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Spy Car Bill's (Hopefully) Excellent ASV Adventure
#81
RE: Spy Car Bill's (Hopefully) Excellent ASV Adventure
(10-27-2017, 11:24 AM)SarcasticDave94 Wrote: Unless I'm missing something, at this point in settings, isn't it more a question of how do you feel? What setting combo makes you feel the best? The answer is "XYZ" makes sleeping feel the best...then that XYZ (fill in the blanks) is "your best combo" of settings.

Hope that makes sense.

Dave B

Great Friday y'all  Coffee

Yes Dave, all I care about at this juncture is maximizing sleep quality. 100%.

I forgot to mention earlier, last night was another night where I woke up remembering dreams. Not a big deal for many--I'm sure--but until starting ASV it had been a very long time since I remembered having dreams. And I think this is reflective of not getting deep sleep. I was feeling pretty thrashed.

I have already seen that the ASV can help me get restorative sleep. That is what I'm after. If I can consistently get refreshing sleep I will be a new man.

Any adjustments should have that goal (alone) in mind.

Cheers Coffee

Bill
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#82
RE: Spy Car Bill's (Hopefully) Excellent ASV Adventure
Yes, glad to hear you're doing better with ASV helping.

Here's to future success with this.  Coffee

Dave
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: Spy Car Bill's (Hopefully) Excellent ASV Adventure
(10-27-2017, 10:06 AM)Spy Car Wrote: I appreciate the input @ajax. One bit of information for you on personal history is that on APAP I was able to use pretty low Max pressures to control events. Raising pressure only drove up CAs and messed with sleep. So I never got anywhere near Max pressures of 19, and for me (who is pressure sensitive) these pressures are requiring an adjustment already. Going to PS 10 made me feel "pressurized" and kind of unwell.

I do wonder about the advice by ajax to raise EPAP mins. My inner-intelligence was wondering the same thing, just based on my breath. Good idea?
Yes the apap would do this. With the ASV I would discuss this with your doctor. AFAIK  The ASV treats the CA with high pressure. It needs the high pressure to inflate your lung, when you don't breathe for yourself. It's the purpose of using an ASV. The flow and tidal volume charts becomes the most valued to me.

The machine will only use the pressure needed to maintain the lung minute ventilation. The pressure from an ASV does take a while to adjust to. I would aim to be comfortable and increase slowly, if you aren't comfortable yet. Honestly, it isn't a long term choice to not increase to the therapeutic pressures needed. It is a matter of getting use to what the machine needs to do, so your breathe.

I don't think raising the PS 1cm, was the issue. As that can only raise the delivered pressure by 1cm, say from 19 to 20.  How you get to the 19 from the 9cm (min epap7 +min PS:2) I think is what you are really noticing and disturbing you. You will get use to it.

There seems some misunderstanding as to why I would open the max settings up and why the doctor prescribed the max pressures he did. It isn't solely focused to treat the UA/H numbers, like you do with apap and bpap. I am talking about the max settings, where the UA/H are treated with the min settings and 7cm is fine, as others have said.
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#84
RE: Spy Car Bill's (Hopefully) Excellent ASV Adventure
(10-27-2017, 01:54 PM)ajack Wrote:
(10-27-2017, 10:06 AM)Spy Car Wrote: I appreciate the input @ajax. One bit of information for you on personal history is that on APAP I was able to use pretty low Max pressures to control events. Raising pressure only drove up CAs and messed with sleep. So I never got anywhere near Max pressures of 19, and for me (who is pressure sensitive) these pressures are requiring an adjustment already. Going to PS 10 made me feel "pressurized" and kind of unwell.

I do wonder about the advice by ajax to raise EPAP mins. My inner-intelligence was wondering the same thing, just based on my breath. Good idea?
Yes the apap would do this. With the ASV I would discuss this with your doctor. AFAIK  The ASV treats the CA with high pressure. It needs the high pressure to inflate your lung, when you don't breathe for yourself. It's the purpose of using an ASV. The flow and tidal volume charts becomes the most valued to me.
The machine will only use the pressure needed to maintain lung ventilation. The pressure from an ASV does take a while to adjust to. I would aim to be comfortable and increase slowly, if you aren't comfortable yet. Honestly, it isn't a long term choice to not increase to the therapeutic pressures needed. It is a matter of getting use to what the machine needs to do, so your breathe.
I don't think raising the PS 1cm, was the issue. As that can only raise the delivered pressure by 1cm, say from 19 to 20.  How you get to the 19 from the 9cm (min epap7 +min PS:2) I think is what you are really noticing and disturbing you. You will get use to it.
There seems some misunderstanding as to why I would open the max settings up and why the doctor prescribed the max pressures he did. It isn't solely focused to treat the UA/H numbers, like you do with apap and bpap.

