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[Pressure] TheWallofSleep's Therapy Thread
#91
RE: Help Calibrating APAP Pressure
Thank you all very much for the input. It has once again proven to be very useful.
I met with my doctor today and overall I must say I am pleased with our current direction. I shared all my complaints about the central events, especially how they have been consistently prevalent on all of the studies thus far, not to mention they constitute more than half of the total events, as well as the fact this is the one variable that has yet to be eliminated- or at least the only variable we have not attempted to eliminate. I voiced my great interest in trying ASV which was met with some hesitation at first since my CSA index was not very prominent. I had explained how theoretically it will either help or do nothing at all, but it will not do any harm. I also made clear that if the only hindrance is justifying it to the insurance company, I am accepting of that and am ready to pay the $1500-1700 out of pocket for a refurbished one, I just need your approval to do it. Our compromise is to try VAuto for a while, the RT will look at the data and we will talk in August. I do not know if I will feel better on VAuto within the month, though I am planning on the RT saying they do not see significant CSA, which will leave me to pleading my case solely off of how I feel-- which I am more than ready to do. However, my doctor was definitely not opposed. I was even reminded about the option of trying stimulants in the mornings, but we both agree trying ASV first seems far more logical. Personally, I do not want to take stimulants, especially if the root cause is something that is treatable. At this point in time, I am merely on the same journey everyone else had to go on in order to get an ASV machine.

As far as leg movement is concerned, I agree it is not something to be discounted, but at this point in time all I can do is isolate variables. Assuming ASV is imminent, I will later be able to cross off respiratory arousals which would lead me to be able to effectively figure out what to do about leg movement. It is a waiting game, but a plan nonetheless.

What data do the ResMed machines transmit? I would assume they can only see static averages and not the flow rate data for the whole night.
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#92
RE: Help Calibrating APAP Pressure
OK first thing, sounds like you did well with your CA and ASV sales pitch. It sounds promising at least, so congrats.

FWIW an ASV like mine, the ResMed AirCurve 10 ASV, will tackle everything Apnea, Central, Obstructive, and Hypopnea. Flow limits maybe would be a little bit of stuff there, but for myself I'd gotten some FL charts to be minimal.

Data they'd see? I think maybe similar to OSCAR, maybe scaled back in detail, I think it'll be off of ResScan. Doc's really don't look too much other than you're using it x hours and that's maybe it. As in compliance. IF they look. DME maybe looks in on compliance too. But I think mostly you're flying the plane yourself.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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#93
RE: Help Calibrating APAP Pressure
OfferUp presently has a Resmed ASV offered for $700 with 771 Run hrs. Search "Resmed ASV" there if interested. I'm not familiar with used ASV prices, don't know if that is good.
I have no particular qualifications or expertise with respect to the apnea/cpap/sleep related content of my posts beyond my own user experiences and what I've learned from others on this site. Each of us bears the burden of evaluating the validity and applicability of what we read here before acting on it.  (Disclaimer use permitted by sheepless)

 
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#94
RE: Help Calibrating APAP Pressure
IMO the price is maybe TOO good. Verify every which way this is in fact ASV before you buy. New ASV can be $4k at some places so hopefully you see why I'm saying what I am.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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#95
RE: Help Calibrating APAP Pressure
(07-09-2021, 03:46 AM)2SleepBetta Wrote: OfferUp presently has a Resmed ASV offered for $700 with 771 Run hrs. Search "Resmed ASV" there if interested. I'm not familiar with used ASV prices, don't know if that is good.

Thank you for the heads up. If so, that would be a steal, so much so that it concerns me. That price is much lower than virtually every single used one I can find on the market right now, even ones with many more hours on them. Regardless, I can't find it anyway. It's very possible that it went up and is gone already, even if you didn't need an ASV, I would think you could have bought that one and flipped it for almost double- not commenting on the ethics of that.
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#96
RE: Help Calibrating APAP Pressure
I have a question for those of you that have used ASV, or even ASV and/or VAuto at some point. Right now, even at higher pressure (9/5 PS4 VAuto, previously 10.0 APAP) I still find I am pulling the mask off an hour or two into sleep. Those who have tried ASV, especially those who have struggled with this, did you notice any difference after going from one mode to the next?
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#97
RE: Help Calibrating APAP Pressure
Clarify your mention of mode please. Are you meaning within one machine and changing modes, or on moving to different machines?

