Please Review The Data & Give Recommendations

[Hojo]

Thanks guys, I was telling Spy Car (PM'd) that I wish they would keep track of the apnea time, not just the number of events.  It takes just that one final apnea to cause death, I don't want that last breath when the CA flag to show up, to be my last breath.  At least the AHI will only show one event, ugh!

Oh well, I wake up feeling I'm not getting the air I need, still can't figure out why my resp rate is so high.  I'm kind of hoping that during the ASV study next week there will be enough events that show I still need it, even if I have had a few good days this week, according to the AHI index.

Thanks guys!

[Hojo]

All:  I have my ASV Titration study next week with my usual pre-study meal already planned     
but now the hard part, what questions to ask prior to 'lights out';

I know the machine will have a back up respiratory rate, so I'm thinking I would like to know how they will set the machine, will they wait and watch the screen for when I go apneic and hit the breathe button, or will the machine be programed for so many miliseconds of a pause before starting a breath.

Then there is my tidal volume.   I would say that with my Sleepyhead history I have a very high resp rate and that my TV tends to be low.  Will they set the machine up to mimic my TV or say no, based on your body weight an activity level, you need more volume.

I have been listening to a few threads on ASV and can't say that I've been able to follow along completely; Pressure Support: well, won't the ASV be more (tidal) volume driven then pressure (CPAP).  Are these little 'ventilators' able to give a nice sign wave or a square wave with a pause (sigh), to fit the needs of the patient?

Are the machines able to overcome a leak and deliver more tidal volume?

I've seen some CPAP/BIPAP titration flow sheets where the patients is observed and the pressure gradually turned up/down.  For an ASV, do they do anything but turn the machine on and tell it to do 'it's thing'; whereby it watches my breathing for 3 minutes and then plays 'copy cat'?

Thank you!!

[Sleeprider]

The backup timing on the Respironics and Resmed machines works differently. I don't know that it matters for you. If you wanted to target tidal volume and rate, an AVAPS or iVAPS machine might be the better option. To deal with centrals and complex apnea, ASV is the choice. We have said several times, we don't really/know what your problems are, but that you need professional evaluation to make good judgements and a proper titration.

Technicians are under the orders of the doctor to conduct a scripted sleep study. Hopefully your doctor is aware of your concern about tachypnea and low tidal volume, as well as the complex apnea and periodic breathing that sometimes appear in your CPAP results. I'm not qualified to design a study to evaluate or titrate this, but I'm sure they will try several different approaches. Your question should be, "what is planned to evaluate these issues". Eliminating the uncertainty will help you relax and do your part....sleep.

[Hojo]

The sleep center called my yesterday morning with an opening and I jumped at the chance for the ASV titration study to be moved up!!!

So, last night I went in, got all wired up, they turned the machine on and I IMMEDIATELY noticed the difference with ASV, wow, what a tremendous difference!  Once the pre-sleep check was started; move your left foot, wiggle your toes, blink your eyes, walk a straight line with one eye shut (okay, I didn't have do that), but when I had to hold my breath and move my stomach, that is when I could really tell what the machine was going to do; it started pushing the air in while I was holding my breath (per the instructions), the mask started to leak so I finally took a breath.  Cool, this thing is working.

Once the pre-sleep check was done I was told my favorite bed-time story (okay, maybe I'm telling stories here), and as I was drifting off, the machine sort of woke me up enough for me to realize that I wasn't breathing.  Nice, this thing is ramping up the pressure to breath for me when I'm not.  I have heard that it takes some folks a long time to get adjusted to an ASV (and some CPAP too I guess), but it didn't take me long to fall asleep.

I woke up at 5 am which was about 2-3 hours later than normal and the only complaint I had was a dry mouth.  Before going to bed I forgot to tell them to turn up the humidity, the last 2 studies (CPAP and BiPAP) I woke up dry so I knew the humidity needed to be adjusted, oh well.

How did I feel?  I felt great!  I wasn't bothered by it at all, I didn't wake up at all during the night, didn't wake up feeling like I hadn't been breathing (apnea is what usually wakes me up, even on CPAP).  My only other complaint was no matter how hard I tried, I couldn't get a copy of the sleep study.  The only bit of info I walked away with was that I did very well and my the highest my respirator rate was 16; a far cry from what I've been seeing.

From times past, it will take 2 weeks before the final report is ready so I'm debating calling the office tomorrow and asking if since the doctor knows I need ASV, can he go ahead and start the ball rolling with insurance.  After all, wasn't the ASV titration study just to see what settings I would need, we can go over that with my next appointment, which will probably be before a machine would be ready for me.

In the meantime, I really don't want to try to sleep, I'd rather see if I can stay awake until I get the machine.

[Walla Walla]

Hojo, Congrats on passing your test.

[Fixit50]

Wow! Nice result! Sounds like you didn't have any trouble acclimating to it. Do you know what make model ASV they hooked you up to?

[Sleeprider]

It seems you've been waiting a long time for this. I'm sure it will work out. I feel badly I had to dismiss the possibility of helping you on CPAP, but it's really great that you've finally gotten to this point.

[Hojo]

All of you have been GREAT help!  I've been a difficult patient when it comes to trying to figure things out, there doesn't seem to be a good reason for the CA events and we may never know the reason, but oh well, I'm a work in progress.

The machine was an ResMed, an older model (not the 10) that I think it may be an S9 but I don't know much about these machines.

I also don't know what pressures I was on but that will come, as will more questions as long as I get to get one...I tried walking out with the one in the sleep center but they caught me.

[Hojo]

Last night, as expected, I woke up early and feeling just awful, like I wasn't breathing or a brick was covering my face; like I can't exhale.

If I were to sleep with the machine turned to the ON position but without the CPAP being turned ON, I'm wondering if it will record certain data; respirator rate, tidal volume, apnea.  I realize it won't be able to tell the difference between an obstructive and central apnea event, but just the baseline info is what I'd like to see without the CPAP running.

I think I'm at my limit and ready to an ASV machine off the black market if I had to.

[Fixit50]

Last night, as expected, I woke up early and feeling just awful, like I wasn't breathing or a brick was covering my face; like I can't exhale.

If I were to sleep with the machine turned to the ON position but without the CPAP being turned ON, I'm wondering if it will record certain data; respirator rate, tidal volume, apnea.  I realize it won't be able to tell the difference between an obstructive and central apnea event, but just the baseline info is what I'd like to see without the CPAP running.

I think I'm at my limit and ready to an ASV machine off the black market if I had to.

Was your AHI also awful last night?
I don't think the machine will record any data if its not providing PAP.  You could set it to a CPAP pressure of 4 however and use it to monitor what is happening.  I'm not sure what this would accomplish however other than to confirm that you have a sleep breathing disorder which you already know.