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Looking for guidance on new Aircurve10 ASV
#21
(03-12-2017, 04:39 AM)holden4th Wrote: I've followed the ASV threads for the last few months with some interest. I'm getting the impression that a BiPAP/ASV machine would provide everything needed for therapy. I'm looking at Storywizard's data and it's awesome. While my therapy on APAP is working it's not optimal and I'm thinking about buying an ASV as my first machine (with the APAP as a back up). I can't lower my RERAs and these can last for over 30 seconds. I've raised pressure to 13 min (my titration recommendation) with a 20 max. I believe it's the RERAs that are compromising my overall sleep.

The ASV is an amazing machine when matched up to its intended purpose of resolving complex apnea, periodic breathing and central apnea arising from a variety of causes including opiod use and even congenital issues.  From what I have seen, you do not match any of these issues, and I completely disagree ASV would be a benefit to you.  I do however think auto BiPAP could resolve your issues well, particularly RERA.  If you want to target RERA a PRS1 BiPAP Auto 760, or Dreamstation 700 would likely be better than the Resmed options in bilevel (VPAP) do not currently report RERA and do not offer variable pressure support.  You might want to take this up in a separate thread since this one is focused on mymontreal.
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#22
(03-11-2017, 09:39 PM)storywizard Wrote:
(03-11-2017, 08:48 PM)mymontreal Wrote: So I continue to be a bit baffled by the data that I am getting from any of these machines... 

Suffering pretty badly with Aerophagia/bloating on the AirCurve10 (and also previously on the AirSense10 APAP), so given that I'm not really seeing any events, I am continuing to wind down the pressures...

Last night and the night before, I'm seeing ZERO OA/H events - which is GREAT, I'm just not sure I understand why...

Last night for the first time my aerophagia/bloating seemed to be very manageable (as I have been able to reduce EPAP and PS quite a bit)  Smile

However, my pressures are very low now, so how am I achieving such a fantastic result... My EPAP range is now down to 4.0-7.0 and I've reduced my Pressure Support down to 0.00-6.00...!!

If I look at the SH graphs for last night, the PS seems to continue to be very active throughout the night - Yet from everything I read, Pressure Support is really only effective in forcing someone to breathe, between about 8.0 and 12.0...

I am definitely a little bit less exhausted Today (for which I am truly grateful), but I continue to wonder what type of sleep apnea problems I have, considering the data that we have been seeing...

Is Max PS of 6.0 (leading to Max IPAP of 13.0) really sufficient to resolve all of my CA events... ?

[url=[Image: WtKNtxVm.png]][Image: WtKNtxVm.png][/url]

Guys, I'm honestly not complaining, I just don't really understand the data that I am seeing... Smile

Regards
Mike

Hi Mike...
When I was just starting ASV treatment I found this PDF very useful....
http://carolinasleepsociety.org/document...of_asv.pdf

Storywizard

Thanks Storywizard

Yes when I was researching ASV technology during the week, this PDF from the Carolina Sleep Society was the best that I found - it is a bit outdated, but it does indeed clarify some of the basics.
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#23
(03-11-2017, 08:54 PM)Sleeprider Wrote: It's good you continue to work with this.  Your pressure support levels are indeed lower than most, but as long as they "kick start" your inspiration, they are doing all they need to.  Your OA was never that severe, and the EPAP is keeping your airway patent.  Life is good. The machine doesn't lie   Smile

I'm looking forward to when you break the news to your doctor.

Hi Sleeprider

I agree that my current OA doesn't look bad at all - just a bit bizarre, when you consider that 5+ years ago when I had all my overnight sleep studies, there were no centrals in play and EVERY time, my OA was considered to be pretty severe, with AHI values of 30-60, even AFTER UPPP surgery...

Who knows... I'm certainly not complaining... Smile
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#24
Hi Mike,
In my case, my first Dr said that based on my first sleep study I had severe Obstructive Apnea and began treatment for that condition. If I continued to focus on that original diagnosis I would have thrown my APAP machine in the lake by now. As SR says your machine is not lying. Keep working on your fine tuning for aerophagia but otherwise I think your results are spectacular.

