New User [need help with my data]

[Sleeprider]

The UA on this chart normally mean that there is obstructive apnea. However, the previous chart you posted did not have this, nor was EPAP so elevated. There are a couple possibilities, and I think i may be best to address this without changing settings if possible. If mom can tolerate a soft cervical collar, that might resolve the cluster of OA/ UA. We just don't know why her airway is occluded and unresponsive to the pressure.

Given that her session on 11/14 featured an AHI of less than 3, while the next night escalated to 14 shows a great deal of inconsistency. This is not a trend, but a data point. So this may not warrant a therapy change, but you should watch for potential positional related apnea. If this trend of persistent OA continues, and positional therapy is ineffective, the usual response is higher EPAP pressure. That may require changing the IPAP max from 22 to 25 so that the pressure support reserve is protected, allowing an increase in EPAP.

[Recurve]

Thanks Sleeprider, On the 1st chart mum forgot to use the cervical collar. She has used it since it was recommended here even with Apap/Cpap. Last night her results where an AHI of 7.2 with most being Hypopnea (5.4) she in general told me she had a bad night sleep with lots of pressing button to restart the ramping. Stupid of me but i forgot to put her SD card back into machine so I only have the basic data from the night no detailed data. I was not uploading data here as it was a new Specialist so was giving them time to observe without my input, I failed to remember to put the card back in.

I have thru searching found a post by DeepBreathing who i think is on the same machine mum is now on that the Hypopnea if it occurs during the ramp up time it is a false positive

I think we are on the correct path to helping consistent results

[Sleeprider]

Recurve, I am not going to overrule any doctor's suggestions, but I have had success with similar events in recommending a PS minimum of 2.0 cm rather than zero. It seems to give a bit more support to prevent hypopnea without encouraging more centrals.

[Recurve]

Once again thanks for the reply, I think it is best for now that I follow our new techs advice and see where that gets us while we are on the 1 month trial of ASV. I truly believe we are at least on the correct path now and they have her booked in for another hospital stay to (I think) test which settings fits her best with ASV.

We had another night with AHI below 8 which compared to before is a huge improvement. 

There is a few questions I am unsure of regarding ASV like why Hypopnea has increased and all others are classed as unclassified? Maybe this machine can not tell 1 event (CA/OA)from the other. Are Hypopnea better than an UA and is Hypopnea during ramp time a false positive. It took me awhile to sort of understand APAP/CPAP and adding ASV there is a whole new world of results to learn.

All I can be is extremely grateful to this forum, without it being here we would still be AVG 15-55AHI

[Sleeprider]

Recurve, in some cases, ASV will stimulate respiration during a central apnea, but if maximum pressure support is not high enough the CA turns into a hypopnea. The default maximum pressure support is 15 cm, but most people do very well at 10-12 as a maximum. For some reason, a low minimum pressure support also works better for some individuals than zero.

UA events are usually obstructive, and may be related to positional apnea or insufficient EPAP pressure. In this case EPAP min is at 8.0, but cannot exceed 12-cm in order to protect the 10 cm PS max and the IPAP max of 20 cm. EPAP and PS could only rise if the machine allowed an IPAP max of 25.0. During the UA cluster on the last page, the EPAP was at 12 and PS at 10 and IPAP at 20, all maximum settings. I would continue to use the cervical collar, but will not be surprised if some of the setting parameters are also changed.

A hypopnea is when a patient doesn’t stop breathing, but the patient’s breathing becomes shallow (i.e., at least a 30% decrease in airflow) for 10 seconds or more, with an associated oxygen desaturation or arousal. So, it can range from near apnea with severe desaturation for a sustained period, or it could be as minor as a reduction in respiratory flow that is transient. So it depends on how good minute vent is heading into the hypopnea, how long it lasts and whether it causes a significant drop in SpO2. In other words, you have to look at these individually to judge. In general, the person keeps breathing, but if that breathing is so shallow that the dead space is not replaced with fresh air, it is just as bad as apnea. Hypopnea can be obstructive (i.e. positional apnea or upper airway restriction), or central in nature (open airway, lack of effort). That further complicates interpretation.

[nappyhair2]

Thank you for posting this information. This is very helpful

[Recurve]

I have to admit some things discussed here I have not yet got my head around but it is all learning!!


Had our 1 week appointment since starting ASV the tech seemed happy and now all we need to do is wait for the hospital stay overnight where they may try and adjust some things. As you can see via the ResScan picture the improvement is there.

https://imgur.com/a/rwZpO

Her Avg over 8 days comes in as a 7.9AHI which I know to some here that can be improved upon but it's a start. I asked again for a copy of her sleep test and they say it has still yet to be completed and they will email me a copy as soon as they receive it. Is this unusual to take over 4 weeks for them to write up the report?


Sleepyhead reports

https://imgur.com/a/iSAfm
https://imgur.com/a/R7u4t
https://imgur.com/a/yMnGz
https://imgur.com/a/wMUJ8
https://imgur.com/a/wjp29

[ajack]

If it was my chart, I would try this tonight. I'd have min epap 9, (one below the median) the max epap being whatever the max is. It is quite a good algorithm and will only use what it needs.
min ps 3-4 ..max ps whatever the max is, again it will only use what it needs.

If you still have UA/H tomorrow raise the min epap 1cm.

I'd remove the pie chart so you can see the stats, I would also put up a 2nd chart with the minute vent and tidal volume in it. The machine has it's targets, my simple target is to keep my minimum tidal volume above 375. This is how I set up mine, I want to know what my tidal volume and minute vent is doing. If it is too low I increase my min PS

this is last nights
https://i.imgur.com/fQKFBrf.png
one with a bit of movement from the 17th

[Recurve]

Thanks for the fast reply I have gone and taken screenshots with the charts as requested. I am struggling here working between 2 computers a small laptop which screenshot does not seem to do as good a job with the smaller screen. When we arrived home today and inserted the SD card back into ASV it said it needed to delete all data...The Tech had not lock the SD card before downloading charts. A quick call and she said all is fine but makes it harder I have tried importing them from the laptop with no success so for now thats all I can do.

https://imgur.com/a/SJBWZ    (bad day)
https://imgur.com/a/JTfai    (better day)

So would you go ahead and make these changes even while in testing stage? We have had to hire the machine for this trial and I would hate for them to blame us for anything going wrong with me adjusting settings. The 30th of this month they have her booked in for the night of testing all ASV settings possible (well that is the plan I hope).

[ajack]

I would change it, I think you can get it better than it is.
can you see the drops in the tidal volume? After you sort out the min epap, as most of them are obstructive. You can see a rise in epap trying to fix them. Then to fix what's left, for the ones where the epap doesn't rise, I raise the min PS.
I would also try a soft foam cervical collar, a lot also look like positional apnea.

The machine can produce a good enough flat minute vent line, not as good as the iVAPS, but I read it's natural for the minute vent to rise and fall during sleep stages, so I'm trying to reproduce a natural cycle.