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Spy Car Bill's (Hopefully) Excellent ASV Adventure
#1
Last night I started ASV, after a year and two months on APAP (ResMed AirSence 10 Autoset).

I like the APAP machine, used it diligently, but over time my numbers and (most importantly) my feeling of being refreshed worsened. To me, it seemed that the worse I felt the more CA events I saw in my charts. I fiddled with settings, but CAs rose over time.

With the help of good counsel on this forum, I was able to work with a sleep doctor, get a study that showed the efficacy of ASV, and as of yesterday, I have a new machine.

Now to dial it in.

There were times last night when I felt in sync with the machine. Other times natural breathing and machine breathing were not in sync and I felt forced into an odd pattern. Overall the pressure seemed WAY TOO high.

Not sure what moves to make based on this data. But I am feeling optimistic this afternoon.

I will try to make this an ongoing thread in hopes it helps someone else one day.

Best to all,

Bill

 
[Image: FEIPSWT.png]
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#2
Sorry my name isn't Ted, but my excellent adventure on ASV makes up for it.
Due to my sarcastic nature, it may not be obvious that I am not a doctor nor do I pretend to be one. My advice is from personal experience. Follow my advice as a choice not as an order. 2 of these  Coffee Coffee per day keep the bad times away.
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#3
Bill, I think you can drop EPAP minimum until you get an OA or two to show up. That is going to drop your overall pressure. If you want to try limiting PS max to 10, go for that and see how it works out. I think just for comfort, I would go with EPAP min 6.0, EPAP max 9.0, PS 2-10 and IPAP max to 20. Your settings are effective, but I can see where pressure support is distorting your normal flow rate by quite a bit. I'd like to help you smooth that out. It's not outrageous, but clearly pressure support of 15 is over-active for you, and it's unnecessary.
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#4
(10-14-2017, 03:54 PM)Sleeprider Wrote: Bill, I think you can drop EPAP minimum until you get an OA or two to show up.  That is going to drop your overall pressure. If you want to try limiting PS max to 10, go for that and see how it works out.  I think just for comfort, I would go with EPAP min 6.0, EPAP max 9.0, PS 2-10 and IPAP max to 20.  Your settings are effective, but I can see where pressure support is distorting your normal flow rate by quite a bit.  I'd like to help you smooth that out.  It's not outrageous, but clearly pressure support of 15 is over-active for you, and it's unnecessary.

Thanks for the input. I care a lot more about getting good sleep than maximizing scores at this juncture and blasts of pressure are waking me up out of sleep (or sleep transition).

And I'm not feeling qualified to make changes without assistance. 

I will post tomorrow and monitor the thread for further thoughts. Today I have a bit of that "inflated head" feeling, KWIM? But this seems like a positive path otherwise.

Bill
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#5
Good news first. 

I'm ecstatic this morning that for the first time in recent memory I woke up remembering dreams (and quite pleasant dreams at that). 

I can't overstate the difference. This was not a perfect night, but I'm feeling refreshed this morning to a degree I have not felt in a very (very) long time. Yippie!!!

I re-set the ASV device to Sleeprider's suggestions above (and thank you sir!!!). Much (much, much) more comfortable and the numbers were better (but different).

@Sleeprider. I still feel the IPAP pressure goes too high. It woke me out of sleep where I had my break. Even when I'm awake (and seemingly not having issues) the machine sometimes kicks in with very aggressive blasts (ones I don't understand). 

I don't think I nee this much pressure and that it is counterproductive to sleep. If you'd look at my charts and offer a suggestion, my gratitude will only deepen. 

I feel like I'm on a threshold of really great things with this ASV. The usual brain-fog and fatigue I feel on waking are greatly diminished and I'm looking forward to a day of accomplishments.

I still don't feel comfortable making moves without guidance. I do think this baby can be dialed in. At the best breathing with the ASV is delicious. I just need it to be less aggressive.

I'm thinking this may, indeed, be an excellent adventure.

Best to all!

Bill

[Image: Hzv6etO.png]
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#6
Bill - Cheering for your continued success. There is very little more invigorating than a good nights sleep. Clearly ASV is what you needed all along. Keep posting as others will indeed benefit.
Coffee

Happy Pappin'
Never Give In, Never Give Up


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. 
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#7
Your graphic does not link to the original so I can't see the finer details. Can you help me out with a link to full sized image?

The exaggerated flow rate has nearly disappeared when the machine reaches max PS, and that is a big improvement. I am seeing movement in the EPAP, so I think we have that nailed down pretty good. We have to have at least 8 cm at max PS, so if you want to drop PS max back to 9.0 that would be a more cautious move. Give it a try and at some point we want to zoom in on any events and take a better look at what's going on in more detail. I'd be especially interested in seeing what is going on in those flow limit spikes and maybe look at a hypopnea and UA. Glad to hear this is working out.
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#8
(10-15-2017, 12:06 PM)Sleeprider Wrote: Your graphic does not link to the original so I can't see the finer details.  Can you help me out with a link to full sized image?

The exaggerated flow rate has nearly disappeared when the machine reaches max PS, and that is a big improvement.  I am seeing movement in the EPAP, so I think we have that nailed down pretty good.  We have to have at least 8 cm at max PS, so if you want to drop PS max back to 9.0 that would be a more cautious move.  Give it a try and at some point we want to zoom in on any events and take a better look at what's going on in more detail.  I'd be especially interested in seeing what is going on in those flow limit spikes and maybe look at a hypopnea and UA.  Glad to hear this is working out.

I'm quickly going to provide two new links. The first (top) "Original," the second (bottom) "Huge Thumbnail" to see if they help.

Then I'll provide any close-up images you desire, just let me know what you need.

Bill

[Image: Hzv6etO.png] [Image: Hzv6etOh.png]
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#9
(10-15-2017, 12:03 PM)sonicboom Wrote: Bill - Cheering for your continued success.  There is very little more invigorating than a good nights sleep.  Clearly ASV is what you needed all along.  Keep posting as others will indeed benefit.

Thank you. I've been slowly losing my mind due to feeling sleep deprived. Last night, while not perfect, was a god-send.

I honestly can't remember the last time I work up and remembered having been in dreamland.

Bill
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#10
The original link worked best. If you use the link called "Linked BBBCode" then simply clicking on the image will open a tab with the full size image. It's "ginormous" as my granddaughter says, and a lot easier for me.

I'll stay with the suggestion to drop PS max by 1 cm to 9.0 and you can limit IPAP max to 18. I think what actually woke you was a UA event at 05:41, and that might be worth a closer look. Your pressure at that time was not exceptional, but it did rapidly increase EPAP. I suspect that might have been a random OA. At this stage, we need to take it slowly and give things a chance to work and for you to adapt.
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