I feel like I've been suffering from long-term sleep deprivation, or at least from a long-term period where I have not been getting deep restorative sleep. 

The initial settings (and the sleep study settings) resulted in very aggressive responses from the machine, which I could not hope to sleep through. Not to mention aggressive pressures when I was awake and heading into a sleep transition that I feel "blew the moment" and kicked me into full wakefulness.

I've been very desperate for sleep. Lowered pressure has been very helpful in that regard. I feel like I need some repair before I try to endure pressure levels that challenge my ability to sleep.

I was very (very) uncomfortable on night #1 when the pressure spiked to 25. There is no way I can sleep with that amount of pressure at this point. 

I could feel the difference between 20 (the night before last) and 18.75 (last night). 18.75 is higher than I'd choose all things being equal, but it is at the raggedy edge of my tolerance currently. If I can acclimate to higher pressures in the future and those higher pressures can help me get better therapy and (most critically) better sleep I'm very open to that.

Do you see things in my flow and tidal volume chats that are noteworthy?

My technical understandings of ASV therapy are quite limited at this point and all I have to go on is how I feel.

I appreciate the feedback. 

Bill
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#85
RE: Spy Car Bill's (Hopefully) Excellent ASV Adventure
You have to sleep and insomnia from pressure rises falling asleep would be frustrating. When you are falling asleep, your tidal volume starts off high and reduces as you go to sleep. The machine sees this as a drop in minute vent and tries to correct it by pumping up the pressure, also if you slow your BPM it tries to breath for you.

I just put the ramp on to see, but I got a pressure rise when I held my breath. It looks as if you will get the pressure rise during the transition to sleep, even with the ramp on. Try it yourself, It may not spike as high as without it. The ramp function is suppose to help you get to sleep.

I see my doctor and he tells me what's wrong, I had another sleep test this week. I don't hold myself up as someone who knows and you should listen to me above other people. I started cpap 1 year ago. I just know it took a while to get use to ASV and eventually you need the PS open enough to treat the events. The machine will work to what it wants, no more.

From your chart a lot of the time you are running at the median epap:7.5 and PS:3 There are a few epap rises but only up to 2cm. The epap UA/H isn't an issue. As I first said, I would fix the max pressures first and maybe give the epap a bump later. If you need to choke down the machine for a week or 2 so be it, but increase it to your titrated pressures as soon as you can.

The difference between PS9 and PS10 was an even 1cm across the board at med/95%/max. I'm tempted to say given the consistency, that I wouldn't pick a 1CM difference in pressure and you just had a bad night. I would say you probably need more than PS10 when you are use to ASV

This is my chart I did a month ago, my med epap 9 with PS:6.5 going to PS:9.5@95% and spikes of PS:15
I've got some stuff but luckily I don't get CA. I could run epap9/ipap 20, just use a BPAP and treat most events. but most of the night I only need ps6 (= Ipap15)
an auto BPAP wouldn't work for me, as you will see I stay around epap9, so my choice is variable PS with ASV or vaps or a bpap with ipap20 all night.

When I look at my chart, I zoom in and scroll through, looking at the events and how the machine treated them. The machine tries to duplicate the last few minutes of minute ventilation. That line can drift up and down as the night goes on. You can also see a couple of dips in the tidal volume down to 370 from a bit of messy breathing. most of it is ok.
[Image: kseqgQc.png]
mask fit http://www.apneaboard.com/wiki/index.php...ask_Primer
For auto-cpap, from machine data or software. You can set the min pressure 1 or 2cm below 95%. Or clinicians commonly use the maximum or 95% pressure for fixed pressure CPAP, this can also be used for min pressure.
https://aasm.org/resources/practiceparam...rating.pdf
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#86
RE: Spy Car Bill's (Hopefully) Excellent ASV Adventure
Last night was remarkable for being so utterly unremarkable. I went to bed, read for about 20 min, felt sleepy, went to sleep, and woke up more than 8 hours later.

It was like what happens with "normal" people. So issues, no struggles, I just slept. Remarkably unremarkable!!!

I'm celebrating a feeling of normalcy. Feeling very good today.