FWIW the ResMed AirCurve 10 ASV has 3 modes, CPAP, ASV, ASV Auto. CPAP is straight single pressure no EPR etc. ASV is Auto range PS within what you set PS Min and Max, while ASV Auto makes EPAP/exhale pressures a range within the min and max you set. This makes IPAP/inhale pressure a range as well. PS is a range as well, so you have Min Max there also on ASV.

I was on the DreamStation BPAP Auto in '17 that was a major fail due to my very high Centrals. Then I went to ResMed's ASV Auto and it was fine until things for more complicated with COPD.
Dave

OSCAR
Standard OSCAR Chart Order
Mask Primer
Dealing With A DME
Soft Cervical Collar Wiki
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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#98
RE: Help Calibrating APAP Pressure
I started with apap. now I alternate between asv and vauto and none of them are better or worse for me with regard to fragmented sleep (arousals and awakenings, often to the point of masking off). the reason in my case, and maybe yours, is because most of my awakenings have less to do with disordered breathing than with my periodic limb movements. machine modality and machine settings will not help this. and while the machine responses to my plm don't improve or worsen my plm, those responses do tend to disturb my sleep.

I will reiterate the point I often make about my experience with asv: the smallest range between min and max pressure support allowed by resmed asv is 5 cmw and the machine response to my plm is to rapidly and frequently raise and lower pressure support to the extent settings allow; with asv that's at least 5 cmw. whether pressure rises against plm induced flow limitations or variable minute ventilation, I don't know, but the effect is the same: even though I'm not usually aware of the pressure fluctuations and even though asv treats my mixed apnea better, active pressure support leaves me feeling less rested than compared to vauto set to more or less fixed epap and ipap (restricting pressure variation).

I mention this because you have evidence of and are being treated for rls/plm as well. pulling your mask off after an hour or two regardless of machine type suggests that something other than the machines is the problem.

I'm a little confused about which machines you're referring to but it looks like you're currently using vauto. you might try settings similar to mine to see what happens. find the min epap you require to treat out obstructives. then, starting at 3 or 4 cmw, incrementally raise pressure support until your flow limitations and hypopnea are minimized without substantially increasing central apnea. try high and very high trigger settings to reduce ca. finally, set max ipap to the sum of epap and ps to limit pressure fluctuations.
  Shy   I have no particular qualifications or expertise with respect to the apnea/cpap/sleep related content of my posts beyond my own user experiences and what I've learned from others on this site. Each of us bears the burden of evaluating the validity and applicability of what we read here before acting on it.  
 
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#99
RE: Help Calibrating APAP Pressure
I should specify that I mean modality across the AirSense, AirCurve VAuto, and AirCurve ASV. The mask removal problem is very hit or miss for me, and I was curious if anybody who has mixed apnea and has used multiple machines had any insight on correlations. I do understand that the curse of PLM/RLS makes the situation more complicated. Someone correct me if I am wrong, but PLM during sleep causes the flow rate to resemble a periodic breathing pattern, correct? I am wanting to change to ASV since it is the strongest method for mixed apnea, but I am concerned my PLM may be prominent enough to make ASV counter-productive. I hear Sheepless on his point about ASV possibly making rapid pressure shifts due to breathing inconsistencies caused by leg movement, but ultimately, I am probably left to the 'try and see' method. I am hoping that isn't a nail in the coffin. Can anyone else chime in who has PLM and experience with ASV? I am hoping there isn't a consensus that ASV and PLM do not mix well.
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RE: Help Calibrating APAP Pressure
Alright, it has been a few days and I have been attempting to establish a trend. I have been using an AirCurve VAuto at 9/5.2, PS 3.8, trigger very high. I have been wanting to make the switch to ASV, but I am feeling very conflicted about it. Without looking at data, I do not feel much better. I feel slightly better on BiPap then I did on CPAP, however, I would gauge it around a 15-20% increase. I am still feeling very tired, having migraines, having night sweats, suffering from brain fatigue, and as usual, my FitBit data still shows awfully fragmented sleep. What is troubling to me is that I have a near envious AHI some nights. The only thing I can find in my flow rate are these reoccurring flat lines, though they are not marked as O/H/C events. My initial impression is that they are just short enough to not be recorded as an event of any kind. Most of them seem around 5-8 seconds long. Has anyone seen these before, and is it something that just barely slips by the machine? Or am I lucky enough this is just PLM? As always, thank you.

Edit: I know how to set user flags, is there a setting that would help diagnose this?


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