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[Diagnosis] S. Manz - Therapy Thread
#1
S. Manz - Therapy Thread
Here's an analysis of how I think my Aircurve 10 ASV intervenes when I stop breathing. 
Although the event gets registered as a "Hypopnea", these events always seem to start with shallow breathing and end with totally stopping.
(I think) that when I stop breathing more than 10 seconds, ASV kicks in and starts intervening by providing breaths with the same characteristics as my normal breathing.


If you have more experience with ASV and OSCAR analysis than me (which is not hard to do), take a look at my analysis and let me know if I have it right or totally out of whack.
Below is a paste of a 2 minute window analysis and I have also included an attachment , in case my URL doesn't work.

[Image: view?usp=sharing]


Attached Files Thumbnail(s)
   
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_______________________________________________________________________________________________________________________________
 "The power of community to create health is far greater than any physician, clinic or hospital.” – Dr. Mark Hyman
"The job of a great doctor is to keep the patient entertained while nature takes it course"-- A less known physician
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#2
RE: Central Apnea: How My ASV Resuscitates Me When I Have a CSA Event
Really I dunno. And I've still got an ASV sitting around waiting to be replaced with even higher therapy called AVAPS on the $16K or so ResMed Astral 150 ventilator.

I can't answer the question, but I can suggest things about the ASV setup that should make it perform better.

1. Kill the ramp
2. Enable ASV Auto mode
3. Give EPAP a new range of pressure, if you want EPAP 4 min so be it, but add an EPAP Max of 10 or so.

EPAP is the pressure that combats Obstructive Apnea and Hypopnea. EPAP 4 isn't enough or your Hypopnea would be lower.

PS along with IPAP and the ASV algorithm have tricks that combat the CA, which your ASV has taken care of them on this chart.

Oh BTW I follow the idea that zero Apnea in the OSCAR is not the goal for good therapy. Low enough and comfortable to sleep better is what I want.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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.
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#3
RE: Central Apnea: How My ASV Resuscitates Me When I Have a CSA Event
I'm still getting the hang of understanding this myself so I could be off base here- but to me it looks like the shallow breathing / hypopnea are obstructive in nature because your flow rate increases only slightly relative to the increase in mask pressure (pressure support). The machine works breath by breath for pressure support so it doesn't wait to take action. The algorithm is working all the time and your pressure support varies every breath relative to the target minute ventilation. This image shows how it works- the one on top for a central- and the one on bottom for obstructive like I think happened to you. The machine will increase EPAP within the range you have set after detecting obstructive and flow limit events after the fact- so you should be able to see that increase after this happened as a check.  (low/no change in flow rate relative to increased pressure support. ) I hope this helps. 

   
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#4
RE: Central Apnea: How My ASV Resuscitates Me When I Have a CSA Event
(07-24-2021, 11:15 PM)SarcasticDave94 Wrote: Really I dunno. And I've still got an ASV sitting around waiting to be replaced with even higher therapy called AVAPS on the $16K or so ResMed Astral 150 ventilator.

Hello, 
The way I understand it, there's a huge difference between AVAPS and ASVs but they are both meant for therapy whereas machines like Astral are designed for high level "life support",
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_______________________________________________________________________________________________________________________________
 "The power of community to create health is far greater than any physician, clinic or hospital.” – Dr. Mark Hyman
"The job of a great doctor is to keep the patient entertained while nature takes it course"-- A less known physician
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#5
RE: Central Apnea: How My ASV Resuscitates Me When I Have a CSA Event
So I killed the Ram and changed over to Auto ASV.
Had a great night asleep, but my hypopnea events (even though at a very low AHI of less than 3), continue to she the same pattern...shallow breathing and mask breaths kicking in to brake it up.
I think I have hit the "close enough" setting range and will try this for a few nights.
Attached is a 3 minute snapshot with 3 events


Attached Files Thumbnail(s)
   
