Need guidance for complex sleep apnea and leaks follow-up

[Sleeprider]

There is nothing in this image that resembles a respiratory flow rate pattern.  The expiration is completely missing and I assume you are exhaling around your mask. All of your charts show a simply massive tidal volume and minute vent, and periods flagged for hypopnea may be a normal breath volume for most people.  You have a long history and I don't have the energy to review it all, so please remind me what came before ASV.  Your event rate is high, but I just about can't make heads or tails out of this.  I'm kind of inline with Rubicon. I have been looking at your charts for several years and nothing here makes sense, and a sensor feedback or machine malfunction is starting to look like the best guess.

[sheepless]

if Sleeprider is confused, I may be in left field. however, since you're not getting any suggestions I'll tell you what I see. without reviewing your history and looking only at these charts, I'd say:

1) you have a leak problem
2) normally I ignore flow limitations with asv but if you ignore the 1.0 bars you still have too many
3) you don't have too many apnea (ua) but you do have a lot of hypopnea that look obstructive to me

so, if it was me, I'd try:

a) dropping max ps to 9 as an experiment to see if leaks decline (good) and if ca/ua increases too much (a few are ok but a lot isn't good)
b) if after a couple nights you still have too many hypopnea (post screenshots) raise epap to 8; if you're not comfortable with that, go to 7 first.

we can adjust min ps for flow limitations if they remain after trying the settings above.

your pressure is maxing out at nearly 25 cmw. tough not to leak. reduce the leaks and let's see how you respond.

[Rubicon]

I'd like to see a stack of 90 second windows with Flow Rate, Mask Pressure, Tidal Volume and Pressure to try to unravel what's actually happening.

If the machine is constantly cycling servo on and off all night, IMO one would have to believe that there are accompanying desaturations and/or arousals.

[Rubicon]

Plan B:

Any chance of getting the OP to upload a data file to dropbox for interested parties to view?

[Rubicon]

An important point is that now we're at the end the story--  not even the middle of the story.  How did we get here?  Does the OP even have CompSAS?  What was the the original CAI?  5?  25?  0?  The ResMed ASV algorithm is MV-based, and in this dated, brief vignette, it never gets used.

As an aside, a lot of CompSAS simple resolves on it's own after about a month as respiration stabilizes.  But IMO if MV is vacillating from 0.00 to 25.63 all night night, every night, the point of stabilization is going to be about a month after never.

[Rubicon]

If the ResMed ASV rate algorithm was being employed, then f would be 15 (or as little as 10 if MV was high).  But patient frequency is often >20, suggesting these are resuscitive breaths, most certainly due to an arousal.  Are there ANY areas of central apnea anymore (refer to original graphs to estimate f)?

So in summary, I do not have the SFI what is going on.

[Rubicon]

What I think is significant here is that in spite of very high driving pressures, often little or no flow actually gets through.  So I'm thinking this is beyond obstructive apnea--  this is all the way up to obstructed airway.

This is the area in question.  You've got like 25/10 pressure there but the first 2 breaths don't go in, the third barely makes a dent.

Hence, "occluded airway".


Y

[Sleeprider]

I have merged the three most recent threads. Nothing has changed and the thought is to bring the useful charts and comments into this thread. I was repeating myself and I see Rubicon is trying to help and would benefit from this previous conversation.

[SarcasticDave94]

One major issue with the therapy is that he's got high leaks. I've used the same ASV model before myself. If leaks aren't better controlled, there's not going to be much chance of therapy getting better.

Second issue, the chart scale needs changed. We're presented a leak chart up to 120. If you need that scale to see your leaks, expect therapy to literally be blowin in the wind. Contrast what I had that was reasonable for leaks at 95% at 10 or so, allowing for a few (something like 2 or 3 per night) spikes upward nightly, likely person or mask movement. So bottom line is leaks must be managed a lot better. Since this has been a recurring theme, it's probably the mask itself.

[Rubicon]

The most recent results show the leaks look well-controlled.

In response to the previous disappearing question, one or two 120-seconds windows aren't really helpful.  I would go through the whole thing in 90 second windows.

Especially since this thing looks like a train wreck after 15 years.

---

And I would try to get the original data to figure out how he ended up on ASV in the first place.

You have to know what you're trying to fix before you can try to fix it.