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Replaced my ASV, not happy, need help
#91
RE: Replaced my ASV, not happy, need help
(11-09-2019, 08:06 PM)bemused Wrote: 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?


I have the collar now, and hopefully that combined with humidity change will make tonight smoother.

Yep, I will get there!
 
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? 
 
You know I got that wrong.  The Pressure and Respiratory Rate charts both use Red signal line.  I mistook the Pressure Charts in those screenshots for Respiratory Rate and I was speaking of the big pressure drop at 1:01am.  

An ASV puzzle I am trying to characterize is around ASV behaviors when Respiration Rates drop within one minute from 12-17 breaths per minute down to 7-8 breaths per minute and stay at 7 -8 breaths per minute for some period of time (E.g. 15-45 mins).

So if that pattern appears in your chart that would be the segment of time I am ask about to gather examples. 

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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#92
RE: Replaced my ASV, not happy, need help
Interesting, I will watch for that one and let you know if it comes up. But when I do a zoom in on the time you are talking about, it looks like I basically stopped breathing for about 55 seconds. I thought ASVs were supposed to keep that from happening. Apparently I can't post any more on this thread, though. Is there a way around that?
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#93
RE: Replaced my ASV, not happy, need help
(11-09-2019, 11:36 PM)bemused Wrote: Interesting, I will watch for that one and let you know if it comes up. But when I do a zoom in on the time you are talking about, it looks like I basically stopped breathing for about 55 seconds. I thought ASVs were supposed to keep that from happening. Apparently I can't post any more on this thread, though. Is there a way around that?

"Apparently I can't post any more on this thread, though. Is there a way around that?"
Clean your browser temp files and cookies?  Reboot?

What get stuck with is getting ahead of my self and trying to "Add Attachment" before I have actually "Chosen File"
 
/////
 
"But when I do a zoom in on the time you are talking about, it looks like I basically stopped breathing for about 55 seconds. I thought ASVs were supposed to keep that from happening."

Nope. Nada. Zip.  ASV could not care less about your breathing rate unless your current Minute Vent is below your current "Target Minute Vent" which is 90% of, 10% below, your recent Minute Vent.  

Some ASV Algorithms are always in action but even if your current Minute Vent is only 2.8L/min it is only when your Minute Vent drops below Target Vent that the ASV kicks in full gear to get you back up to a higher Minute Vent.  This is why I am a mite biased to recommend supplemental Oxygen with the ASV when I see a Minute Vent consistently low.      

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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#94
RE: Replaced my ASV, not happy, need help
Et voila! So I used the collar, and kept the humidity low. And this is what happened:

   

Is that pretty or what? It would appear that you all were right on, and the events were positional. As an added bonus the collar should help with my chronic neck pain.I also suspect I was right that the nasal blockages along with the positional issues were keeping the MV low. With the humidity at 1 I had no problems breathing. And no aerophagia. So I'm a happy camper this morning. If this keeps up, and I don't see why it should, my life should get a lot better.

I also have a hypothesis about the situation you were describing. 17-20 BPM is hyperventilation, which combined with pressurized air leads to hypocapnia. Low CO2 means reduced need to breathe. So the RR would stay no higher than the minimum prompted by the machine until the blood gases stabilize and the RR goes back to baseline. Does that ring true?
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#95
RE: Replaced my ASV, not happy, need help
(11-10-2019, 12:33 PM)bemused Wrote: Et voila! So I used the collar, and kept the humidity low. And this is what happened:

Is that pretty or what?  And no aerophagia. So I'm a happy camper this morning. If this keeps up, and I don't see why it should, my life should get a lot better.

AHI = 0.0    Congrats!    like


You feel better and your Minute Vent was a whole Liter per minute higher than we have ever seen it before.  

That is awesome!

(11-10-2019, 12:33 PM)bemused Wrote: I also have a hypothesis about the situation you were describing. 17-20 BPM is hyperventilation, which combined with pressurized air leads to hypocapnia. Low CO2 means reduced need to breathe. So the RR would stay no higher than the minimum prompted by the machine until the blood gases stabilize and the RR goes back to baseline. Does that ring true?

You are getting strong on the underlying theories.   Some pretty reasonable thinking.

Normal breathing is 12-14bmp.  For Ventilation what I have read says 12-22bpm is a GREEN and normal status.  For low volume protective ventilation (what the ASV is not too far from mirroring) 15-18 breaths per minute are preferred and higher breath rates are sometimes OK if the intention is to further reduce Tidal Volume (E.g We would not want a lot of tidal volume action banging the lungs around during open heart surgery).

When your Minute Vent drops below your Target Vent the ASV algorithm kicks into full gear and tries to increase your Resp Rate to 15. The the ASV algo seems to like 15-17bmp.     


"... the situation you were describing."
I have seen across charts from 3-4 people sometimes an ASV airflow waveform where breathing is 12-17bpm and then there are 2-4 failed inspirations (appear as double peaks in a single breath) and then ASV seems to forces the patient into a Resp Rate of 7.5bpm (exactly half of the mentioned as target 15bpm) until the next flow limit drives an algorithm reset.  The primary concern: In all but one user Minute Vent fell significantly and most likely significant desaturations occurred during these periods.

This double-top failed inspiration patterns appear when there is a sudden drop from 12+bmp by 40-50% to a lower bpm.  When they last a long time it is easy to find these from a fully zoomed-out view in OSCAR.  

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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#96
RE: Replaced my ASV, not happy, need help
Interesting. I can see why that would be a concern. That does make me wonder if something like that happened with my previous machine, when I felt like it wouldn't let me breathe any faster than that. Is this the pattern you are talking about?

   

It would be useful to see if people are using oximeters during these events to back up your thoughts. Would be interesting to see what Resmed and Philips have to say about it.

btw, I meant "I see no reason why it shouldn't (underlined) continue."
S
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#97
RE: Replaced my ASV, not happy, need help
(11-10-2019, 03:12 PM)bemused Wrote: Interesting. I can see why that would be a concern. That does make me wonder if something like that happened with my previous machine, when I felt like it wouldn't let me breathe any faster than that. Is this the pattern you are talking about?


Yes, given the ongoing low Minute Vent this pattern was one of the first things to come to mind when you mentioned you felt like the machine was not letting you breath.  

The best potential place to check in this screenshot you just posted would be to zoom in so we can see the Resp Rate, Flow Rate airflow waveforms, etc for the 2.5 mins from 5:51:30 to 5:54:00

Update: just corrected the time to 5:51:30-5:54:00

Not as likely but 6:09:00-6:11:00 and 5:41:00-5:43:00 would be two additional places to check.

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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#98
RE: Replaced my ASV, not happy, need help
Here you go:
   
   
   
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#99
RE: Replaced my ASV, not happy, need help
Thanks!

The 6:09 to 6:11 event is just a flow limit.  Nothing of note. 


For the other two.  

Are the same as the pattern I am trying to characterize in that an event (E.g. Start of Leak, End of Leak or Flow Limitation of some kind) occurs and then respiration is roughly halved.  

Are different than the pattern I am trying to characterize in that:
  • As respiration is halved Minute Vent on your chart goes up (which is good news for you).  
  • As respiration is halved is not accompanied by a "failed inspiration double-top" except for once at 5:42:50 on this chart  http://www.apneaboard.com/forums/attachm...?aid=16907
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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RE: Replaced my ASV, not happy, need help
Well, at least it adds some to your data set. I'll be interested to see how your research goes -- let me know if you have a thread for it.
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