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Replaced my ASV, not happy, need help
#11
RE: Replaced my ASV, not happy, need help
Good point DB. My mushy brain cell missed that.
Dave

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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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#12
RE: Replaced my ASV, not happy, need help
Wow, thanks for all this -- a lot to take in. First the easy stuff. I changed out the small nasal cushion for a medium, which I had been using before (not sure why I switched), and replaced the climate line. That cut down on though didn't eliminate the leaks, and there seems to be less correlation between leaks and events. I am ordering a new frame today so should have that next week. I have been using manual humidity and now have it at 80 degrees and 6, which seems to be fine.

I am pretty confused as to the significance of minute ventilation and didn't realize mine was low, so would like to hear more about that.

Just as an fyi I have been taking baclofen to help with reflux and it makes me have to pee, which accounts for some of the wake-ups. I'm going to stop it tonight and see if the reflux reappears but hope to eliminate a couple of wakes.

Now for the bizarre part. The first part of last night seemed to go really well -- when I woke up the first couple of times  AHI was 0.0 and then 0.7, and I was breathing comfortably with no air hunger. But then things got really weird. I woke up around 5 and was having to fight to breathe --for what felt like seconds there would be literally no air coming through at all, like trying to breathe through a brick wall. Then I would get a burst for inhale, but it wouldn't let up so I could exhale. Then the whole thing would happen again. And the AHI went through the roof. It lasted till I shut off the machine, went to the bathroom and restarted it, after which things got mellow again. What the heck was that ??-- it was pretty horrible.

So here are a bunch of charts to hopefully give some insights. First per WillSleep the 2 minute shots from the 29th:

[attachment=16647]   [attachment=16649]

The full night details for last night:
[attachment=16650]   [attachment=16651]

To be continued
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#13
RE: Replaced my ASV, not happy, need help
And a close-up of the weird portion of the night:
[attachment=16652]

Let me know if you want 2-minute shots from last night.

So it sounds like I should go ahead and up the EPAP minimum, yes?  By just 1, or to 6? And raise the max to ??
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#14
RE: Replaced my ASV, not happy, need help
it sounds like you got out of sync with the machine for a while. when you have runaway pressure or this kind of out of sync experience, either blow back hard until it settles down or turn the machine off and on again.

I haven't re-read this thread so take your history into account to determine if this is a sensible suggestion:

based on the screenshots in the last 2 posts only, I would inch epap up 1 cmw at a time to see the effect on the hypopnea. I would also lower my max ps to determine if pressure rising in response to flow limitations is causing some of the h. (it does for me but most of my flow limitations are my response to periodic limb movement, which may not be a problem for you, so an experiment to gain more information). if h are obstructive, the higher epap will help. if h are central (e.g., breath holding against rising pressure), lowering max ps may help. do one adjustment at a time. once you find the min epap that produces the lowest ahi, residual h may be helped, if necessary, by raising min ps.

there's another line of thought that says set max ps to the highest setting in order to allow the asv maximum potential to use ps to trigger a breath during a ca. knowing that there's a lot of trial and error in this business, I'd try that too in an attempt to determine if the h is obstructive or clear airway.
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#15
RE: Replaced my ASV, not happy, need help
One thing that strikes me is that the EPAP didn't go to the max with all those hypopneas -- maybe just because the machine was out of sync? But I will try this for tonight:
EPAP min 5, max 8 (raising min and max both by 1 cm)
PS min 5 (same as before) max 12

And see what happens. . .
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#16
RE: Replaced my ASV, not happy, need help
Bemused, are you using a soft cervical collar? The "weird section" sure looks like an obstructive cluster to me. I can think of ways we could increase PS, but I'd rather see more response to what we have, and I think perhaps we should look at positional correction rather than more pressure. Please verify pressure settings for EPAP min, EPAP max, PS min, PS max. EPAP max seems too limited. Chart organiztion would be better with Events, Flow Rate, mask pressure and leaks prioritized.
Sleeprider
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#17
RE: Replaced my ASV, not happy, need help
true, epap rises very slowly. I figure that's why it may be useful to experiment with higher min epap, to be closer to where you (may) need it.
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#18
RE: Replaced my ASV, not happy, need help
IDK why I didn't think of a positional issue. like that occams razor thing: it's the simplest explanation, and easy to try a collar. I wonder if your tidal volume and minute ventilation should be a bit higher though, depending on your size. search the internet for a tidal volume calculator. if it's low, pressure might help that too.
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#19
RE: Replaced my ASV, not happy, need help
(10-31-2019, 01:27 PM)bemused Wrote: And a close-up of the weird portion of the night:


Let me know if you want 2-minute shots from last night.

