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Everything is a UA (Help with ASV settings)
#11
RE: Everything is a UA (Help with ASV settings)
You could just fix EPAP at 5 and use 3-15 PS. As I said, I'm hoping we tame the obstruction with positional aids. The worst that can happen is it doesn't work. If events increase with a low EPAP we can at least learn the obstructive element needs more pressure. On the other hand, if we reduce AHI, then we learn the PS is key.
Sleeprider
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#12
RE: Everything is a UA (Help with ASV settings)
Numbers look much better today.  Can't say that I do, but the numbers improved.


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#13
RE: Everything is a UA (Help with ASV settings)
Well this helps us to understand that the higher event rates arose from central apnea rather than obstruction, and that is a huge insight. The lower minimum PS may also have helped reduce events, but the higher peak PS is apparently important in your therapy to overcome CA and trigger a breath. The flow morphology is still nothing to write home about, but at least you're breathing and the long apnea have gone away. The desaturation at 00:35 might merit another closer look. I don't think this is fully optimized yet, but i think you should repeat this to be sure it's real improvement. Let's reduce max EPAP from 15 to 7.0. I'm hoping we can develop some supporting data for you to discuss with your doctor. I think it's fair to say from both a comfort and efficacy POV your initial settings were not good.
Sleeprider
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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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#14
RE: Everything is a UA (Help with ASV settings)
I want to comment on your Oscar charts and hopefully make them easier to interpret. You're doing a very good job, but the charts would be improved with some "dotted line" additions to the flow rate and SpO2. You can right-click the left margin of any chart to change the Y-axis defaults or to add a dotted line. Add a dotted line at zero for the flow rate and at 88% for SpO2. These help us identify inspiration/expiration transition and critical oxygen saturation threshold respectively. This is illustrated near the end of the Organizing Charts wiki here http://www.apneaboard.com/wiki/index.php...ganization
Sleeprider
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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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#15
RE: Everything is a UA (Help with ASV settings)
Thanks again for looking over everything. I will get the dotted lines added. 

Despite the numbers being better last night, my sleep was horrible. I think it was from the PS ups and downs waking me up. Regardless, you are very correct, the numbers the doc set were no where near what I needed. I know I have centrals, that’s actually what prompted me to pursue the testing. The docs focus has been OSA but I really think the centrals are more of an issue. At least I have the correct machine for the job and don’t have to fight that fight.
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#16
RE: Everything is a UA (Help with ASV settings)
The most recent results give us tremendous insights. Your problem with sleep quality is going to be partially adaptation to the ASV and perhaps we can find a way to make it less disruptive. That seems to be the challenge, and we had to learn that in order to progress. One trick you can try when you awaken and find the machine is in full blower mode is the "blow-back" technique. A number of ASV users have used that to improve comfort and regain control over the respiration rate and volume. It's simply a forceful exhale and letting the machine know you're back in control. The other thing is, we have defined your problem! It is comfort. There isn't much we can do about your need for high maximum pressure support, and I suspect any reduction we attempt will diminish effectiveness, but that is eventually where we will go. The plan is to work towards finding the minimum EPAP pressure and minimum PS Max that can keep you out of hypoxia.

We want you to have strong support for your next doctor appt to be able to clearly show the effective EPAP range is much lower than he had guessed. This leaves room for more PS which works, but is disruptive to your sleep. That set of facts will enable you to work together to find better solutions.
Sleeprider
Apnea Board Moderator
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____________________________________________
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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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#17
RE: Everything is a UA (Help with ASV settings)
Your insights are much appreciated Sleeprider.

Attached is a zoom of the 0035 SpO2 drop with dotted lines turned on. 

It is definitely going to take some time to get used to using the machine but hopefully not too long.  Sleep would be good.
The central events were my concern going into this.  As much as I don't like the PS changes, I agree that there probably isn't much play room there. Will cross that bridge when we get there.  For now, I adjusted the EPAP max to 7 as you recommended and will post the results in the morning.  Wonder if the doc will look back at his notes from day 1 when I told him I was having some impressive centrals (way worse than what is happening now)...  


Bob


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#18
RE: Everything is a UA (Help with ASV settings)
Not horrible last night.  Actually fell like I got a bit more sleep too.


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#19
RE: Everything is a UA (Help with ASV settings)
We have to consider that progress. The UA events are still a concern because nothing gets through. The encouraging part is there are several long periods of quiet breathing with relatively low PS. If we can find a way to make that the more common therapy mode, you would probably be happy with the results. We have learned higher EPAP does not stop the UA events, but higher PS seems to significantly reduce them. I'm tempted to try PS min 2.0 and PS max 16.0 to see if we can further reduce initial CA or UA events, and then treat them more assertively when they occur.
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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#20
RE: Everything is a UA (Help with ASV settings)
Progress in the forward direction is always good.  I'll adjust the PS and see how it does.  Will post the results tomorrow.

Thanks again for the help.

Bob
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