Post-radiation changes... help requested

[REMember]

That's an interesting observation. Yes, I do take a couple of meds at bedtime, one of which could come into play. I've been on the meds for five years though, and the CAs are relatively new.

[REMember]

I'm not sure how much useful information can be drawn from this. It was an atypical night with multiple arousals and time spent lying awake. PS was dropped to 3. Trigger was raised to Very High. TI Max was increased to 3.4. No meds at bedtime. The evening med that was cut out is a muscle relaxer. Breathing was comfortable. The AHI is much better than yesterday's number, and I feel much better today than I did for the last two days.

My last sleep study was three years ago, two years after radiation treatments. My AHI dropped from 117 in the previous study to 31. The tumor was at the base of my tongue, and I think we figured out where the point of obstruction was. My tongue and the muscles in my throat have continued to atrophy. I think it may be reasonable to assume that my obstructive events may be even less now.

My S9 has 23905 hours on it, and the motor warning makes for a nice nightlight. My Devillbis IntelliPAP blows tiny pieces of foam into the humidifier chamber. I need a new machine. Based on what you see in my data, what kind of machine should I be on now? Do you have enough data? When is an ASV a good fit?

[Sleeprider]

You seem to be on the right track, and it makes sense to continue using these settings to establish a baseline to decide if further optimization is needed, or if this is going to work longer-term. Feel free to put a Post-It over your screen if it is disruptive.

[REMember]

Well, you put me on that track, Sleeprider, and I am quite grateful.

[Crimson Nape]

Not looking too shabby! Based on how you feel, I would ride with these settings for a few days. The current CPAP settings, along with changing your medication dosing schedule, should establish a stable baseline.

- Red

[REMember]

Will do. Many thanks for all your help, Red.

[Peach25]

Hi there, I was wondering if you’ve got it in S/T mode with a default backup breath rate..? I can’t remember the actual settings available on these machines (it’s been some years since I have worked with them), however setting a resolution for CA’s is a backup breath rate (aka the machine will prompt the breath when your airway is clear and there is an apnoea occurring)…and if a volume can be specified, then that’ll be even better…

[REMember]

heh heh... what language was that in? This machine has an S mode but I've never used it, never explored it, and have no idea what it's for. Please tell me more. You have my interest, and thanks for your response.

[Peach25]

Oh; I’m very sorry to speak a little shorthand - I used to work with these machines some years ago, however my default mode is still to this day a bit of technical speak…my apologies
S/T stands for spontaneous/timed (spontaneous = the machine is waiting for the patient to breathe spontaneously, and it supports that spontaneous breathing pattern; timed = there is a given backup breath rate entered as a setting, so if there is too long a timeframe between breaths, the machine pushes a breath using baseline ipap min plus pressure support required -/+ volume set depending on machine type), according to the proprietary algorithm - each manufacturer has their own software magic that determines support based on sensory data it gathers from real-time patient use feedback). 
If there is S mode, that usually means (and I might not be 100% correct here - I have been out of the game for a while now) the machine supports spontaneous breathing with that proprietary support. If it has auto backup rate, that usually means the machine either fully automatically determines the breath rate based on algorithms, or there is a facility to set parameters that the auto backup rate works within (eg: like a min and max breath rate)…usually I found -anecdotally - that a back up breath rate of 12-15 was most comfortable for many people (my own bbr is 12). 
When it comes to clear airway apnoeas (CA’s), if there wasn’t a timed backup breath rate facility, I used to ask the specialist (when I worked as a tech) if I could adjust the pressure support to have a larger range, thus maximising the efficacy of inspiration for each breath, in case there was a longer timeframe between breaths. To do this, I would narrow the inspiratory time min and max so there was inspiratory consistency (keeping in mind that the sleep centre in the brain is like the ticking of a clock metaphorically speaking, and consistency helps keep it regular). By the way, from what I understand, inspiratory time is the time from the beginning of the inward breath to the end of the inward breath. Reducing the gap between inspiratory time min and max means the time of the total inward breath from beginning to end is going to be more consistent across a given number of breaths than if the inspiratory time min and max were set very far apart. Also, with a higher inspiratory time, that means the breath inwards takes much longer - sometimes resulting in the volume of air breathed in being less, before the out breath commences. If you have rise time, that is how fast the machine ramps up to the set ipap -/+ pressure support, during said in breath. Maximising the trigger sensitivity would help the machine to kick in the ipap with very little spontaneous effort from the patient. 
Hopefully this is helpful - and I do apologise in advance if this info isn’t quite 100%; it’s been a while since I was a sleep tech

[Peach25]

I was just reading back through the thread and you mentioned the S9 motor warning, and the DV bits of foam…these are potentially very toxic (motor bearings worn out, and insulation foam degradation, respectively) so if you can get a bacterial filter and place it in your circuit somewhere after the humidifier and before your mask, it will prevent some physical debris (you may see tiny bits of contaminant on it in the morning), however please keep in mind that foam that is degrading can also off-gas toxic gasses which the bacterial filter will not be able to prevent from passing into the mask.
Also, an ASV machine works well for disordered breathing patterns - I don’t recall seeing those in your screenshots of your downloads (please correct me if I’m wrong here), so an asv may not be the right machine, as a replacement.