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Need adult guidance for complex sleep apnea follow-up
#21
RE: Need adult guidance for complex sleep apnea follow-up
(11-23-2021, 12:45 PM)Geer1 Wrote: It is always best to review available data and make one change at a time. 

Understood, but guess I thought the only real change from my recent settings from Default was Min PS of 4 instead of Default 3, and PS Max of 19 instead of Default 15.  Last night was first time on default, and no cosmic changes noted yet.  

Circa Sep-Oct-Nov 2016, there was a lot of Moderator review and discussion about high AHI with many labelled CA’s – consensus seemed to be these were Central – (Thread: RE: New User Problem with BiPAP AVAPS – Part 1)  The CA's seemed to disappear with first the BiPAP Auto SV Advanced and then the current AirCurve S10 ASV, leaving mostly Hypopneas.  

I remain inept at recording data graphs as requested.  Do I dimly recall there used to be a way to send larger files, through DropBox or something similar instead of only screen shots?  Or send the whole durn SD card data?
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#22
RE: Need adult guidance for complex sleep apnea follow-up
The other change was decreasing min EPAP from 9 cm to 4 cm but if that didn't create obvious issues with worsened hypopnea/apnea then you might not need that higher EPAP you were previously using. 

To upload screenshots first go to OSCAR, get view to the desired time/duration, click the view tab and then take screenshot (alternatively can press F12). That saves a screenshot to file (mine goes to documents/OSCAR data/screenshots).

When responding with a post scroll down slightly to attachments, click choose file, select the file you want (will be named by date/time), click add attachment. Then if you want to get fancy you can click the area in your post you want attachment to be and then click insert into post (otherwise it just gets added as a general attachment).
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#23
RE: Need adult guidance for complex sleep apnea follow-up
For my Screenshots to show all five of "the most requested" graphs I have to severely shrink the width of each graph.  I wonder if that interferes with their interpretation?  Or is it better to retain each graph's default width and accept that each screenshot will only show 3 or 4 at a time?  Also, I have ResScan and routinely run each day's data through Oscar and ResScan.  To my untrained eye the two programs always seem to agree, at least so far as the "numbers" show.  I wonder if the wave form records of ResScan would give any help in interpretation?  

I was going to wait at least several days before posting anything with the default settings, but can't stand it.  To address the perennial leak problem, I am using a neck collar (Dr, Dakota), don't sleep on my back, started taping my mouth closed, using a supplemental velcro strap around the mask in addition to the normal straps.  Don't know what else to do??  Let me just check a shot for quality control.  Is this effort acceptable?  

   
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#24
RE: Need adult guidance for complex sleep apnea follow-up
Pardon my forgetfulness. Have you tried any other mask or different cushion sizes for this one? Some part of this mask isn't cutting it with leak control. Either the mask is the wrong shape for your facial features, cushion isn't correct size, the straps aren't adjusted correctly and not too tightly, or something like that. My opinion, until leaks are a bit better controlled, therapy isn't going to help as much as it has the potential to do.

Also, on future charts, flow limits can be replaced with some other chart. ASV typically gives ugly FL charts. FL can't be addressed well with ASV, it's not an ASV therapy goal. Maybe mask pressure or something else can go there.
Dave

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#25
RE: Need adult guidance for complex sleep apnea follow-up
The main thing we need to see is event flags, flow rate, pressure and leaks. For zoomed in shots I prefer mask pressure instead of pressure because you can see the individual pressure waveforms, for full night of data either works but the pressure graph is slightly easier to interpret. The minute vent chart is probably the next most helpful chart in your case (flow limitations not important in your case imo) because it shows what the machine is targeting.

This data you posted appears to have higher AHI and more apnea than before, do you agree (I haven't seen enough of your data to know if this is the case for certain or if this is just a bad night)? It sounds like you feel these settings are worse as well, if so what specifically about them do you not like/find bad about them?

Edit: Curious about your comments on the number of apnea in this data. At first thought maybe because of the lower pressure but I see they occurred mostly when pressure was higher (~9-10 EPAP).
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#26
RE: Need adult guidance for complex sleep apnea follow-up
While awaiting a trend, here is my first night at default settings (last night - 22 Nov 21).  Over the last couple of years my total AHI's seems to have averaged slightly under 5 to slightly under 10, with by far the majority ID-ed only as Hypopneas, and a scattering of UC (Unclassified) apneas, no OA or CA reported.  That has been so much better than early years, pre-ASV and I've felt fairly well and I didn't fuss much at the sleep doc.  My leak rate has always seemed high but I never really tried to correlate it to AHI reported.  More recently I haven't had any extreme changes, but do have increased nap attacks and PM sleepiness.  Perhaps that is more related to the "normal changes of maturity" than to sleep therapy?  

I can't say it's a trend yet, but the last 2 nights I have awoken with the feeling I needed to take a deeper breath - yet overall felt I slept soundly and felt rested in the morning.  

   
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#27
RE: Need adult guidance for complex sleep apnea follow-up
All Resmed ASV apnea are "UA", you will never see an OA or CA because these machines do not attempt to differentiate type of apnea (because the method they normally use to do so interferes with some of the ASV treatment aspects). That is part of what makes it important to learn how to review your data and interpret flow/pressure curves if you are having apnea present.

On these two nights at regular pressure you had 2.17 and 1.5 UA. When I look back at the summary you posted I see an average UA of 0.31 to 0.87 depending on the month and that makes me think your apnea is worse at these settings. That would support an obstructive aspect to these apnea since they appear to be better at higher pressure.

Lets try increasing EPAP min to see if that helps. Can try 9 cm again.
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#28
RE: Need adult guidance for complex sleep apnea follow-up
(11-24-2021, 07:55 PM)Geer1 Wrote: All Resmed ASV apnea are "UA", you will never see an OA or CA because these machines do not attempt to differentiate type of apnea (because the method they normally use to do so interferes with some of the ASV treatment aspects). That is part of what makes it important to learn how to review your data and interpret flow/pressure curves if you are having apnea present.

I did not realize that after all this time.  And I thought I had been through all the ResMed AirCurve S10 ASV guides and clinical manuals.   I'd think that would be an important detail to point out but I sure did not find it.  That's why I need adult supervision.  I thought the ASV was stopping all of the CA's that were reported back in my BiPAP days, or diverting them into Hypopneas.
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#29
RE: Need adult guidance for complex sleep apnea follow-up
It is because Resmed uses what they call forced oscillation technique to determine if an apnea is OA or CA. They send little pressure waves and interpret how they bounce back. Your ASV has backup rate that forces a pressure wave/breath during the time it would normally be trying to use this technique so it is not capable of doing it and thus labels everything as unknown apnea.

The easiest way to try and tell CA from OA is by looking at your flow rate chart. CA will usually have a periodic nature of declining breath amplitude, apnea and then increasing amplitude breaths that start out smaller but end up large amplitude. OA can have declining amplitude prior but sometimes is abrupt and at the end you usually have large amplitude recovery breaths that decline in amplitude back to normal breathing. With ASV this gets a little trickier because the machine is actively changing pressure/flow each breath and that manipulates the flow rate shape so in complicated cases can be tough to determine what is going on and what is breathing and machine effects (that is why seeing the mask pressure graph beside flow rate can help a bit).
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#30
RE: Need adult guidance for complex sleep apnea follow-up
Just for an experiment let me post pdf attachments of one day's screenshots of ResScan report, just to test the format and see if it is helpful or just duplicates Oscar - not intended for seeing trends or titration yet.  

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