Rich
Apnea Board Member RobySue has posted a Beginners Guide to Sleepyhead Software here:  http://www.apneaboard.com/wiki/index.php...SleepyHead

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#25
Hi All

I am continuing to make good progress with my Aircurve10 ASV machine but still struggling with painful episodes of Aerophagia/bloating, that wake me up multiple times during the night...

My current machine settings are 

Min EPAP = 1.0
Max EPAP = 5.0 (seems to be the minimum I can set)
Min PS = 1.0
Max PS = 6.0 (seems to be the minimum I can set)

These settings seem to yield an IPAP range of 6 - 11. 

Despite the very low EPAP settings, I am still seeing almost nothing in the way of obstructive events, but the pressure support is pretty active all night long.

If the pressure support was only kicking in occasionally (to deal with occasional CA events), I would probably be ok with a Max IPAP of 11, but my pressure support appears to be active throughout the night (presumably in response to large # of CAs, or more likely, periodic breathing), so I appear to be spending much of the night at IPAP = 11 and it's just too much for me from an Aerophagia/bloating perspective...

(I do know from previously being on the Airsense10 APAP that a pressure range of 5-8 did not cause any aerophagia problems, so I'm hoping that I can find a way to wind down my ASV pressures a little further...)

I know I am probably an OUTLIER in terms of seeing a benefit from very low ASV pressures, but I think I am moving in the right direction... ?

I was originally diagnosed with pretty severe obstructive apnea, but now suspect that I was either mis-diagnosed, or have some weird complex-apnea situation that seems to be controlled by a pretty low level of continuous pressure support...

Anybody have any thoughts... I know I'm probably not a typical user...  Big Grin

I may take a look at the settings in the machine's MANUAL ASV mode tonight and see if I can find a workable combination that will reduce the pressures a bit further...

Attached are Sleepyhead graphs from the last few nights (I think IPAP was slightly higher on the first one, but only marginally).

Regards
Mike


[Image: iDoDPrgm.png]


[Image: gxhYOSFm.png]


[Image: tYhCStfm.png]
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#26
Quote:the pressure support is pretty active all night long.

I think there is a misunderstanding about the nature of pressure support. It is simply the extra pressure the machine applies on top of EPAP every time you inhale. It is active all night long because you are inhaling all night long. The trick in your case is to keep the pressure support low enough so that you don't get the bloating, but high enough to prevent any central apneas. Just checking the manual, it looks like the PSmax can be set as low as 5, which might give you a little relief.

However your pressures are really on the low side and I don't know how low you could go while still getting enough pressure to satisfactorily treat you. I think you may need to consider other ways of controlling the bloating. Perhaps raising the head of your bed might help (if you haven't already done so). And I heard just recently that because of the shape of your stomach it is easier to control bloating if you lie on one side rather than the other - I think it is the right side. In this position any gas which builds up can more easily escape back up the esophagus. I suppose the other thing to consider is whether it is only xPAP which causes you this problem, and whether you should be checked out for any underlying issues.

Quote:I was originally diagnosed with pretty severe obstructive apnea

Yeah, I think a lot of doctors just automatically assume that all apnea is obstructive. In my case my PSG showed an obstructive index of 25 and a central index of 34 but the diagnosis was still "obstructive apnea". The doc seemed a bit nonplussed when I challenged this.
DeepBreathing
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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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#27
What was your best event rate on CPAP, and how did you feel compared to what you have achieved in ASV so far? As I recall, we got some decent results, but no way was all the CA going to be treated. Now that you've had a chance to try both, what are your thoughts?
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#28
(03-28-2017, 01:15 AM)DeepBreathing Wrote:
Quote:the pressure support is pretty active all night long.

I think there is a misunderstanding about the nature of pressure support. It is simply the extra pressure the machine applies on top of EPAP every time you inhale. It is active all night long because you are inhaling all night long. The trick in your case is to keep the pressure support low enough so that you don't get the bloating, but high enough to prevent any central apneas. Just checking the manual, it looks like the PSmax can be set as low as 5, which might give you a little relief.

