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New Machine - Feedback on the Data?
#21
RE: New Machine - Feedback on the Data?
(12-19-2017, 05:13 PM)ajack Wrote: Yes, keep bumping up the epap, till it settles, you are getting close.
The 7.2 you reference is a guide, your's will be different. Your target MV looks ok for now, If you want to talk about target MV, it would help if you put the tidal volume and minute vent chart up as well. You can right click  on the chart name and adjust the Y-axis scale to make it clearer. Then you can see what it is doing over the night.
after the basics of leaks and such are fixed. I mainly use my pressure. minute vent and tidal volume charts

 
We are better together!
- I have so much appreciation for the generous wisdom and expertise shared by what I will call in this context the broader xPAP community
- I seemed to have more of a cardio bias than is the norm here
- To this you add insights from a ventilation perspective
- What a wonderful situation.   We can all grow faster, be better, be stronger.
 
 
On my Laptop it is very difficult in Sleepyhead to modify the Y-Axis of the charts.  
 
Not quite sure what you wanted to see so this is a starting point.  
 
What's next?
 
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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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#22
RE: New Machine - Feedback on the Data?
Ajack, these charts might be closer to what you were suggesting.   

The first chart is the whole night the second chart is a period when ASV is pretty quiet and my SpO2 is still 2-3% below   where I was expecting it to be. 

Thoughts?


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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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#23
RE: New Machine - Feedback on the Data?
I think you could be mouth breathing at 7:40 and 5.50. other than that it's not that bad, just a few drops, a fairly straight line. Do you have a full face mask you can use for a week? that will take any mouth breathing variability out of it. Then see what the minute vent does. I raise my min PS to support any long drops.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#24
RE: New Machine - Feedback on the Data?
Let it ride...AKA don't change anything. You are very close and you need more time at these settings to be sure you have a solid plan if changes are to be made.
Sleeprider
Apnea Board Moderator
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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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#25
RE: New Machine - Feedback on the Data?
Thanks Sleeprider


"Need a plan..  "

Based on largely what you taught me I developed and published a plan a few posts above.  

"Near term plan:
- I will target reducing Hypopneas, Flow Limit events and ~'near-hypopneas' and increasing oxygenation while avoiding determent to AHI.  I am seeing a number of 'near hypopneas' at EPAP 6.2, 6.3 & 6.4 
- In last night's and previous night’s charts pulse-ox chart and the sleepyhead chart below I noticed that the 20 min period that had the best combination of AHI, breathing waveforms, MV and heart metrics had EPAP = 7.3 & PS of 3.3.  Reaching toward these numbers make incremental adjustments to EPAP min and PS Using .4 to .6cm increments, assess results and plan the next night's adjustment.  

Tonight's specific next step:
-  Raise EPAP min from 6 to 6.6" 


...


So for last night's run I bumped EPAP from 6.0 to 6.6

I want good data at these settings and don't yet see a reason to change anything so currently plan to let these settings ride for tonight's session. 


Results

I forgot to put the SD card back in so the data is soft today, however with the increase in leaks not sure how valuable the data would have been.

AHI = 0.3  - Fantastic!

Heart:  Saturation is now OK.  Heart rate variability, avg heart rate & min heart rate all a sliver better but still need work.  

How do I feel/Quality of Sleep:  Better than average but needs work, 69% Deep Sleep, zero REM sleep    


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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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#26
RE: New Machine - Feedback on the Data?
AHI = .8  Another very impressive night for the ASV

No change to ASV settings from previous night (AHI = .3)


Results: 
  • AHI = .8    Three hypopneas in the crazy first 10 mins while going to sleep, two hypopneas while the sleep tracker reported REM Sleep.  How could one complain about that?
    Heart:  Saturation down again, avg 2% lower than with the Dreamstation.  When all else was perfect except sat low MV was a low 6.1.    Remaining heart metrics better than before on the ASV.
  • How do I feel/Quality of sleep:    Tired.  Sleep cut short by IPAP pressures for near hypopneas caused by what I think are positional reasons.   Tracker reported one hour of REM.


Analysis:  
  • Fewer near-hypopneas after lifting EPAP from 6 to 6.6.  Some light Near-hypopneas at 6.75, 6.8 & 6.9.   
  • Best Case for overall AHI & Heart metrics - EPAP 7.1 and PS 3.1 but saturation was still low (previous best case read was pretty consistent at EPAP 7.3 and PS 3.3 also with low sat) 


Next Steps - unless I get other inputs:
  • Address positional issue - done
  • Raise ramp starting EPAP to 6.6+ during 10 min ramp to try to reduce first 10 min H
  • Make few and only small incremental changes while AHI averages < 2.0, get more miles in the saddle around these settings
  • Slowly explore .2 incremental changes to EPAP and PS to try to increase saturation while not adding detrimental effects.   
    
Thoughts?


[Image: j3Geerg.png]

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
RE: New Machine - Feedback on the Data?
Results update - A good report out:
  • The last week's AHI averaged .45
  • 70% of the negative SpO2 & cardio metric impacts from the switch from the APAP to the ASV have been recovered.   


Even though I, Doh!, forgot to put the SD card in last night I felt a responsibility to post the my first smiley face  Smile image to acknowledge and thank you guys and the forum community for what an awesome help you guys have been for me.  



[Image: aOZOThe.png]

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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#28
RE: New Machine - Feedback on the Data?
There are some dips in your minute vent that are associated to the OA and a rise in pressure. on the 21/12 I would try min 8, or 7.6 if you want to sneak up on it. would have been what I would have said.

vola, it looks like the OA have settled down nicely, using 6.2 as a min, did the pressure stay around this and the median /95% come down?
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#29
RE: New Machine - Feedback on the Data?
"vola, it looks like the OA have settled down nicely, using 6.2 as a min, did the pressure stay around this and the median /95% come down?"

Hi ajack,

"..6.2 as a min, did the pressure stay around this"

No. I only chase and have never been able to catch up with the Median.   On both machines that I use Med has always been at least ~10%+ more than the Min I set.  So trying to raise the set Min to the Median is a futile effort, will just keep driving the Median up, up and up...  


"and did the median /95% come down?"

Yes notching EPAP Min up to and 7 and then notching down again each saw correlating increases and decreases in Median and 95%

Slowing notching PS up to 3.8 at the same time as dropping the EPAP Min to 6.2 has so far produced both good AHI and heart metric results over the last ~6 experiments, but we really need more data samples, more nights to get more data before we will really know anything for sure.    

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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#30
RE: New Machine - Feedback on the Data?
There are lots of ways to skin a cat, lifting the PS will work too. The main thing I watch out for is that my epap is under the 95%, so the machine can move a little bit. That way I know I haven't got too much.
Get some charts up with flow data and show off your good work Smile
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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