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Chart Envy
RE: Chart Envy
I did wonder about the term quack btw, must be wakening up :-)

https://en.wikipedia.org/wiki/Quackery

I certainly wouldn't put my sleep doc in this category, as whilst I really value and have largely followed the views expressed here, my step change in treatment happened by his recommendation of setting of a single pressure at 17 which I was hugely reticent of doing at the time. The fantastic advice and help received here has allowed me to better understand (now 10% versus 0% maybe??) apnea as a whole and my specific issues and therefore question in a more informed manner meaning working towards optimum treatment so for me its very much both rather than either / or. 

Rob
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RE: Chart Envy
Sorry.....and another thing :-)

Jas - having tried both and ST and ASV, how would you describe the difference in how the treatment feels and perhaps how different you felt with ASV versus ST - trying to better understand why you went ASV if ST also treated your apnea ?

I will now stop spamming my own thread !

Rob
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RE: Chart Envy
(02-21-2019, 01:44 PM)Technopauper Wrote: Sorry.....and another thing :-)

Jas - having tried both and ST and ASV, how would you describe the difference in how the treatment feels and perhaps how different you felt with ASV versus ST - trying to better understand why you went ASV if ST also treated your apnea ?

I will now stop spamming my own thread !

Rob

First a typical graph from my Autoset AHI of 10 a good night a bad night would have an AHI of 30 all clear airway in a very tight time frame, zoomed in on the flow you can see the periodic breathing during REM sleep

   

The blast of air from the ST on every breath was like being kicked in the teeth when I first tried it I raised the rise time to 300 ms to make it comfortable i was on a 30 day trial it reduced my worst night AHI from 30 CA’s to about 10 Hypopnoea.To get better results than that I would have needed to increase the pressure support further from the 8cm of pressure support prescribed.

Graph of the ST treating my periodic breathing you can see the square pressure waves and how it tries to create a breath but fails causing the chair shaped flow limited breath AHI was 12 on this night

   

An ASV follows your breathing it raises the pressure support from 3 to 15 if needed and does nothing at all other times. At the start just as you are about to fall asleep the ASV thinks you are stopping breathing and gives you a blast of air, it’s disconcerting and wakes you up. Using the blowback technique causes the ASV to backoff for 3 minutes and by that time I am asleep.

ASV graph AHI 0.0 you can see the blue mask pressure line raising upto 15cm to fill in my breaths, the pressure form is curved and very comfortable, you can see the effect on the flow graph, the ASV is trying to keep the flow volume the same, the flow is reduced in some areas but no desaturation

   




I hope this is useful I have also attached a summary of my full treatment history just so you can see my treatment history, the initial purple is CA's on an Autoset the Blue AHI rise during August was the 30 day trial on the ST, before that and after was on a self purchased Resmed S9 VPAP Adapt

   


Jason
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RE: Chart Envy
(02-21-2019, 01:27 PM)Technopauper Wrote: Jason - updated the format, charts attached

I am not sure that the pressure support of 4 provided by you machine in its current configuration is sufficient to treat/reduce your CA's, normally on an ST maachine the PS needs to be nearer 8 to treat the CA's.


Your EPAP is 15 and IPAP of 19 giving a value for PS of 4, you can see from my graphs on the ST the EPAP was 4 and IPAP was 12 so a PS value of 8.
I would think you EPAP would need to be reduced further to provide adequate treatment with the ST I would need to look back through your graphs on the autoset when in auto mode to guess a better EPAP setting.
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RE: Chart Envy
Bingo - same trend ! You say this is periodic breathing I guess meaning that on bad CA nights I only breath periodically when in REM sleep ? These do tend to alway happen later in the night so maybe explains ?

Current support of 4 seems (2 nights only) to have gotten rid of centrals and replaced them with a few Hypos

In your long term trend there seemed to be a long period before you tried the ST with minimum AHI ? What made you want to try it ?

Rob
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RE: Chart Envy
(02-21-2019, 02:52 PM)Technopauper Wrote: In your long term trend there seemed to be a long period before you tried the ST with minimum AHI ? What made you want to try it ?

Rob

The ST cannot score a Central nor an Obstructive apnoea a full apnoea will show as green UA Unknown Apnoea or partial reduced flow Apnoea as a Hypopnoea.



I bought my own ASV as that was outside of the NHS here in the UK, my consultant is unable to prescribe an ASV without a BiLevel with backup rate trial this was that trial. So it was a 30 day loan under my Dr’s order, the prior period is the time it takes to get anything to happen which is why I went off plan and bought my own ASV used imported from the states for $800us


If the ST was successful I would have kept the machine free of charge and used it, instead I went back to the ASV I have since hade my 3rd overnight study this time using the ASV but never got the results but I know it is successfully treating me. When I have a follow up next June I may get a prescription for a NHS supplied ASV I might not who knows
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RE: Chart Envy
The ST cannot score a Central nor an Obstructive apnoea a full apnoea will show as green UA Unknown Apnoea or partial reduced flow Apnoea as a Hypopnea.

Here is a zoom in from last night, so the unknowns actually look like centrals ?

And the hypo apneas look to me like centrals ? Which would be treated by more support ? IE dropping the EPAP pressure ?

Either way though only 2 central events during the night is pretty good compared with my bumpy 'central heavy' last couple of weeks so maybe the ST is working, as you say if so then and ASV will simply work better.

Right will let you get back to your life - will post again in a few days after I see if there is a trend

Thanks for all this, its becoming less muddy......

Rob


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RE: Chart Envy
Either way though only 2 central events during the night is pretty good compared with my bumpy 'central heavy' last couple of weeks so maybe the ST is working, as you say if so then and ASV will simply work better.

Ignore that comment, as you already said the ST can't classify and they look and 'quack' like centrals where the ST is 'blipping the throttle' to try and start a breath (unsuccessfully) ?

Rob
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RE: Chart Envy
Rob, do you see that square-wave mask pressure? How do you like it?

I'm sorry for inferring the doc is a quack, but his approach just made no sense to me. After he has wasted another month or two with this misadventure into ST, you might see why I was hasty to jump to such a rash conclusion.
Sleeprider
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RE: Chart Envy
Sleep rider - I really don't know what the square waved mask pressure means, if you mean the step up and down in pressures then I must say I'm not a big fan........

How does the zoomed in trend look to you - look like centrals with a 'blip of throttle' in the middle if the flat bit ?

If so then likely my foray into ST is likely a failure as you say - anything I can do on settings to make it work better until I get the prescription / buy an ASV ?

Should I be concerned about the shorter IPAP times I'm seeing with the ST ?

Rob
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