Chart Envy

[Sleeprider]

The square wave is how the ST produces pressure, because it has no EasyBreathe ™ like the other machines. The Airsense 10, Aircurve 10 S, Vauto and ASV all have the classic smooth wave form of EasyBreathe that is more comfortable. I see in your breathing constant machine assisted breaths that are flat-topped, so actually it is working like a ST and providing "functional" therapy. It's not great but your doctor may see it a good-nuf. There is something much better around the corner, and you know what it is, so I won't get tedious with telling you there is a better option. Compare your respiratory flow rate and wave form with your previous machine with EasyBreathe. Is is more rhythmical and rounded and even where events are not occurring? Comparatively, are you more comfortable on ST? These are important questions to consider whether ST is for you or not.

[Technopauper]

Thanks Sleeprider,

Last night I did another refinement mid session, reduce the respiratory rate down to 9, as it felt like I was breathing too fast and this made it much more comfortable.

I'd have to say I'm feeling much better again today, could be a few low AHI days (without naps) after a rough spell or could be better treatment, time will tell.

Looking at a zoom in of last night (during events) and an example of a previous good night (during events) I'd have to say that in last nights example the breaths (before and after) seem much more regular but more angular as you said? Read anything else ?

My summary for now, the puff or throttle blipping is partially working, the binary nature of the breaths is pretty unpleasant but getting better and it looks like it is partially treating meaning ASV will be much better at treating - what is my argument for getting ASV is what I need to think about ?

Rob

[jaswilliams]

My summary for now, the puff or throttle blipping is partially working, the binary nature of the breaths is pretty unpleasant but getting better and it looks like it is partially treating meaning ASV will be much better at treating - what is my argument for getting ASV is what I need to think about ?

The argument for the ASV

The puff is only partially working 
The on off of the breaths is unpleasant/uncomfortable
I get a puff even when I don’t need it
My resultant flow is pretty irregular and unnatural


Jason

[Technopauper]

Thanks Jason,

Just went back through stats, since being fixed at or around 17 fixed pressure, almost 6M !

- I have only been 'treated' (>5 AHI) on 75 of last 174 nights - 43% of the time
- CA accounts for on average >70% of events of those nights

+

- The puff is only partially working, it starts a breath sometimes but misses the ones that are showing up 
- The on off of the breaths is unpleasant/uncomfortable - on / off versus an increase to what I need to start
- I get a puff even when I don’t need it
- My resultant flow is pretty irregular and unnatural

This helps, using this as my log..........thanks

Rob

[cbombzzz]

Sleeprider and Bonjour gave me amazing advice to get me from a CPAP machine to a
BIPAP, and finally to an ASV machine. My complex sleep apnea could only be resolved by going the ASV route. I'm consistently getting sub-1 AHI numbers now. I also switched from nasal pillow mask to the WISP and love it.
I'm still experimenting as to what get's me the best results. For example I slept on my back all night last night with my cervical collar and had my first AHI above 2 since I changed to the WISP mask. tonight I will try for all night on my side.

C

[Technopauper]

Bit of an update from me, ST and its settings seem to be working as well as they can ?

Last night was 0.14 but heavily sleep drugged, as you can see the last 10 days I've been on ST have been the lowest AHI I've seen. Breathing still very un-natural but livable.

I'm in night 1 of a large timezone change so will post again in about 10 days but feel pretty remarkable today after a 12 hr zone change !

I spoke to the hospital sleep doc and have a an appointment to borrow an ASV from them (own doc doesn't have a rental) for a trial and an appointment at my regular sleep doc so will hopefully get an ASV prescription from him him and then order from supplier 2 once I know it works for me.

Any words of wisdom for initial set up of ASV when I get there ?

Rob

[Sleeprider]

The ST is apparently working well and by the AHI that is going to be tough to beat. On an ASV auto trial, I would suggest ASV Auto mode, EPAP min 8.0, EPAP max 14.0, PS min 4.0 and PS max 15.0 Normally I would set PS min lower, but this seems to be working on ST. The main difference will be that EPAP will rise if obstruction is detected, and could reach the same EPAP as you are currently using; and with ASV the machine will maintain your breathing rate and volume using variable (adaptive) pressure support. Anyway, the ST results proved me wrong in earlier assertions. I would not have anticipated it to fully resolve the central apnea. It may come down to a comfort difference.

[Technopauper]

Bit of an update from me - 20 nights average AHI is 1.97 on the ST and getting used to the binary breath, however......

Managed to get a lightly used 370 hr Aircurve 10 ASV for only $950 which should arrive in the next few days - there's another couple by the same seller on eBay just now if anyone is looking for one ?

Last night I got a 0.00 AHI, short sleep before an early start by still..... - never thought I'd see that 6 months ago so definitely progress but back home to altitude today so lets see how it does with that usual 'bump' until I swap over next week.

Feeling much better in the last few days, was a 12 hr timezone shift and felt human after only about 3 days this trip so all feels like progress

Rob

[Technopauper]

So saw the sleep doctor yesterday and to say he was unimpressed I managed to get an ASV online cheap would be an understatement - well at least you've prevented this thing from killing someone else would be a reflection of his thoughts !

On ST I have averaged 2.1 over 30 days with my coming home (altitude perhaps) spike only being above 3 once @ 9 so much much better than previous - so great if a little uncomfortable results but feeling very good, best yet.

He was impressed with the results from the ST but wanted to back out rather than move forward thinking that Bi-level was doing its thing rather than back up, the Resmed report he put up on the screen showed send initiated breaths 93% of time and assisted about 5% - saying it really wasn't helping much and that I should try a simple bi level which would smooth out the lumpy pulses that I wasn't liking. I took home a DS Bi Level as they didn't have a Resmed and have just had the worst sleep night for probably 5 months, adjusting down the flex as I went but just felt out of sync with it totally.

His assertion against ASV is that it can cause Kidney damage through CO2, no idea how but this is what he kept talking about, it messing up your CO2.

Meanwhile last week I borrowed and ASV from the hospital sleep doc office with no mention / worry of this and my nearly new one arrived from eBay so I am left with a massive quandary - I have two ASVs, the ST I kept (just in case the biped didn't work) and the bipap....very glad I kept the ST .......


I really don't understand the risks associated with going full rogue and using the ASV considering just how against it he is - off on holiday on Monday, which one do I take ?

Have done lots of googling over the last few weeks and this article spoke to me most

https://www.aastweb.org/blog/pros-and-co...leep-apnea

I don't (know to have) any of the pre conditions but also haven't been tested, I'm an unfit, fat but active 51 yr old with no medical issues or known heart issues and just don't know what to do - going rogue will likely end the relationship with sleep doc which I'm ok with as have the hospital one to fall back on but would really love a number of views on the risks for me of using an ASV if I don't really need it simple engineer terms please folks - really need advice please let me know what you think oh learned ones.....

What would you do and why - I'd really value many views here please to help me decide whether to hook up the ASV or not

Rob

[Gideon]

IMHO the ASV. Looking back over the thread I see occasional really bad Central Apnea, Which I assume was not every day. It also looks like on a normal day any ole CPAP will do you fine with really good numbers.
BUT . . . . . .
When you're BAD you're really really bad. The ASV will mimic the CPAP (APAP) on those "normal" days keeping all pressures down until the Centrals raise their ugly head, and then will stuff them, the centrals, back down into the hole they were trying to climb out of.

Thus the ASV.