Spy Car Bill's (Hopefully) Excellent ASV Adventure

[Spy Car]

Practice what Mr. Miyagi of the Karate Kid may have said "breathe in; breathe out" instead of the more famous "wax on, wax off" line.

Dave B

Apropos of nothing, but the apartment building where Mr Miyagi and Daniel/Ralph lived (the South Seas) is located in the neighborhood where I grew up and I had a classmate in elementary school who lived in the building who I would visit.

When the movie came out, I almost jumped out of my seat when I saw the locale.

Bill

[SarcasticDave94]

I bet that made the movie more interesting.

[Spy Car]

After the beautiful (and very rare) refreshing/restorative sleep on Friday, last night I had insomnia an maybe slept a little towards morning.

I'm feeling pretty shattered today. Oh, the ups and down of poor sleep.

I can't blame the machine, as the ASV and I have been in a general groove. I did feel the IPAP pressure getting high at times (I don't like it), but it wasn't behind my problems.

I don't know if there is anything to conclude in terms of changes based on last night's charts, but here they are:

Bill

[Sleeprider]

Your PS max of 8.0 is being worked pretty hard, and especially around the remaining events. You may need a slightly higher PS max, simply based on the fact that your setting is quite low for ASV. It needs to be high enough to cause a breath to be taken when necessary. I know you're sensitive to pressure, but when we see persistently flat-topped PS peaks in a chart, it's a pretty clear indicator that the machine would be providing more pressure support if it were available. Check out the alignment of flow limit and pressure support, as well as events. You might have to get in a little closer to see what's actually going on.

[Spy Car]

Your PS max of 8.0 is being worked pretty hard, and especially around the remaining events.  You may need a slightly higher PS max, simply based on the fact that your setting is quite low for ASV.  It needs to be high enough to cause a breath to be taken when necessary.  I know you're sensitive to pressure, but when we see persistently flat-topped PS peaks in a chart, it's a pretty clear indicator that the machine would be providing more pressure support if it were available.  Check out the alignment of flow limit and pressure support, as well as events.  You might have to get in a little closer to see what's actually going on.

Shall I go to 9 on the top range of PS?

Is EPAP OK? 

I can't think today.

Bill

[SarcasticDave94]

FWIW on the PS: don't know if it helps to see clearly or of I'm just muddying the waters, but for me and my settings, my EPAP max plus PS max allows my machine the capability to go to max IPAP 25 even though I rarely if ever go past 19, or I should say I'm not seeing my device go past 19.

speaking of muddy water 

[Sleeprider]

Bill, in the world of trial and error we live in, I think an increase of PS max to 9.0 is a worthy experiement. We want to see the flow limits and events reduced, and hopefully it pays off in more restful sleep. I do think you're pretty close, but seeing the event rate creep up near 4 is a trend I'd like to reverse.

[Spy Car]

I will adjust the PS Max to 9.

Unfortunately, I think the bad night's sleep was a "Bill issue" and not a machine issue (per se), but dialing-in the machine is important and I appreciate the on-going help.

Grasshopper

[Spy Car]

I raised the PS Max to 9 as suggested. All the UA events are gone. Only Hypopneas left.

I don't quite understand the "events" with ASV. Will every event be a UA or H? How do I understand these?

I'm open to adjustments to see if Hypopneas can be reduced.

The good news is despite a short night (I worked late on a project) is that I sleep pretty well and the machine and pressures were comfortable.

Two things I will note for future ASV users who stumble on this thread:

One, it seems to me that there is a process where the machine and the user both learn to adapt to one another. It is different than the ResMed 10 APAP. In the beginning, I felt times when the machine and I were not always in sync with regard to breathing rates, but that is changing. In early nights, at times, I found myself trying to either "over-breathe" the machine (forcing it to my will) or very consciously adapting my breathe to the machine's will. It was almost like dancing with a partner who sometimes wants to take the lead.

That is changing. The "partnership" is feeling more intuitive. More like we are of one mind.

Two. I've written that I'm sensitive to high IPAP pressures. I'm finding that with the P10s (a mask that I did not do well with AHI number-wise with APAP, despite loving the minimalism of the design) that the way this pillow mask delivers pressure is more tolerable to me than the nasal masks and that the brilliant was this mask diffuses exhaust means the disruptive body-wash of air that comes with higher pressures is gone. Love it.

It does show that at least in my case a mask that did not work especially well for APAP is working very well with ASV, YMMV.

Do I make any moves?

Thinking of turning off the ramp. Yes, no?

Bill

[Sleeprider]

Four of your 11 events resulted from the use of ramp. Your choice, but should be obvious.

Let's let this go for a while before making any other pressure changes, and if we still have hypopnea, we will use PS min of 3.0.