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Please Review The Data & Give Recommendations
RE: Please Review The Data & Give Recommendations
Thanks for the information Hojo.  It is interesting that you have such a difficult time exhaling with even mild CPAP pressures.  I seem to tolerate high CPAP pressures as long as i have some EPR cranked in.  I guess we're all different.  
I was probing about your respiration rates during your BiPAP and ASV studies to see if we can get some additional or more concrete confirmation on the respiration rates reported by the AirSense being either real or artifact.  Has anyone ever heard you breath at night to confirm high rates?  In my case, I’ve had my wife take some notes about what she’s heard and the exact time she heard it.  She has reported normal breathing rate and depth both when my waveform looked good and also when it was absolutely trashed and pegging the rate indicator at 50.  That said, there is some indication that these episodes of reported high rates in my case are not good.  Often, they start and end abruptly (movement in bed or change of sleep state maybe?) and at the end of the episode, I normally see a recovery period (much like what would be seen after a long apnea) suggesting in my case that I may not be getting the air I need during these episodes.  
In any case, I share the optimism that the ASV will solve your problem.
Sleeprider:  Since you are familiar with resmed’s FOT technique, do you by chance know the system they use for measuring respiration rate?  I suspect they are counting zero crossings seen in the flow rate and averaging over time but I have no way of confirming this or knowledge of what they are doing.  Also, I can’t remember if there was any sensor during my two sleep studies separate from the machine to measure flow or respiration rate or if they just relied on what the machine reported.  Respiration Rate did not show up in the report they gave me.
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RE: Please Review The Data & Give Recommendations
The Resmed respiration rate calculation is not infallible, and we often see multiple breaths counted when the expiration ends abruptly or respiration is uneven. The fact the resp rate can be highly erroneous means I often take a high respiration rate like the one reported by Hojo with a strong dose of skepticism. We did however verify his extraordinary respiration in close-ups of the flow rate charts. As I recall, I called it "panting" at the time. It was exceptional, unusual and real. I have no way to know, but came to regard the phenomenon as a manifestation of central apnea, because the respiration was so rapid and shallow, it never ventilated the lungs.
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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RE: Please Review The Data & Give Recommendations
While I (im)patiently await the prescription to be sent to the DME, I am also contemplating a back up plan in the event of machine failure and it takes an extended period of time for a fix/replacement for an ASV machine.

While ASV is what I am waiting for, I wonder if a (lesser) expensive BiPAP wouldn't help me feel better even though I know it doesn't prevent the CA events that I have.  I did see a used ASV machine for sale on Craig's List but I'm concerned about making a transaction over Craig's List without being able to pick it up.

What are others doing?

Thank you.
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RE: Please Review The Data & Give Recommendations
While I'm waiting for my ASV to arrive, I got a copy of my prescription and it says:


https://imgur.com/a/ZRoSu

It looks like ERP of 5 but I'm wondering if it really means EPAP of 5 
PS of 3
Maximum Pressure Support of 15

What does all this mean, and the prescription doesn't list a back up rate which has me wondering why.

I thought PS was the difference between the Max Inspiration Pressure (say 15) and the Min Expiration Pressure (say 5 in my case).  15-5=10

Or, perhaps the PS is 3 but can go to a max of 15, depending on my inspiration needs??
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RE: Please Review The Data & Give Recommendations
There's no IPAP setting on ASV. If I remember right it's EPAP and a minimum PS and a max PS. I think.
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RE: Please Review The Data & Give Recommendations
(12-13-2017, 05:55 PM)Walla Walla Wrote: There's no IPAP setting on ASV. If I remember right it's EPAP and a minimum PS and a max PS.  I think.

Interesting, during the ASV titration study it felt like the machine was delivering a preset amount of pressure, which initially I felt like I was getting a deeper than normal breath.  I'm still waiting for the actual sleep study report to be given to me, it takes 2 weeks to get it into the hospitals system where I can pick it up.
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RE: Please Review The Data & Give Recommendations
Hojo, those settings are right out of the Resmed Titration guidelines. EPAP min 5.0 PS Min 3.0, PS max 15.0. Should work great and the only difference I would have probably suggested was a PS min of 2.0. I'm all for it, and if there are any problems at all, we can talk about it after you have had a chance to get adapted to the new therapy. The only thing I didn't see on the prescription was mode, and you want to be sure that is in ASVauto mode. On a Resmed the BPM is automatic and targets 15 BPM by default. On a Philips machine the BPM has to be specified.

As far as a backup, I would not hesitate to buy off Craigslist, but would try to talk to the seller and make sure their story is plausible. Paying with PayPal offers some protection. I have bought two machines off Craigslist, and was aware of a Philips System One Auto SV Advanced for sale near me in Butler, PA. I tried contacting them, but got no response. So a responsive seller, especially one that will talk on the phone is important.
Sleeprider
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____________________________________________
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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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RE: Please Review The Data & Give Recommendations
Last night was my first (home) night on ASV and here are a few observations:

The Min EPAP of 5 was ordered but when I started, it felt like I couldn't exhale as well so I lowered the EPAP min to 4 and it felt better.  Later in the night when I woke up I felt as though I may be getting use to the the EPAP again and I could probably increase it to 5 but I left it at 4 so I could look at the data first.

I didn't feel as though the I was getting as much of a push during inhalation as when I had the ASV titration study, I felt as though I was working a bit more to inhale.  It could have been because I wasn't as tired when I went to bed last night, whereas during the ASV titration study I was ready to fall asleep well before all the wires were connected to me.

I woke up around 2:45 am probably because I was behind on calories (long bike ride during the day) and respiratory wise, I felt good (thank you ASV).

With over 100 nights on various CPAP settings, my RR Medium was 17 and RR 95% was 25.7.  My tidal volume Med was 432 and 675 for 95%.  On ASV last night my RR Medium was 12 and 95% was 15, the tidal volume medium was 480 and 95% was 840.  Hence, even that looks much better.

https://imgur.com/a/9mUoC
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RE: Please Review The Data & Give Recommendations
Congrats
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Advisory Members serve as an "Advisory Committee" to help shape Apnea Board's rules & policies.

Membership in the Advisory Members group does not imply medical expertise or qualification for advising Sleep Apnea patients concerning their treatment.



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RE: Please Review The Data & Give Recommendations
Hojo, I think you found your answer. The resp rate tells a big story in your case, and the improvements in tidal volume go along with that improvement. I don't ever recall seeing your AHI at a decent level, and even when it was, the breathing was terribly disordered. It took a while to get here, but it looks worthwhile. Yours was not a "typical" case of complex or central apnea, but elements of that were present. I'm sure you will be feeling more restored soon...about time!
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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