Today I'm going to post the main charts plus close-ups of the events (there being so few) to see if they have any diagnostic value.

If I hoped for an "excellent" adventure with ASV, last night would definitely qualify.

Bill

Main Chart:

[Image: v6F3lTQ.png]

First two Hypopnea events:

[Image: j6jr8mB.png]

First UA:

[Image: runMiJO.png]

Second UA

[Image: 1hezISB.png]

Third (Final) UA

[Image: tKeJJJN.png]
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#87
RE: Spy Car Bill's (Hopefully) Excellent ASV Adventure
(10-27-2017, 02:24 PM)Spy Car Wrote:
(10-27-2017, 01:54 PM)ajack Wrote:
(10-27-2017, 10:06 AM)Spy Car Wrote: I appreciate the input @ajax. One bit of information for you on personal history is that on APAP I was able to use pretty low Max pressures to control events. Raising pressure only drove up CAs and messed with sleep. So I never got anywhere near Max pressures of 19, and for me (who is pressure sensitive) these pressures are requiring an adjustment already. Going to PS 10 made me feel "pressurized" and kind of unwell.

I do wonder about the advice by ajax to raise EPAP mins. My inner-intelligence was wondering the same thing, just based on my breath. Good idea?
Yes the apap would do this. With the ASV I would discuss this with your doctor. AFAIK  The ASV treats the CA with high pressure. It needs the high pressure to inflate your lung, when you don't breathe for yourself. It's the purpose of using an ASV. The flow and tidal volume charts becomes the most valued to me.
The machine will only use the pressure needed to maintain lung ventilation. The pressure from an ASV does take a while to adjust to. I would aim to be comfortable and increase slowly, if you aren't comfortable yet. Honestly, it isn't a long term choice to not increase to the therapeutic pressures needed. It is a matter of getting use to what the machine needs to do, so your breathe.
I don't think raising the PS 1cm, was the issue. As that can only raise the delivered pressure by 1cm, say from 19 to 20.  How you get to the 19 from the 9cm (min epap7 +min PS:2) I think is what you are really noticing and disturbing you. You will get use to it.
There seems some misunderstanding as to why I would open the max settings up and why the doctor prescribed the max pressures he did. It isn't solely focused to treat the UA/H numbers, like you do with apap and bpap.

I feel like I've been suffering from long-term sleep deprivation, or at least from a long-term period...

Bill
I feel the pain on that one. Until my ASV was issued, I've not slept well for several years. My sleep deficit is still an area I'm working on. I have a realistic expectation that maybe around year's end I'll be doing better in the sleep dept. Just remember, I've got other illnesses beyond apnea therapy, bad back and COPD specifically, and probably high BP and/or heart issue too.

Wishing successes,
Dave
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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#88
RE: Spy Car Bill's (Hopefully) Excellent ASV Adventure
Ajak, I really appreciate your valuable contributions to this thread and the time you've put into thoughtful responses. My hope for this thread is that my journey with ASV will be helpful to others down the line (as well as being helpful to me). I appreciate your perspective very much!

A few responses below:

(10-28-2017, 12:02 AM)ajack Wrote: You have to sleep and insomnia from pressure rises falling asleep would be frustrating. When you are falling asleep, your tidal volume starts off high and reduces as you go to sleep. The machine sees this as a drop in minute vent and tries to correct it by pumping up the pressure, also if you slow your BPM it tries to breath for you.

Insomina has been a problem for me for quite some time. When asked by my new physican a year and a half ago if I had "sleep issues" I said "insomnia" and never considered sleep apnea. When he asked if I snore, I said, "so I'm told." But SA wasn't on my radar.

As I metioned earlier, I feel like I've suffered from both long-term sleep deprivation and a lack of "deep sleep."

So nights like last night are incredibly hopeful for me. I don't expect to completely undo years of deficit overnight, but what a difference!

As to the particulars of ASV, I think you very accurately describe what the machine is doing. Unfortunately, I think my breathing habit as I'm about to go into sleep transition is to take one especially deep-breath just before slowing down to a steady regular "sleeping pattern." It seems to me the ASV hates this habit of mine and that it responds with high pressure at the exact moment I need it least.

So I'm trying to change what is a well-established pattern with me (I wonder if the last deep breath evolved as a way to open airways maximally before sleep?) and to not do that (if I can) and to limit the IPAP pressure.



(10-28-2017, 12:02 AM)ajack Wrote: I just put the ramp on to see, but I got a pressure rise when I held my breath. It looks as if you will get the pressure rise during the transition to sleep, even with the ramp on. Try it yourself, It may not spike as high as without it. The ramp function is suppose to help you get to sleep.

