Help with optimizing PAP for 85-year-old

[SarcasticDave94]

I think your OSCAR info is there but scattered a bit. Can you repost it with top to bottom, Events, Flow Rate, Pressure or mask pressure, Leaks?

Flow Limits in the ASV I've found to be space wasting on the charts as we really can't address them. Just ignore FL. There's always likely to be some.

With Hypopnea activity, I think EPAP Min needs bumped. You're at 4 now? Try 5 EPAP Min. and see what shows.

[QuestionableQuerant]

Whoops...

Attached screenshots A and B (of ASV session) updated to include Event Flags, Flow Rate, Pressure, Leak Rate, and Respiratory Rate.

Attached screenshot C (of possibly relevant APAP session) updated to include Event Flags, Flow Rate, Pressure, Leak Rate, Flow Limitations, and Snore.

[SarcasticDave94]

No problem, that OSCAR order was my personal preference to tune my ASV when I had it.

OK, try EPAP Min. 5 and see how it goes. My experience with ASV was I'd notice both a difference in events and feel within the first night of the edit.

[QuestionableQuerant]

Thanks, Dave.

For tonight, we'll lower min PS back to 3 (from 4) and boost min EPAP from 4 to 5. I'm also inclined to increase max PS from 14 to 15 as it seemed that the ASV maxed out on PS last night when responding to a few of his hypopneas.

As I recall, Sleeprider also suggested increasing min EPAP by a tick...but I let my curiosity get the better of me that evening and might've overdid it a bit (having increased it to 6 cm rather than 5...to mixed results).

I still can't help wondering whether the hypopneas are, at least in part, of central origin. But, I suppose there's only one way to find out - by first trying to treat for obstructive, which requires raising min EPAP (is that correct?).

Anyhow, I'll post an update either way early next week. Thanks again - have a great weekend.

[SarcasticDave94]

Yes raising EPAP Min. should address Obstructive Hypopnea. I doubt you'll get much Central activity as Apnea or Hypopnea.

Just be careful to try limiting to one edit at a time so you can pinpoint the results were from a single edit of X.

[Fabby]

You are an awesome son! In the end, the patient has to tell the doctor what they need or want and you have done just that for your father. I’ve been following this thread and can’t wait to hear he’s improving, both sleep wise as well as the smaller things.

One other thing I read is that there are some leaks. Get him some REMZZZZ liners. They made the difference in leaks for me. Best of luck. You have a Dad from the Greatest Generation!!!!

[QuestionableQuerant]

Thanks, Fabby, for your note and your suggestions re: leaks. One thing that seems to be helping is regularly using his machine's native mask check utility to optimize fit. Not to jinx anything but so far, so good.

His sleep is much improved from what it had been since switching to an ASV, but there is one remaining concern, which I'll touch upon in a separate post.

Take Care.

[QuestionableQuerant]

Dave/Sleeprider,

First, the good news: dad's sleep has improved and his events seem far better controlled, overall.

However, he continues to experience periodic clusters of hypopneas (w/apneas occasionally sprinkled in), which, given their timing, I suspect are largely confined to his pre-REM sleep. Perhaps unsurprisingly, we often saw similar event clusters while he was still using APAP; however, those clusters were typically categorized by his APAP as CAs - but, every so often, as OAs. In addition, the clusters would occasionally be flagged by his APAP as CSR periods but could've been, in reality, more generic episodes of periodic breathing.

I've attached 3 screenshots. Screenshot "A" is an overview of Sat night (min EPAP = 5), "B" of Sun night (min EPAP = 6), and "C" a zoom-in of Sun night's hypopnea cluster. With the exception of min EPAP, the settings for both Sat and Sun night were the same (max EPAP = 12, PS of 3 to 15).

From what the screenshots show, is there any way to tell whether last night's hypopneas were more likely central or obstructive in origin? Further, is there anything that jumps out that suggests one pressure adjustment or another - to either EPAP or PS - might be helpful in limiting or managing? Or, is the clustering one of those things that'll sometimes just happen regardless of pressure settings?

Thanks again guys for all your help.

[QuestionableQuerant]

*** quick update ***

Looks like min EPAP (i.e., obstructive events) may have been the issue after all - as Dave and Sleeprider have been trying to tell me for days.

Boosting min EPAP to 8 seems to have helped to reduce his hypopneas, particularly clusters occurring when he first falls asleep.

Also, while I understand that OSCAR's flow limitations graph may not be as relevant for ASV as other types of xPAP, I noticed that the timing of the limitations tended generally to coincide with the presence of the hypopneas - also suggesting that they're obstructive in origin.

I'll continue to monitor his sleep data and (carefully) boost min EPAP, if needed.

Thanks again, everyone.

[quiescence at last]

Outstanding night! I would keep the setting at current for a while to see if that is the new normal resulting chart.