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Replaced my ASV, not happy, need help
#81
RE: Replaced my ASV, not happy, need help
Just heard back from the doc -- she reviewed the MV and TV numbers with the pulmonary specialist and they think they're fine. But we scheduled an overnight oximetry test with the ASV just as a precaution.
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#82
RE: Replaced my ASV, not happy, need help
Good to hear that. I'll wait to hear the results of that and what your new ASV therapy trends to report.
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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#83
RE: Replaced my ASV, not happy, need help
(11-08-2019, 01:04 PM)bemused Wrote: Just heard back from the doc -- she reviewed the MV and TV numbers with the pulmonary specialist and they think they're fine. But we scheduled an overnight oximetry test with the ASV just as a precaution.
 

Congrats!  Awesome.  
 
"she reviewed the MV and TV number"
Your Tidal Volume numbers alone has never raised any concern for me.   
Minute Vent has been the number catching my eye.  
 

"But we scheduled an overnight oximetry test with the ASV just as a precaution."

Excellent.  
 
You might find your SpO2 stays very high all night which is good news.  You might find it is lower than it could be which is also can be good news because you found something you address.  

Is being 'normal' for someone my age good enough?  I personally suspect that if we are not in the upper half of the range of normal for SpO2 the answer is NO!   I have seen research that says even just in the short term (28 days or less) the brain shows signs of impact/injury from being repeatedly deprived of oxygen for periods of time at any SpO2 below 95%.   So I am concerned, I 'suspect,' the ranges for "Normal" SpO2  (above 88%, 92%, 93% .. )  too low to be helpful for long term treatment full success in the same way that this community accepts that an AHI of 5.0 or less is an inappropriately high measure to consider fully treated long term for Apnea.

I would for sure try to get your own copy of the night long report.  Average SpO2 for the night is less important than time below 'strong health" thresholds of 94-95%.   Hopefully you will be a report back that includes time below 92% and what I think are more valuable metrics for the tuning stages of treatment  "time below 94-95%".  I believe knowing the time you spend below 95% (and have seen research published on this) indicates that amount of time your brain did not get all the oxygen it really wants.  
 
When she reviews the results with you and they if are "normal" or within "normal ranges" but not high in the range might push a little further.     ~"Yes but will I be less tired if they are a little higher?  The on the Epworth Sleepiness Scale I am still tired in these ways."    http://healthysleep.med.harvard.edu/narc...ness-scale   Note: Like AHI, the Epworth Sleepiness Scale is a common diagnostic to determine if the patient is fully treated or additional treatment is warranted.
 

Just continuing to work to try to help you achieve goal #3. Be Less Tired      
 
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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#84
RE: Replaced my ASV, not happy, need help
(11-08-2019, 12:43 PM)bemused Wrote: 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.    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.

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.

"I am feeling much better than I have the past week." 
This is great news.  Happy to see you like that new machine!  

"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."
Could be the mask, lower leaks, or all electronic products have slight variances, and this ASV might have newer firmware.   Over time the cause of the improvement might become more clear. Regardless the cause this is great news

Might bump EPAP Max up 1cm H20, might help lower the Hypopnea.  A Max of 8 is pretty low and it is generally viewed here that on the ASV let EPAP Max have all the room it wants to run until you see it cause a problem.   

"I may switch pillows back. (But it occurs to me the pillow might affect the leak rate? Is that possible?)"
Mask changes often affect Leak Rate.  Bleep then Pillows often have the lowest, then Nasal and, depending on the person, and Full Face often have the most Leaks as they have the most surface area that has to maintain a good fit.  


Great.  

Have a great night Sleep!

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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#85
RE: Replaced my ASV, not happy, need help
I did suspect that the firmware might have something to do with it, No way to know for sure, but it does feel different -- in a good way.

The oximetry test will be the 25th, so not too long to wait on that. She's been real good about sharing info with me so i should be able to get the full report. I'll make a point of asking for it as I agree that relying on averages risks missing some important information -- which is why Oscar is so helpful. The info the doctor gets is much less comprehensive.

I may bump the EPAP later., but want to see how I do with the collar first.

Just to repeat, thanks for all this. I know it takes some time and attention, and I am grateful for the help.
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#86
RE: Replaced my ASV, not happy, need help
(11-08-2019, 04:17 PM)bemused Wrote: I did suspect that the firmware might have something to do with it, No way to know for sure, but it does feel different -- in a good way.

The oximetry test will be the 25th, so not too long to wait on that. She's been real good about sharing info with me so i should be able to get the full report. I'll make a point of asking for it as I agree that relying on averages risks missing some important information -- which is why Oscar is so helpful. The info the doctor gets is much less comprehensive.

I may bump the EPAP later., but want to see how I do with the collar first.

Just to repeat, thanks for all this. I know it takes some time and attention, and I am grateful for the help.

 
Sounds like you have great plans in place and are following a great 'make changes slowly, thoughtfully, and methodically' cadence.
 
Have a great night's sleep.
 
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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#87
RE: Replaced my ASV, not happy, need help
Almost forgot.  

One more thing.

In the screenshot you posted this morning.

IF from ~2:45 - ~3:05am your Minute Vent was at or above your 4.38 Median Minute Vent ...

THEN you might grab and save as benchmarks of screenshots of 2:30-3:15am and a few two min screen shots within that really super smooth, low pressure period of between ~2:45 - ~3:05am. 

For the OSCAR charts that are showing in this screenshot that ~20 min time frame is the very best deep, non-rem sleep segment I have seen in all the screenshots you have posted.  So if Minute Vent looks good during that time as well then learning all can from this "example of best case" might help you figure out how to replicate this experience more often, hopefully much more often. 