So it sounds like I should go ahead and up the EPAP minimum, yes?  By just 1, or to 6? And raise the max to ??


Yes to all the concepts Sheepless mentioned.  


Saw a 9 hour sleep session.  Nice.

Nice job beating back some of those leaks!   



EPAP Min: The two minute screenshots you posted at 4 & 5cm H2O showed some healthy foundational components to the waveform shapes, they all were just crying out for more flow and fighting flow limits so in this case they are calling for more EPAP.   Minute Vent is still low so more EPAP.  

You have screenshots above at 4 & 5cm H20.  Now lets round out to get a good comparison test set with EPAP Min set to 6.5cm H20.   

EPAP Max:  I see no reason to constrain EPAP Max any lower than 12-13cm H20.

PS Min:  At this distance the leaks 95% look related to high pressure.    You are showing no CAs and high pressure is unhelpful / hurtful (causes leaks, slows Resp Rate, etc) when it is not needed.     

As you are raising EPAP Min to 6.5 and we don't see a reason to keep PS high I would drop PS 2-3cm H20 from whatever you had it set to last night.   Dropping 3cm H2O will help a little to control the Leaks and also reduce ASV algo chaos from recovery to Leaks.  


Summary:  Tonight I would try lift EPAP Min from 4.0 to 6.5cm H20 and drop PS Max by 2.0-3.0cm H20 and then post results in the morning.  


/////////////////////////////////////////////

"I am pretty confused as to the significance of minute ventilation and didn't realize mine was low, so would like to hear more about that."

Minute Ventilation is the best measure visible in OSCAR to show how much Oxygen you are getting and if you are getting enough.   Minute Vent is a far more medically important number to follow than AHI.  A low Minute Vent leads is a warning that your therapy may not be helping you get enough oxygen in your blood (Hypoxemia) which on an ongoing basis leads to being tired, not feeling refreshed, a increased probability of high blood pressure, early stroke, exacerbation of other medical concerns, etc.  

The Minute Vent number in OSCAR good to use when that is the best option we have and is handy because it is automatically updated when we load our nightly data into OSCAR. However the Minute Vent number in OSCAR is one degree of separation and not as accurate as the better widely available tool to make sure your getting enough Oxygen through the night. Wearing a Pulse-oximeter and reviewing nightly results to see if, when and how far your Oxygen dropped below 95% is a more accurate measure to confirm you are getting enough oxygen.

Your Minute Vent results might be impactfully low for an average sized woman. Do you feel fully refreshed when you wake up or sort do not have quite as much "Zing as you used to have in your daily Zang"?   Lol.    I would not at all be surprised to see your answer is "tired" 

The loose accepted normal Minute Ventilation for an averaged sized male (5'10" 155-170 lbs) while sleeping has been published at 7.1-7.2 Liters per Minute (7.1L/min).  This number would appear as Mint Vent 7.1 in OSCAR's Daily stat box. 

We can try to sort what the US Gov Health agency (HHS) has published or endorsed as the loose standard "normal" Minute Ventilation for a woman of your height.   If you want us to look just post or message how tall you are (we just need male or female and height, no other inputs are used in the formula).  

Did that clarify? If not please post with any remaining question on any of these topics.

Have a great day!

WillSleep

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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#20
RE: Replaced my ASV, not happy, need help
(10-31-2019, 02:47 PM)Sleeprider Wrote:  Chart organiztion would be better with Events, Flow Rate, mask pressure and leaks prioritized.

Hi Sleeprider, 

I asked her to organize the chart this way because the primary set of biggest unknowns to sort out at the moment have to do with Tidal Volume, Minute Vent, Inspiration Rate, Expiration Rate, etc.   So far I think the 'find the right pressures' work looks pretty 'run of the mill' and between the traditional we do not yet need the other charts to sort out steps on that. So far, the more traditional layout charts (including the historic example of a good night) she included in the first few posts plus this layout focusing on Minute Vent paints a pretty good picture to work from.

Though I should have also asked her to include Response Rate even if she needed to scrunch up the other charts a little to make it fit.  

WillSleep

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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