.
.
_______________________________________________________________________________________________________________________________
 "The power of community to create health is far greater than any physician, clinic or hospital.” – Dr. Mark Hyman
"The job of a great doctor is to keep the patient entertained while nature takes it course"-- A less known physician
Post Reply Post Reply
#6
RE: Central Apnea: How My ASV Resuscitates Me When I Have a CSA Event
Those look to me like obstructive hypopnea also- your flow rate doesn't increase with the increased pressure support as seen with mask pressure. To me that indicates you need a higher EPAP since pressure support can't open a closed airway. You get some flow rate change with higher pressure support when the airway isn't completely closed. If you look at EPAP on the pressure chart and see it increase after these events then you will know the machine interprets it as obstructive and it will increase EPAP some to prevent the next one. So you could try to work up the min EPAP off of 4 and see if you find a sweet spot. Also some folks here seem to suggest 6 is a good min value for an adult. Again I'm no expert - just two week into my own ASV journey and I've been trying to get schooled up myself.
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#7
RE: Central Apnea: How My ASV Resuscitates Me When I Have a CSA Event
How much EPAP do you have dialed in for min and max? Maybe increase Min EPAP to 5 and be sure EPAP Max is about 10. EPAP still isn't strong enough. However, unless these events are ruining sleep, maybe just let them be. Your choice on this, with the end goal to maximize comfort.

As for my stating AVAPS on the Astral for myself is that's what the RT and nurse that's been working on my therapy said we'd need to change over for AVAPS mode on the Astral. One prior RT likes Respironics and their Trilogy, a similar machine.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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.
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#8
RE: Central Apnea: How My ASV Resuscitates Me When I Have a CSA Event
can you post the same area of hypopnea at a 10 minute view scale? adjust the view with the slider at the bottom of the events tab. looking to rule out periodic limb movement as your screenshot has some characteristics similar to a typical respiratory response to plm.

nothing at all wrong with ahi of 2ish but in time with some fine tuning you should be able to get ahi under 1 with asv. otherwise your stats are very good.
  Shy   I have no particular qualifications or expertise with respect to the apnea/cpap/sleep related content of my posts beyond my own user experiences and what I've learned from others on this site. Each of us bears the burden of evaluating the validity and applicability of what we read here before acting on it.  
 
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#9
RE: Central Apnea: How My ASV Resuscitates Me When I Have a CSA Event
(07-25-2021, 11:55 AM)Mike L Wrote: Those look to me like obstructive hypopnea also- your flow rate doesn't increase with the increased pressure support as seen with mask pressure. 
Trust me , they are Hypopnea events just like detected. (I have had my wid=fe watch me with a timer).
We went through this diagnostic last year with my doctor. My CSA events start by my breathing slowing down very rapidly to zero, then I don't breath at all for upwards of 30-45 seconds at a time before my body awakes and I start breathing (rapidly at first, without a machine). The ASV has reduced these events to incredibly low numbers, and 10 seconds is the mas I go without breathing on the machine...This is a massive improvement for me.
I have practically no obstructive events and zero snoring. (again have had my widfe watch me as well as setting up an entire night video recording of my sleep).
I just stop breathing. Period......>>>>> Central Apnea.
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.
_______________________________________________________________________________________________________________________________
 "The power of community to create health is far greater than any physician, clinic or hospital.” – Dr. Mark Hyman
"The job of a great doctor is to keep the patient entertained while nature takes it course"-- A less known physician
Post Reply Post Reply
#10
RE: Central Apnea: How My ASV Resuscitates Me When I Have a CSA Event
(07-25-2021, 12:53 PM)SarcasticDave94 Wrote: How much EPAP do you have dialed in for min and max?..............

It is a ASV machine. It calculated IPAP breath by breath.
My EPAP MIn/Max is 4/8
Calculated IPA is between 6 to 15 (what machine calculates for delivery on each breath)
These are the highest settings that I can get some sleep with. Any more and I keep waking up, not being able to handle the pressure in my face.
Last night was great.
.
.
_______________________________________________________________________________________________________________________________
 "The power of community to create health is far greater than any physician, clinic or hospital.” – Dr. Mark Hyman
"The job of a great doctor is to keep the patient entertained while nature takes it course"-- A less known physician
Post Reply Post Reply






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