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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#88
RE: Replaced my ASV, not happy, need help
(11-08-2019, 05:14 PM)WillSleep Wrote: Almost forgot.  

One more thing.

In the screenshot you posted this morning.

IF from ~2:45 - ~3:05am your Minute Vent was at or above your 4.38 Median Minute Vent ...

THEN you might grab and save as benchmarks of screenshots of 2:30-3:15am and a few two min screen shots within that really super smooth, low pressure period of between ~2:45 - ~3:05am. 

For the OSCAR charts that are showing in this screenshot that ~20 min time frame is the very best deep, non-rem sleep segment I have seen in all the screenshots you have posted.  So if Minute Vent looks good during that time as well then learning all can from this "example of best case" might help you figure out how to replicate this experience more often, hopefully much more often. 

WillSleep

Just caught this -- I don't seem to be getting all the email notifications of postings.

Yes, it's a nice smooth line that looks like deep sleep (yay). But the minute vent is way below 4.38:
   

So apparently I breathe very shallowly when in deep sleep? I had a similar period last night -- a couple of them actually, where the minute vent went below 2 for about 8 minutes.
   

Weird. Guess it's a good thing I'm getting the oximetry test.
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#89
RE: Replaced my ASV, not happy, need help
(11-09-2019, 06:45 PM)bemused Wrote:
(11-08-2019, 05:14 PM)WillSleep Wrote: Almost forgot.  

One more thing.

In the screenshot you posted this morning.

IF from ~2:45 - ~3:05am your Minute Vent was at or above your 4.38 Median Minute Vent ...

THEN you might grab and save as benchmarks of screenshots of 2:30-3:15am and a few two min screen shots within that really super smooth, low pressure period of between ~2:45 - ~3:05am. 

For the OSCAR charts that are showing in this screenshot that ~20 min time frame is the very best deep, non-rem sleep segment I have seen in all the screenshots you have posted.  So if Minute Vent looks good during that time as well then learning all can from this "example of best case" might help you figure out how to replicate this experience more often, hopefully much more often. 

WillSleep

Just caught this -- I don't seem to be getting all the email notifications of postings.

Yes, it's a nice smooth line that looks like deep sleep (yay). But the minute vent is way below 4.38:


So apparently I breathe very shallowly when in deep sleep? I had a similar period last night -- a couple of them actually, where the minute vent went below 2 for about 8 minutes.


Weird. Guess it's a good thing I'm getting the oximetry test.

Its a bummer the Respiration Rate was not high then.   So yes it would be a real surprise to find out you did not see a desaturation during that time.  

Even if you don't see a similar extended period of a low Minute Vent during the night of your Oxygen saturation test you already have evidence with these screenshots to use as comparison.    ~~"I was at SpO2 xx% when Minute Vent went down to 3.8L/m, how much worse it must be when Minute Vent gets down into the 2's"

Is this the right machine for you?

1) The VAuto has access to settings that have good potential to help address the Low Minute Vent but I saw how much higher you AHI was with the VAuto.  If you have not yet fully explored tuning all the settings options there may be a way to get that AHI down on that Machine.  The group could help you.

2) On the ASV, the zoomed in portion your shared when the lines were all smooth looked from here like you were getting less range on inhale and more on the exhale which calls for a higher IPAP pressure, probably increasing EPAP Min 3x as much as you increase PS Min as you add on the next 3cmH20 in total across both of them.   But you are currently maxed out on pressure so bleeding in supplemental oxygen might be the best short term method of bolstering your success on the ASV.  
http://www.apneaboard.com/wiki/index.php..._with_CPAP

That requires a prescription for continuous oxygen and a ~$65 "ClimateLineAir Oxy" tube replacement that includes the port to which you connect the oxygen line.     Horrible search but a search hard to find a search that did not break rules.  ResMed has gummed up finding the right tube by publishing inaccurate images.   Look for the hose with the white port sticking out the end.    
https://www.google.com/search?hl=en&tbm=...ineAir+OXY

If you go this route with your ASV recommend buying through your DME or one of the vendors on our Suppliers page http://www.apneaboard.com/forums/Thread-...plier-List


3)  I would be remiss if I did not point out that Philips sells a machine that like the ASV is more PS driven than EPAP driven and it is really a pretty good machine.   This might be a better machine for you.   Dreamstation Bipap Auto SV


======= 


On the zoomed in portion of the chart you posted.  I would be interesting to see a three minute view of when you went from 17-20 breaths per min down to 7 breaths per min.     I itching to confirm or prove wrong a suspicion about what transpired right at the open of that drop to that long period of 7 breaths per minute.     


You will get there!!!  

We are learning more everyday and you have a few options to try.

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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#90
RE: Replaced my ASV, not happy, need help
Well I bought this machine out of pocket so am pretty much committed to it at this point. And I am still feeling better on it, despite the weird numbers. I felt horrible on the bilevel, so have no interest in going that route again. I still think I can get this one to work -- though I suppose oxygen might be in my future. My doctor actually mentioned it at one point. It sounds like a hassle and potentially expensive depending on what my insurance covers, but feeling good would be worth it. So we'll see how it plays out.

I'm not sure which 3 minute segment you're asking for? I don't see where it goes from 17-20 down to 7? But I also think it's possible I was awake during the slow breathing episodes -- I was awake a lot last night, mainly because I was having problems breathing through my nose. Finally figured out about 6 AM that I breathe better at room level humidity than with a lot of moisture, so dropped the machine setting down to 1 and breathed better -- though by than I was pretty much done for the night. I have the collar now, and hopefully that combined with humidity change will make tonight smoother.

Yep, I will get there!
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