(04-05-2016 09:19 AM)tmoody Wrote: As you can see, my AHI went up last night, from 3.8 to 4.2. It's not a huge increase, and the trend for the past three nights has been upward anyway (1.6, 3.3, 3.8, 4.2). Centrals went from zero to 1, not a significant change. PB dropped to .4%, so really the only significant change is another increase in hypos, which is consistent with the recent upward AHI trend. There appears to have been one major OA...151 seconds? if I'm reading it right.
Sorry - but I don't see any data posted for 4/04.
If there really was an OA for 151 seconds, that would be 2 minutes 31 seconds, which would have been an enormously long OA and quite alarming, really, if it actually happened. Perhaps you are reading it wrong, or perhaps your tiredness from your workout contributed.
If you get a second very long OA (longer than 60 seconds) I would suggest an immediate call to your doctor to discuss an immediate increase in Min EPAP by at least 1 or 2 cmH2O.
The ASV titration protocol from Respironics which DeepBreathing posted is very clear that the Min EPAP should be increased when obstructive events are observed.
As DeepBreathing has pointed out, hypops are almost always obstructive if occurring during ASV therapy, especially when the Max PS setting is very high, as yours is. When Max PS is high, the ASV algorithm will probably be able to prevent all central events, so any hypops which occur will most likely be obstructive in type.
I agree with DeepBreathing that it would be advisable to gradually increase Min PS to at least 2 cmH2O (for example, 3 or 4 is more common, I think), and to gradually increase Min EPAP until the hypopneas become rare (less than 1 per hour on average).
I think the plan you described in a more recent post (Min PS set to 1 and Flex set to 2) is a good start, and when it is time for another adjustment I would suggest trying Min PS set to 2, because although I wouldn't expect higher Min PS to help prevent the hypopneas, my general impression from listening to other ASV users is that ASV algorithms tend to work better when the Min PS is set to at least 2 cmH2O.
One other thing - If feasible, please consider investing in a recording pulse-oximeter, to monitor your average SpO2 at least once in a while, plus whenever starting or stopping a medication. When worn all night, the type worn on the wrist with separate finger sensor cup is far more comfortable.
If you ever see deep dips (like below 80%) I suggest letting your doctor know right away. And if your average SpO2 (ignoring the brief dips) is low (like below 90%), raising Min PS will help that, too.