Welcome to Apnea Board !
As a guest, you are limited to certain areas of the board and there are some features you can't use.
To post a message, you must create a free account using a valid email address.
Login or Create an Account
02-12-2023, 12:20 PM (This post was last modified: 02-12-2023, 12:28 PM by cmpman1974.)
RE: Low O2 Levels During Sleep with Low AHI
(02-12-2023, 08:47 AM)Sleeprider Wrote: There is a lot of distortion in your inspiratory wave-form and I can't differentiate it from the mask pressure or airway flow restriction. Do you have nay charts from when you used ASV? That device uses EasyBreqathe and if we can compare some flow rate weve charts from that therapy, we could probably say whether this is unique to the ST-A or was also present with ASV.
I think you may have me mixed up with another person regarding use of ASV. I was never on that type of machine. I used a ResMed Air Curve 10 VAUTO for 10+ years before I got this new ST-A machine a few weeks ago. I truly wish I would've downloaded charts into OSCAR of my data before I returned the machine, but I didn't even know things like this exist at this point. My doctor never mentioned anything.
Yesterday, while the AHI seemed OK, wasn't a good night. I feel quite tired today and yawning a lot. My wife has a Fitbit and I wore it solely to try the O2 function. It claimed average of 93% O2, but that's not a very meaningful figure probably. It showed some significant O2 variation around 7 AM, whatever that means.
I posted a few OSCAR charts of my sleep yesterday. I'm trying to understand if the more meaningful statistic is the mean leak rate of 95% leak rate. I guess the same question applies to all categories of data presented by OSCAR. Mean is not average so why doesn't OSCAR report averages? I assume again the leak spikes may represent some positional apnea issue since as always, they are clustered. Am I correct?
Me mixed up? Of course! There is another ST user previously on ASV, and I'll try to keep it straight. The Vauto information would have been useful.
Your current chart shows that except for therapy breaks and leaks, you are maintaining a good minute vent with relatively little pressure support variation from the ST-A. We might be able to help with the shaping of the pressure support by adjusting rise time. What is your current setting?
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.
(02-12-2023, 12:48 PM)Sleeprider Wrote: Me mixed up? Of course! There is another ST user previously on ASV, and I'll try to keep it straight. The Vauto information would have been useful.
Your current chart shows that except for therapy breaks and leaks, you are maintaining a good minute vent with relatively little pressure support variation from the ST-A. We might be able to help with the shaping of the pressure support by adjusting rise time. What is your current setting?
Ti Min: 0.3 sec; TI Max: 2.0 sec; Rise Time: Mild; Trigger: Med; Cycle: Med; Ramp Time: 5 min with starting EPAP: 4.0 during ramp
I'm not familiar with Rise Time Mild. Rise time is usually expressed in the range of 150 ms (fast) to 900 ms (slow). I was ging to suggest about 500-600 ms. It's good to know you have trigger sensitivity settings. We might use that eventually. In face, set it to high for a night and let me know what you think. On high trigger sensitivity the machine requires less spontaneous flow to trigger IPAP. This often feels like easier breathing.
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.
02-12-2023, 05:39 PM (This post was last modified: 02-12-2023, 06:08 PM by cmpman1974.)
RE: Low O2 Levels During Sleep with Low AHI
This is all I could find on the Rise Time function in the clinician's manual...see attachment. Maybe it's coincidence, but since I've been on this ST-A machine, I swear my diaphragm muscle hurt. Everything feels so sore. It's odd. I'm also intrigued what happened on the mask pressure chart where you see close double or triple peaks within seconds.
02-12-2023, 06:09 PM (This post was last modified: 02-12-2023, 06:12 PM by cmpman1974.)
Double - Triple Spikes in Mask Pressure in Short Periods
Any ideas why the odd spike pattern in mask pressure over a short period? Am I gasping for breath during a short interval? This article makes it sound like a quick rise time is always preferable: https://derangedphysiology.com/main/cicm...-rise-time
02-13-2023, 11:34 AM (This post was last modified: 02-13-2023, 11:36 AM by cmpman1974.)
RE: Low O2 Levels During Sleep with Low AHI
Looks like the 'clusters' of leaks for 15-30 min continues...weird. Then they disappear as quickly as they arrived. Very frustrating to have these events ruin otherwise decent sleep from what I can tell. It's like they pop up literally out of nowhere.
02-13-2023, 09:56 PM (This post was last modified: 02-13-2023, 10:01 PM by cmpman1974.)
RE: Low O2 Levels During Sleep with Low AHI
Interestingly, I found a copy of an overnight O2 study a pulmonary doc ordered for me 5-6 years ago when I still was on my BiPAP therapy. No concerns were brought up by that doc or my sleep medicine doctor. after the results were in It was never performed again since then. Are these type of desaturation levels acceptable when on BPAP? Is it still expected to get significant drops like this? Every re-titration study for the last 4-5 years show a low O2 level in the 70-75% range on therapy and many 'short' durations under 88%. Does this mean bad news or typical of anyone in my condition? My daytime O2 levels are 93-95% any given day. I never had an AHI better than 4-5 on ANY titration study in the lab the more I look back. How would I now consistently be getting AHIs of 0.5 - 2.0 every night? It really makes me wonder should I have always been prescribed IVAPS all these years when all I was given was normal BPAP? It brings up a lot of questions in my mind. I know I'm not an easy case by any means, but...
Regarding rise-time, you are on a fast rise time, and this causes your respiratory flow to peak very early in the inspiration cycle rather than rise gradually to a peak ahead of expiration. We have already noted that you have an unusually high tidal volume that I would characterize as hyperinflation. My thought on a longer rise time is that it might enable a more normal breath morphology while still enabling a full breath. You are breathing spontaneously, so I am not concerned about inhibiting inspiration at all by using a longer rise time. As I said before, if you try it and do not find it comfortable, it is very easy to resume the previous setting.
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.
02-14-2023, 10:08 AM (This post was last modified: 02-14-2023, 10:28 AM by cmpman1974.)
RE: Low O2 Levels During Sleep with Low AHI
(02-14-2023, 09:06 AM)Sleeprider Wrote: Regarding rise-time, you are on a fast rise time, and this causes your respiratory flow to peak very early in the inspiration cycle rather than rise gradually to a peak ahead of expiration. We have already noted that you have an unusually high tidal volume that I would characterize as hyperinflation. My thought on a longer rise time is that it might enable a more normal breath morphology while still enabling a full breath. You are breathing spontaneously, so I am not concerned about inhibiting inspiration at all by using a longer rise time. As I said before, if you try it and do not find it comfortable, it is very easy to resume the previous setting.
I was curious why the Tidal Volume is in the 600-700 mL range. All I know is since I've started this ST-A machine, I continue to feel like my breathing muscles are so overworked. I did not feel this muscle pain before starting the machine. It's wearing me out. I would try telling my sleep doctor, but unfortunately the doctor released me from their practice very unexpectedly right at the worst time (new therapy). Told me to go see another doctor way out of the way. All this after 14+ years of being their patient.
Thanks for the suggestion on the rise time part. I remember a previous comment you made about rise time usually being in milliseconds. Min must be less than 150 ms as the menu starts at min and as you rotate the dial goes from 150 ms to 900 ms. I assume min is less than 150 ms even. I wonder why anyone would choose such a fast rise time?
Does everyone feel these leaks continue to be 'positional apnea'? Another bad night of high leaks at specific times of the night. I'm confused as always.
