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[Update] ASV vs APAP Oscar data
#1
[Update] ASV vs APAP Oscar data
I am back with an update and need help in some questions.

I have changed doctors since I last posted here. During that period I was doing MRI and thankfully no issues were found. My new doctor had a look at my data and suggested I use CPAP again rather than ASV. I took all learnings I had from this forum and for past few nights used APAP (7-8) Pressure for few days with EPR1 and I feel good. I would dare say even better than ASV. I was initially diagnosed with complex apnea AHI 30.

I am confused at this point and would love some help. 
1. Do I have Central apnea based on my APAP data or I don't or maybe I did recover? 
2. Based on the 2 data points from today and day before (I actually did test over past few weeks going back and forth between ASV and APAP and logging how I feel) why would I feel better on APAP than ASV. Is flows or leaks etc better on one vs other or what exactly. I will attach last nights data which I feel were good. Does data show anything irregular to support 1 vs the other?
3. What can I do to change my ASV settings to closely match APAP so I can test better and compare better or atleast get same feeling on APAP

Over multiple weeks trying APAP vs ASV If I felt 7 on ASV , I feel 8.5 on APAP despite never being able to get lower than 3 AHI. So, not sure what this all means, can I somehow get ASV to act like APAP with added benefit of crushing centrals if it appears?

I feel much better on APAP and would love all your help to know why and If having an ASV can help me get even better


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#2
RE: [Update] ASV vs APAP Oscar data
I think your ASV results would have been better with a higher EPAP pressure and using the ASV auto mode. It appears the residual events there were mainly obstructive. With pressure range of 7-8 and EPR 1 there is no indication of a central or complex apnea problem. If you feel better with CPAP rather than ASV, the event rate shows no good reason to change back to ASV. Normally patients are required to trial CPAP and fail before being approved for ASV. Somehow, you seem to have skipped that step, and it is unusual to see a high level of success with CPAP when a diagnosis of complex apnea is made. Your results are very good at these settings, however it would be interesting to see a minimum 8.0, maximum 10.0 and EPR 2. That might trigger more centrals, but the if you don't have the complex apnea, then it would help reduce the flow limitation and should reduce OA and H events. So it's a bit of an experiment to see if centrals increase with higher EPR, but it is also a logical change given the events we are looking at.

Please minimize the monthly calendar in charts by clicking the triangle in the date line, or F9.
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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#3
RE: [Update] ASV vs APAP Oscar data
(03-15-2022, 04:30 PM)Sleeprider Wrote: I think your ASV results would have been better with a higher EPAP pressure and using the ASV auto mode. It appears the residual events there were mainly obstructive.   With pressure range of 7-8 and EPR 1 there is no indication of a central or complex apnea problem.  If you feel better with CPAP rather than ASV, the event rate shows no good reason to change back to ASV.  Normally patients are required to trial CPAP and fail before being approved for ASV. Somehow, you seem to have skipped that step, and it is unusual to see a high level of success with CPAP when a diagnosis of complex apnea is made.  Your results are very good at these settings, however it would be interesting to see a minimum 8.0, maximum 10.0 and EPR 2.  That might trigger more centrals, but the if  you don't have the complex apnea, then it would help reduce the flow limitation and should reduce OA and H events.  So it's a bit of an experiment to see if centrals increase with higher EPR, but it is also a logical change given the events we are looking at.

Please minimize the monthly calendar in charts by clicking the triangle in the date line, or F9.

Thanks SleepRider,

I actually was on APAP for a year before going BiPAP (6months) then ASV. The difference I had when using APAP at time was that I was not aware of Oscar or mouth taping or SCC. I don't recall ever feeling good for a whole year, which is why I am confused at the moment. I will do your settings and report back (8-10 with EPR2 on APAP)

For ASVAuto what min\max epap you suggest given APAP data?
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#4
RE: [Update] ASV vs APAP Oscar data
(03-15-2022, 04:30 PM)Sleeprider Wrote: I think your ASV results would have been better with a higher EPAP pressure and using the ASV auto mode. It appears the residual events there were mainly obstructive.   With pressure range of 7-8 and EPR 1 there is no indication of a central or complex apnea problem.  If you feel better with CPAP rather than ASV, the event rate shows no good reason to change back to ASV.  Normally patients are required to trial CPAP and fail before being approved for ASV. Somehow, you seem to have skipped that step, and it is unusual to see a high level of success with CPAP when a diagnosis of complex apnea is made.  Your results are very good at these settings, however it would be interesting to see a minimum 8.0, maximum 10.0 and EPR 2.  That might trigger more centrals, but the if  you don't have the complex apnea, then it would help reduce the flow limitation and should reduce OA and H events.  So it's a bit of an experiment to see if centrals increase with higher EPR, but it is also a logical change given the events we are looking at.

Please minimize the monthly calendar in charts by clicking the triangle in the date line, or F9.

