mark. I was starved for air, possibly the reason for ripping the mask off. The ASV time is off as I forgot to set it. These issues will be noted as symptom/complaint that Dave's ASV therapy is not working towards restful sleep. It's actually a source of sleep disruptions instead.

BTW the newly gained mask F&P Simplus was used; great mask. Better feeling than my ResMed F20 AirFit. Both medium cushions.

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