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Replaced my ASV, not happy, need help
#71
RE: Replaced my ASV, not happy, need help
I stuck it out all night, but it was rough going -- multiple wakes and a lot of feeling starved for air and straining to breathe. Still lots of resets. Decreasing the PS range doesn't seem to have made a lot of difference. Finally around 6:00 I decided to try increasing the minimum PS to see if that helps. Raising PS instead of EPAP because - UARS. I have narrow nasal passages that block up easily, especially when I am trying to pull in air rather than being able to just let it happen. And I have never had more than a few OAs. So I need help on the inhale, and lots of room on the exhale.

I wobbled between settings trying to find the sweet spot that let me breathe naturally without puffing up from over-pressure. I ended up at 4.6 but that seems a little too high as I started getting some lip flutters and chest/abdominal discomfort, but by then it was time to get up. So 4.4 seems like the number to try.

Anyway, here is the visual.

   


New machine just arrived. Proposed settings:
EPAP 5-8
PS 4.4 - 10

Thoughts?
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#72
RE: Replaced my ASV, not happy, need help
The new machine will be an opportunity to see if the change of machines and AHI was a fluke, or something else. If your results return to comfort and efficacy, then it is the machine. Let's see what happens at the same settings.
Sleeprider
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#73
RE: Replaced my ASV, not happy, need help
Overall, the chart doesn't look bad. AHI of about 3 is acceptable IMO. I'd say an important factor is if this can be repeatable. To be good doesn't mean a zero AHI. Go by feel/comfort. The AHI currently is all hypopnea, which I think is addressed by higher EPAP Min. You can choose to try an edit or not by determining if these are a disruption.

It's possible your pressure is being artificially flat topped, maybe it's on purpose and may not require attention or action.

Bottom line: I think any adjustment from now on will be comfort derived.
Dave

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#74
RE: Replaced my ASV, not happy, need help
Yeah, it's not the AHI that bothers me so much as the multiple wakes and perceived difficulty breathing --that's what I want to change.

Not sure what you mean by "artificially flat-topped"?
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#75
RE: Replaced my ASV, not happy, need help
(11-07-2019, 12:37 PM)SarcasticDave94 Wrote: Overall, the chart doesn't look bad. AHI of about 3 is acceptable IMO. I'd say an important factor is if this can be repeatable. To be good doesn't mean a zero AHI. Go by feel/comfort. The AHI currently is all hypopnea, which I think is addressed by higher EPAP Min. You can choose to try an edit or not by determining if these are a disruption.

Bottom line: I think any adjustment from now on will be comfort derived.

I agree with Sleeprider and Dave ... generally let these settings ride for a few days continuing with only small adjustments as you see fit for comfort/best balance to get through the night well. 

Short term possibilities:
 
  • Keep trying to reduce the leaks.  You might really like or might really dislike the 'Bleep' mask.  If you have not seen it check it out.  Provides a tighter nose seal reducing leaks and also may allow you to have more direct and enforceful control of external pressure through the nose.  
     
  • If those clusters of hypopnea were not driven by high leaks or because you were really awake then there might be a positional (Less chin tucking or sleep on side rather than back) opportunity to reduce a few more hypopnea.   


Longer term possibilities:
     
  • As mentioned above, this week I would just use this week finding the most comfortable settings so that you again build consistency with your use of the xPAP and have a pretty reasonable night.   
         
  • Slowly (.2 increments a week at a time) increase EPAP Min.   Dave nailed it above on raising EPAP Min as the path to reducing more of the hypopnea events.   
     
  • As far as being less tired even when the AHI is low (maybe even less tired than your previous machine at it's best) use a Pulse-Oximeter to check to see if your SpO2 levels are not ideal through the night.  If you find your SpO2 is not above 95% nearly all night then might talk with your doc about adding "continuous oxygen" to your ASV treatment.   
    Your Minute Vent still looks unusually low and I do not believe lack of desaturation during your sleep studies should be viewed as fully conclusive that you are not seeing a desauration now.   What I have seen from three xPAP machines I have used for a number of nights the ASV is the most comfortable but has lower SpO2 performance effectiveness.       
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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#76
RE: Replaced my ASV, not happy, need help
The pressure chart seems to look flat on top sometimes, at least to me. It's probably nothing to be concerned with.

Let's focus on getting those areas you find distracting to decrease. I'll get back on this in a bit, I'm trying to reflect what I did myself.
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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#77
RE: Replaced my ASV, not happy, need help
All good advice. I will definitely keep away from big changes for now, and if I make any just do one at a time so I can evaluate -- and do my best to track them in the Oscar notes. I looked at the Bleep mask and it looks interesting -- but I am not due for a new mask with my insurance until February so would be out of pocket. Also the environmental impact of the disposable adhesives bothers me. But I will keep it in mind. Meanwhile I'm going to keep working with the Dreamwear, maybe try different size cushions and/or the nasal pillows again.

And I guess it would be a good idea to get the oximeter based on your observations about the minute ventilation. Any recommendations for what to buy?
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#78
RE: Replaced my ASV, not happy, need help
Actually looking at how pricey they are I will hold off on the oximeter and see how I feel when(!) I get the ASV optimized. I don't think I could tolerate the finger type -- last home study I did with one my finger really hurt the last third of the night. . .
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#79
RE: Replaced my ASV, not happy, need help
Just for future reference, I think several here use an oximeter by Contec model CMS50F. And there's other variants available too.
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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#80
RE: Replaced my ASV, not happy, need help
The saga continues. . .
Well I have the new machine, and subjectively I am much happier with it, though the picture doesn't look it at this point.
   

As you can see the AHI went bonkers. However, I am pretty sure they were mostly if not all positional. Just to confuse things I switched pillows last night. The new one is quite high and firm, which feels good to my neck but means my chin tends to slip down toward my chest. So I followed your suggestions and ordered a cervical collar -- a narrower one this time which hopefully will be more comfortable than the last one I tried. Good ole Amazon Prime so it will be here tomorrow. So I want to hold off on any conclusions regarding all those blue and green lines.

Also as you can see the leaks dropped back to almost nothing. How that can be a factor of the machine I have no idea as the mask hasn't changed, but there you are.

Subjectively I don't feel jerked around by this machine as I did the last one, even though the pressure runs the gamut. I think it's especially interesting that this one does raise the EPAP, at times to the max, where the other one never took it much above the minimum. I never had that feeling of having the air flow stopped altogether. Also, despite the wide pressure swings, I have no aerophagia, which had been getting worse. Weird, I know. But today, despite the high AHI, I am feeling much better than I have the past week.

I did email my doctor regarding the low MV, and will see what she says. One option might be to do a home study with the ASV, if they do that, and see if the saturation actually drops.

I'm also going to see my ENT surgeon, even though I'm wary of more surgery, to see if there's anything we can do about my right nostril closing up. It's fine in the daytime -- any time I visit a doctor my saturation is 98-99%. But night is a different story. I am wondering if that is actually the reason behind the low MV.

So onward. I'm not going to touch any of the settings for now. One more night without the collar -- I may switch pillows back. (But it occurs to me the pillow might affect the leak rate? Is that possible?)

Will keep you posted.
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