Had a chance to try couple of days with 8-10 EPR 1/2 and my AHI is still 3+ Is this saying that I do indeed have CA but not extreme? Also the duration seems high for some is that expected CA and OA?


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#5
RE: [Update] ASV vs APAP Oscar data
Well, you appear to be between a rock and a hard place with pressure. The OA events coincide with the low range of your pressure, and CA has emerged at the upper range. I think this is pointing toward a narrower range of pressure. The range is currently 8.0 minimum, 10.0 maximum. What if we just split the difference and do 9.0 minimum and 9.0 maximum with EPR 1?
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


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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#6
RE: [Update] ASV vs APAP Oscar data
I am curious what your tidal volume chart looks like with the APAP.

Results under 3 AHI are adequate with either machine so its a personal choice on which one feels better to you. Your results don't really look obviously different so hard to understand why you might be feeling better with one machine over another. One thing to note is that you are using a higher EPAP with the APAP (6.7-8.2 in the couple examples posted) then you are with ASV (5.4). EPAP is what prevents obstructive apnea so it is possible you are having more obstruction/restriction because of the lower EPAP and just not seeing it because of how the ASV machine works to overcome them. If you want to compare more evenly you should increase ASV EPAP to 7 cm.

If you are still finding better results with APAP it might just be because you are sensitive to the pressure changes, since your AHI is reasonable on both machines small things like this can make more of a difference on how you feel than AHI.
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#7
RE: [Update] ASV vs APAP Oscar data
(03-20-2022, 05:43 PM)Geer1 Wrote: I am curious what your tidal volume chart looks like with the APAP.

Results under 3 AHI are adequate with either machine so its a personal choice on which one feels better to you. Your results don't really look obviously different so hard to understand why you might be feeling better with one machine over another. One thing to note is that you are using a higher EPAP with the APAP (6.7-8.2 in the couple examples posted) then you are with ASV (5.4). EPAP is what prevents obstructive apnea so it is possible you are having more obstruction/restriction because of the lower EPAP and just not seeing it because of how the ASV machine works to overcome them. If you want to compare more evenly you should increase ASV EPAP to 7 cm.

If you are still finding better results with APAP it might just be because you are sensitive to the pressure changes, since your AHI is reasonable on both machines small things like this can make more of a difference on how you feel than AHI.

Added yesterday night APAP tidal and recent ASV tidal. Let me know if anything stands out. For your suggestion of EPAP ASV 7 CM is that min or max or both? and what should PS range be (1-6)?


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#8
RE: [Update] ASV vs APAP Oscar data
(03-20-2022, 04:57 PM)Sleeprider Wrote: Well, you appear to be between a rock and a hard place with pressure. The OA events coincide with the low range of your pressure, and CA has emerged at the upper range.  I think this is pointing toward a narrower range of pressure.  The range is currently 8.0 minimum, 10.0 maximum.  What if we just split the difference and do 9.0 minimum and 9.0 maximum with EPR 1?

I will try a fixed pressure. I also find this odd. I would like some help understanding why my apnea events last more than 10 seconds though and would APAP effectively help? Reason I ask is historically on ASV my apnea event time is anywhere between less than a minute to 3 minutes (Yet I felt 7/10 restful) with APAP its mostly 3-5 minutes. So not sure what that means.

Also will follow your suggestion and report back!
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#9
RE: [Update] ASV vs APAP Oscar data
Reason I was curious to see TV chart for APAP is because from the overview I could see there appeared to be a minor periodic nature to your breathing with it, this is more apparent when looking at the fluctuating TV chart and you can see how ASV fights these fluctuations and smooths it out.

Apnea time will almost always be shorter with ASV because it sends a blast of air during an apnea to break it up which often is successful and ends up preventing an apnea from being flagged and time in apnea from being recorded.

Time in apnea of a few minutes, AHI under 3 and periodic breathing aren't generally issues so results and deciding which machine to use depends primarily on which feels best for you.

As for ASV I would just use fixed EPAP. You don't have that much apnea that drives pressure up to be worried about it, main thing I was pointing out was that you weren't previously using the same EPAP and maybe it explains why you feel you sleep better with the APAP.
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#10
RE: [Update] ASV vs APAP Oscar data
Hi Geer, Sleeprider and all,

I am back after some more trials and have an Oscar chart that would love to get some insights into. So from the thread above, I found that APAP on fixed pressure around 9-10 mark was working good for me specially as Sleeprider suggested that with APAP range, that was causing my Centrals to be high.

I took that learnings and applied it to ASV but i changed from ASVAuto to ASV mode only for couple of days. I would say that in terms of feeling, I feel much better than on ASVAuto with similar settings. But I also feel as good as on APAP with some variance but overall cant complain.

I need help parsing this latest chart that shows a good day to see if anything stands out as great or needs fixing. E.g. does flow rate look good? what are the spikes in flow rate? Also, do leaks look bad? and generally anything that stands out to your experience as great or needs fixing.

I am so close to getting the optimal therapy thanks to you all so i am excited for your feedback on this chart


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