However your pressures are really on the low side and I don't know how low you could go while still getting enough pressure to satisfactorily treat you. I think you may need to consider other ways of controlling the bloating. Perhaps raising the head of your bed might help (if you haven't already done so). And I heard just recently that because of the shape of your stomach it is easier to control bloating if you lie on one side rather than the other - I think it is the right side. In this position any gas which builds up can more easily escape back up the esophagus. I suppose the other thing to consider is whether it is only xPAP which causes you this problem, and whether you should be checked out for any underlying issues.

Quote:I was originally diagnosed with pretty severe obstructive apnea

Yeah, I think a lot of doctors just automatically assume that all apnea is obstructive. In my case my PSG showed an obstructive index of 25 and a central index of 34 but the diagnosis was still "obstructive apnea". The doc seemed a bit nonplussed when I challenged this.

Thanks DeepBreathing

Over the last few years I have tried many ways to reduce the aerophagia/bloating, but have had no success unless I reduce the pressure... this was the main reason I had to sop CPAP 6 or 7 years ago... I swear I must have some "leakage" inside me as the air seems to make it's way al around my body, including my lower back, which get's a little painful - I have been checked out a couple of times and nobody has been able to attribute it to any other health issues...

Can we go back to the nature of "pressure support" for a minute as I want to make sure I understand... I thought that the way PS worked was that it only intervened when there was a reduction in the height of the flow-rate waveform... ? I thought it monitored the waveform and if it started to decrease in height (whether due to CA or Periodic Breathing), then PS would kickin and intervene until the flow rate waveform was back to normal... ?

I guess there must be more to it than this, because if this was the case I would expect to see less PS intervention in my situation... When I was on the Airsense10 APAP even at very low pressures, I would see 25-30 CA events and often 10-25% Periodic Breathing during the course of the night - I therefore assumed I would see a similar rate of PS intervention when switching to the Aircurve10 ASV machine... ???

Thanks
Mike
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#29
(03-28-2017, 04:59 PM)Sleeprider Wrote: What was your best event rate on CPAP, and how did you feel compared to what you have achieved in ASV so far?   As I recall, we got some decent results, but no way was all the CA going to be treated.  Now that you've had a chance to try both, what are your thoughts?

Hi Sleeprider

Just been looking back at all of my data from the last 3 or 4 months. I used the Aircurve10 APAP from Mid Oct 2016 to Mid Jan 2017 - it varied quite a bit, but during that time, I would say that my average AHI value was 6 - 8, 90% of which were attributable to CA events. There was also a portion of CSR/PB on some nights...

I was not seeing a lot of benefit and stopped using the Airsense10 from about Mid Jan onwards.

Early March I got my new Aircurve10 ASV machine and since that time, my average AHI value has been < 1.0 (sometimes 0.0)...

I still feel pretty damn tired, but I have to say that I don't feel quite so tired and seem to have a bit more energy on the ASV machine... It's so easy to forget how bad it was even a couple of months ago, but I try to keep a log, and on the ASV machine, I've definitely had less days where I feel the urgent need to sleep for 2 or 3 hours between 4:00pm and 8:00pm... I guess it's only been a few weeks and I need to give it time (which I will do) - I just wish I could sleep throughout the night without the aerophagia waking me up a few times...

Mike
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#30
Quote:Can we go back to the nature of "pressure support" for a minute as I want to make sure I understand... I thought that the way PS worked was that it only intervened when there was a reduction in the height of the flow-rate waveform... ? I thought it monitored the waveform and if it started to decrease in height (whether due to CA or Periodic Breathing), then PS would kickin and intervene until the flow rate waveform was back to normal... ?

Sorta kinda... Pressure support is given on every breath regardless, though it will be quite low if you're breathing normally. I've been trying to find a video on the Resmed Pacewave algorithm which explains things very clearly, but it must have been taken down when they "enhanced" their site. Sad

What the algorithm does is measure your minute volume (ie total volume inhaled / exhaled over a minute) and reacts to any change in that volume. So if your breathing stops or becomes more shallow (even by a small amount) the the minute volume will change and the machine will adjust pressure support to bring it back into equilibrium. It does this on a breath-by-breath basis.

So even if you're not having apneas, the machine is monitoring your breathing very closely and constantly adjusting the pressure support. And just to reiterate, PS is simply the extra pressure applied on top of the EPAP pressure when you inhale. IP = EP + PS
DeepBreathing
Apnea Board Moderator
www.ApneaBoard.com


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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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