How to identify central or complex apneas using software

[biz1219]

Monday, 6/24, I took delivery of a RsMed ASV ventilator.   The attached files reflect the results.   Apnea down, Hypopnea not so much so or up some..   That has happened before.  Subjectively I slept quietly and comfortably.  I did not experience any discomfort from the ASV action.   For the most part, I was unaware of it.

As an aside; I am caught up in DME problems regarding masks.   Masks are far from a dead issue but the next shot at a new different one won't come until November.  I am ready to "kick that sleeping dog" to see if I can stir up some life before November.

Meanwhile the charts should speak for themselves.  I have a follow-up on July 16th.  I do not foresee any non-prescribed changes in the immediate future.  My intent is to update the Apnea Board as progress is made.   Thanks to all for helping and for your support.   Clif / biz1219

Additional data will follow in next post.   See Details from Oscar and copy of Oximeter report to follow.

[biz1219]

In follow-up to immediately previous post - attached are additional details.

clif / biz1219

[SarcasticDave94]

Seems that this mask unfit issue is borderline insanity. No offense intended. No machine can possibly give therapy anywhere near remotely helpful until leaks are resolved, given the very high leak rate noted. This DME must provide a replacement mask that actually fits. If they refuse to replace, maybe consider calling your insurance customer service and get them to assist. If this were myself going through this, somebody is getting a call every day until this is fixed properly. Best wishes for quick resolution.

[sheepless]

IDK how anyone could sleep through that. "quietly and comfortably" no less. you must be a sound sleeper!

those charts aren't likely accurate given the extent and magnitude of leaks. your 95% is also your max at 24 cmw. that's a lot for most people to tolerate for very long. more-experienced members may have more and better suggestions but until you get your mask and leaks sorted, I'd reduce my max ps (apologies to ajack :-)). in fact, doing so might help you sort out your mask issues. in addition, you might actually get some marginally effective treatment out of your machine. your h may be the machine partially treating oa but my guess is they're your body's reaction, fighting the big leaks and all that pressure. for starters I'd try to keep max ipap below 20, even lower until after leaks fixed. personally, I'd drop max ps and I'd either start slowly raising min epap or switch to autoasv with a max epap of about 12 (you could try 15 but with the leaks maybe not) to work against the obstructives. reevaluate once mask/leaks resolved.

[ajack]

I wouldn't change pressure. Like before, you really need those leaks under control. In the settings is a mask fit function. That blows high pressure air, to help you fit the mask. There is also a mask fit link below and mask fit videos on youtube.

I really can't stress the importance of mask fit enough. The leak chart should be the only one you look at. Till everything is under 20, looking along the chart as a first goal.

[biz1219]

ResMed mask fit utililty always comes up just bine but in application leaks persist.   On top of that I have mask issues with DME who recently took over another vendor.  

[biz1219]

Question for other's experiences:

Premise:   The patient is ultimately responsible for mask leaks.    Well - at least sort-of.

Question:   Other than the patient - who is responsible and to what extent?

a.    The DME vendor; or
b.    The sleep lab who issued orders; or
c.     ????   WHO?

What recourse does the patient have?

[biz1219]

28 June 2019:


Good news:  Without exaggeration, last night was the first night in my recorded PAP history to show "0" / zero apnea events.   Probably from a practical standpoint the first time since sometime prior to 1984. The previous night had just "1" / one apnea event.

I do not anticipate "0" every night ; but it is good to know it is possible.

Mask leaks and hypopnea events continue but they are being worked on to the fullest extent possible (including "kicking the dog" to get some helpful action.)

About mask leaks the WHAT is "mask leaks."   No disagreement about that.

The HOW is how to eliminate mask leaks.  That leaves a very big unanswered question.

If leaks persist after:
    ResMed Mask Fit utility says all is okay; and
    After following steps outlined in the Apnea Board's WiKi on the subject; and
    After tightening straps to the point of permanent skin marks; and
    After using masks that leave bloody sores on the nose; and
    Then making multiple adjustments to straps in steps of 1/8" at a time both tightening and loosening and then testing; and
    Then adjusting straps to alter the tilt of certain masks where that is possible; and
    Trying at least four different types, styles and sizes of masks;

    THEN

    WHAT is the next step(s) to eliminate mask leaks?

So far the current DME vendor is of little help (but that is a different story).   There are several manufacturers all offering similar but different masks at about $150.00 US$ a pop.....   I could go broke sampling all of them on my own.  In a separate thread I asked about who is responsible for resolving mask leaks - I have not received any replies to that question.   I think it rests with the patient.

Anyway, I am very thankful the ASV machine is resolving the apnea events.  Wonderful news for me, leaks or not.

I am very thankful for the help offered here on the Apnea Board.

Another question - does any one know if the ResMed ASV ventilator carries memory of a breathing pattern from from one night to the next?  That could be helpful.

Thanks for reading and thanks for comments and answers, they all help.  Best regards,  Clif / biz1219

[sheepless]

experimenting with various pillows and methods of hose management might help. for some like me working to stay off my back is important.

cool to get to 0! sounds like you know 0 is kind of a symbolic moral victory. pleasing to the eye and psyche. I love to see 'em too, even though paradoxically they aren't always my best nights' sleep.

IDK for sure but believe the machines incapable of learning and do not maintain memory beyond a moving last few minutes of flow prescribed in the algorithms'. these may differ slightly according to the algorithm's purpose and target but limited in duration nonetheless.

it does maintain summary data I believe but I don't think that's what you're asking.

[SarcasticDave94]

Question for other's experiences:

Premise:   The patient is ultimately responsible for mask leaks.    Well - at least sort-of.

Question:   Other than the patient - who is responsible and to what extent?

a.    The DME vendor; or
b.    The sleep lab who issued orders; or
c.     ????   WHO?

What recourse does the patient have?

This is my opinion that’s hopefully based on truth and reality:

1. All aspects of masks and leaking are ultimately the user’s responsibility; you wear it, you’ll need to adjust it in a knowledgeable manner. If it doesn’t fit properly, make the DME test fit you for the right mask. That can be a different size or seal type or a different style or even manufacturer/brand. They provided the current mask, therefore they need to correct it by helping you get the correct one. If they refuse to assist, report them to your insurance.

2. The DME is paid to provide the correct equipment. You must keep the fire to their feet to force action. If they refuse to help, FIRE THEM! Shop elsewhere in this case.

3. The sleep lab as you referred to them is to give you a sleep study and possibly to do a titration. They need to create a report on that, thereafter they’re done.

You might not like the answer, but at the end of the whole process, you either make it happen or not. You do your due diligence on making the current mask work via proper adjustments and fitting it with the right sized seal. If it becomes impossible for whatever you have currently, then you’ll need to advocate for yourself. Make the DME provide the correct mask in the right size.