I wish there was a "ramp" feature than only limited the IPAP max.

Otherwise, ramp has induced hypopneas and I don't require it for comfort.

(10-28-2017, 12:02 AM)ajack Wrote: I see my doctor and he tells me what's wrong, I had another sleep test this week. I don't hold myself up as someone who knows and you should listen to me above other people. I started cpap 1 year ago. I just know it took a while to get use to ASV and eventually you need the PS open enough to treat the events. The machine will work to what it wants, no more.

My relationship with my sleep doctor is newish. He has a good reputation, comes out of the Stanford Sleep Clinic, got the ASV approved, and I will certainly listen to his advice. However, I appreciate the caseloads that specialists deal with and the prescribed settings were based on a sleep study where the tech (or the wide open setting) were driving pressure so high that I could not sleep.

What I like about you ajack is that you are able to have a dissenting opinion and articulate your reasoning very well. In an era where much online discourse devolves to flame-wars, personal attacks, or "fine, don't listen" responses, you are a thoughtful, intelligent, and helpful. I appreciate that very much.

(10-28-2017, 12:02 AM)ajack Wrote: From your chart a lot of the time you are running at the median epap:7.5 and PS:3 There are a few epap rises but only up to 2cm. The epap UA/H isn't an issue. As I first said, I would fix the max pressures first and maybe give the epap a bump later. If you need to choke down the machine for a week or 2 so be it, but increase it to your titrated pressures as soon as you can.

I will keep this in mind as time goes by. And, if you feel the urge, bump me again. For now, due to my sensitivity to pressure, I think I will focus on getting good sleep (and avoiding pressure disturbances) and see if start to acclimate to higher pressures. I'm listening to your message that higher pressures might optimize the machines ability to squelch all events.


(10-28-2017, 12:02 AM)ajack Wrote: The difference between PS9 and PS10 was an even 1cm across the board at med/95%/max. I'm tempted to say given the consistency, that I wouldn't pick a 1CM difference in pressure and you just had a bad night. I would say you probably need more than PS10 when you are use to ASV

This is my chart I did a month ago, my med epap 9 with PS:6.5 going to PS:9.5@95% and spikes of PS:15
I've got some stuff but luckily I don't get CA. I could run epap9/ipap 20, just use a BPAP and treat most events. but most of the night I only need ps6 (= Ipap15)
an auto BPAP wouldn't work for me, as you will see I stay around epap9, so my choice is variable PS with ASV or vaps or a bpap with ipap20 all night.

When I look at my chart, I zoom in and scroll through, looking at the events and how the machine treated them. The machine tries to duplicate the last few minutes of minute ventilation. That line can drift up and down as the night goes on. You can also see a couple of dips in the tidal volume down to 370 from a bit of messy breathing. most of it is ok.
[Image: kseqgQc.png]

Congratulations on your good therapy!

Again, thank you for all your thoughts. I take the advice seriously. I expect to be on ASV for a very long time. Getting used to higher pressures (if they would optimize therapy) is something I expect may be a process.

Cheers,

Bill
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#89
RE: Spy Car Bill's (Hopefully) Excellent ASV Adventure
There will be good days, and some that make you wonder. Don't let anxiety over a setback cause you to undo what you have achieved for the long-term. At this point any changes should be carefully considered, with a clear idea of what you're trying to accomplish. The pursuit of comfort supersedes events or numbers. Well done.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

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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: Spy Car Bill's (Hopefully) Excellent ASV Adventure
(10-28-2017, 01:01 PM)Sleeprider Wrote: There will be good days, and some that make you wonder.  Don't let anxiety over a setback cause you to undo what you have achieved for the long-term.  At this point any changes should be carefully considered, with a clear idea of what you're trying to accomplish.  The pursuit of comfort supersedes events or numbers.  Well done.

If I can say one thing with certainty, it is I'm feeling no anxiety what-so-ever with the ASV adventure. Part of that is based on feeling like things are already far improved from status quo ante (and I suspect will get even better) and the other part is knowing I have others--and you particularly--watching my back.

I felt pretty compromised when we started and hope to return to full cognitive functioning if my sleep quality remains in the neighborhood of last night's. You're getting me going was a great blessing for me and my family. I'm deeply grateful.

I will stand pat for now. I will also continue to update this thread. When you have thoughts, I will listen. 

Bill
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