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Newbie: Severe CSA, OSCAR help request.
#41
RE: Newbie: Severe CSA, OSCAR help request.
You go girl!!!!
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I would recommend that you delete all data off your FlashAir and create a new profile in OSCAR for your new "baby".
Crimson Nape
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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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#42
RE: Newbie: Severe CSA, OSCAR help request.
Just checking "ASV" at Supplier #2, it would seem their price is now about $3,000 (USD) to get into an ASV from their current (fluctuating) inventory.  If the expense is yours alone, there must be other options to look at locally.  I'm reminded of a comment from a previous sleep doc that mentioned that, in one part of the world, he had heard that their doctors would just automatically provide a premium auto-ASV for all their (wealthy) patients.  It would be an interesting place to track results - or even move to.

Regarding a flatter pillow, I can only sleep on my back and have gone pillow-less to some degree.  I opted for a large roll under my neck, and nothing under my head.  Best "pillow" ever for me.  Eventually, I bought a buckwheat husk roll that is amazing.  

Always appreciated your highly insightful contributions, Ratchick.  We're all hoping you get those CAs reduced.  We need a healthy you for all your future postings!  Hang in there and please post ongoing updates on your progress.
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#43
RE: Newbie: Severe CSA, OSCAR help request.
Thanks guys.

I was expecting some teething troubles, and it didn't take that long for me to adjust to the different way the ASV works, so that's good.

Other good news. My AHI was <6 and most of that was hypops. My AI was 0.1. Six apneas all night long. That is... miraculous.

Bad news though. My sats TANKED. I'm not sure if it's the pressure being too low most of the time, or the effect of the pressure support or what... but holy moly, it was a BAD night and I have the worst headache today.

Plus point, though - no leaks, I don't remember being wakened by the pressure changes (though I wasn't sleeping amazingly anyway because my sats were so awful, and settling in but that's okay).

But yeah, previously I was on static 15 CPAP with EPR off. Now I'm on this:

Mode: ASVAuto
Min EPAP: 4.00 cmH2O
Max EPAP: 14.00 cmH2O
Min IPAP: 6.00 cmH2O
Max IPAP: 28.00 cmH2O
PS Min: 2.00 cmH2O
PS Max: 14.00 cmH2O
Ramp: Off

Any advice, suggestions etc gratefully received. Technically I'm meant to do two nights like this as a trial but I want to be able to futz with it ASAP.

Charts below. One showing just the hypops and apneas, one showing those plus the user flagged events (the "almost events", and my SpO2 report.

Note: The last 20 or so minutes of the SpO2 data are on a second session, but not included as they're much of a muchness, just the average is 85% instead of 87%. When it says low of 70, it really means it stops recording below 70. In this case, it doesn't look like it actually dropped into the 60s. So there's that.

[attachment=38826][attachment=38827][attachment=38828]
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#44
RE: Newbie: Severe CSA, OSCAR help request.
(01-10-2022, 03:13 PM)WakeUpTime Wrote: Just checking "ASV" at Supplier #2, it would seem their price is now about $3,000 (USD) to get into an ASV from their current (fluctuating) inventory.  If the expense is yours alone, there must be other options to look at locally. 

Thankfully, I don't need to purchase out of pocket now. Here, the going rate seems to be about £5000 for a new one, though one supplier is supposedly selling then for £3500 new. Still, that's a lot and I'm glad I don't have to fork it over just yet.
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#45
RE: Newbie: Severe CSA, OSCAR help request.
You may have peeked at your clinical menu, but if not here's what you'll find.

Mode: CPAP/ASV/ASV Auto
EPAP: I think this by itself will be on CPAP mode, this as a single static number on ASV mode, and Min/Max on ASV Auto mode, this equates an EPAP range, I used ASV Auto, it felt lots better to lower the PS kicks just a bit by that range
PS: I think this is grayed out in CPAP mode, otherwise it's a Min/Max range, PS Max must be 5 clicks above PS Min, PS Min can be as low as 0
No user edited IPAP directly. Changing EPAP and PS indirectly influences IPAP.
Humidifier, heated hose, Ramp, smart start identical to other PAP's. Note there's no timing, trigger, cycle, Ti Min/Max, backup breath rate, all these are algorithm controlled

I ran near default PS, for a bit at 4-15, but went to and stayed at 3-15 for most of the 2 years on it, except a short trial at 0-? I forgot now, had tried at the end EPAP 4-10 I think, but no-go.

My adjusting settings was focused on EPAP. I used 8-13 most of the time, but near the end I edited EPAP and PS down to demonstrate that ASV wasn't synchronizing with my breathing.

I felt that EPAP needed a bit of a head start so that's why the 8 Min pressure. It seemed to use EPAP for Obstructive, PS kicked in for Centrals.

If the ASV PaceWave does its job well, you might get results like I did, OSCAR AHI from 0-3 most nights. Just ignore flow limits, on ASV they don't run the show like other ResMed PAP machines. When mine was working well with me, my FL was pretty much under control, sometimes a completely flat 0.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#46
RE: Newbie: Severe CSA, OSCAR help request.
I have definitely peeked. LOL I just have to go through this process and then I can fidget. Seriously, though, after a year on fixed 15, 4-6 feels like nothing. LOL
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#47
RE: Newbie: Severe CSA, OSCAR help request.
Yep I'm sure that was a light breeze compared to the other.

Best wishes to your success on this.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#48
RE: Newbie: Severe CSA, OSCAR help request.
Last night was bad, honestly. My new and improved pulse ox is great, but it taps out below 70%. So I don't exactly know how low my oxygen got, but I spent 20 minutes (out of five hours) <70%, in three big chunks. The average overall wasn't too bad aside from that, but that really scared me, a LOT. Especially waking UP with my sats down there and taking a minute for everything to start getting back into a regular place. That's the LAST of my experiments without oxygen. I ended up taking a nap for an hour and used the oxygen and that made a big difference. I still need to boost the min EPAP and possibly the min PS a little... If I can't get hold of my doctor before the end of the day, though, I'm gonna start fiddling.

That said, it's doing something. Four apneas overnight, none during my nap, just a bunch of hypops where my sats plummeted. So I feel like that's an improvement already.
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#49
RE: Newbie: Severe CSA, OSCAR help request.
If you have your OSCAR data, post it whenever you're ready. For my self Titration of ASV, I just needed basics of Events, Flow Rate, Pressure (but sometimes Mask Pressure was a better look), Leaks. Skip Flow Limits, ASV doesn't target them and to work on them is counter to working on CA.

I did view my other chart segments, but the basics were the ones I used for tuning. If leaks were an issue, ASV makes them worse, likely the quick PS blips.

To O2 or not to O2...
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#50
RE: Newbie: Severe CSA, OSCAR help request.
Congrats on the new machine. I'm a bit surprised at the low SpO2, and I suppose we will give your medical team some time to take the actions they see necessary. Your current settings are near the default ASVauto settings, with the only differences being PS min 2.0 instead of 3.0 and PS max at 14 instead of 15. With low SpO2, my first inclination would be to increase EPAP min to hopefully recruit more lung volume and improve oxygenation. I'm sure you have heard me discuss positive end expiratory pressure (PEEP) and it is likely going to help in this case.

When things settle down a bit, I'd like to see some "advanced detail" charts using Events, Flow Rate, Mask Pressure, Tidal Volume, Resp Rate, and SpO2. The idea is to try to correlate the desaturation periods with some other respiratory or pressure parameters. Congrats on the new machine. I'm certain this will work out better, but you appear to need a supplemental oxygen bleed. I'd have to go back and look at your old results to compare.
Sleeprider
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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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