afib and sleep apnea

[poppypete]

Thanks for going to this effort Sleeprider...I do appreciate it.

re: "Once you get situated with ASV, it is very easy to dial you in."

Unfortunately, I can't just go out and buy an ASV machine, as in our system here in Australia, only with a medical prescription can I go there...

• ...consequently I'm having to work through my cardiologist and sleep specialist to get there.
  

As I explained previously, my hands-on clinician and CPAP technician recommends as you do (ASV), but their hands are tied to these medicos too.

In the meantime, my dilemma remains:

1. go off the machine until the Afib issue is resolved (on beta blockers now, trialling for a little while before a final assessment to cardioversion treatment in June. The cardiogram/EF answers I won't have until 28 May.).
   
2. persevere on the machine, but only use for one session a night...but on which best settings given my condition and performance to date.
   

Sorry to be such a pain, but it's a decision I'm trying not to take lightly...but within the parameters of these circumstances.

Cheers...poppypete   

[Hojo]

Is there any way to get in to see the doctor for just a few minutes, I did this and brought my laptop to show him my CA events.  In doing so, it was important not to be aggressive but to kindly explain the problems and ask if he/she would be interested in what you are seeing on a daily basis.  As soon as my doctor saw it I was given an appointment for ASV titration study.

As mentioned already, you most likely need to demonstrate compliance, in the USA we have to try CPAP, make at least one change to the machine, do a BiPAP study, if that 'fails', then an ASV study.  When I met the compliance period and I just couldn't take the CPAP any more, I ended up staying on CPAP until my ASV study, but set my alarm clock every 2 hours. 

By having my 'sleep' disrupted every 2 hours, I never went into a deep sleep where I may start experiencing more CA events, instead, I was able to get just enough rest but not experience the profound apnea (30-40 minutes a night).  While I was still tired, I didn't feel the 'hypertension' as a result of the long periods of apnea.

[poppypete]

Hojo pid='255840' dateline='1524529460']Is there any way to get in to see the doctor for just a few minutes, I did this and brought my laptop to show him my CA events.  In doing so, it was important not to be aggressive but to kindly explain the problems and ask if he/she would be interested in what you are seeing on a daily basis.  As soon as my doctor saw it I was given an appointment for ASV titration study.

As mentioned already, you most likely need to demonstrate compliance, in the USA we have to try CPAP, make at least one change to the machine, do a BiPAP study, if that 'fails', then an ASV study.  When I met the compliance period and I just couldn't take the CPAP any more, I ended up staying on CPAP until my ASV study, but set my alarm clock every 2 hours. 

By having my 'sleep' disrupted every 2 hours, I never went into a deep sleep where I may start experiencing more CA events, instead, I was able to get just enough rest but not experience the profound apnea (30-40 minutes a night).  While I was still tired, I didn't feel the 'hypertension' as a result of the long periods of apnea.[/quote]
Hojo...

I take to heart your suggestion about taking the laptop in with me when I see the sleep physician...but first I have to see my cardiologist/s (one private; the other through our public system for the hospital treatment of cardioiversion)...so I'm a few weeks away from that. At that private visit I will establish if my heart's LVEF is above the 45% point, and that would clear the issue of suitability to use ASV for when I need to discuss my sleep problem with the sleep specialist from whom the prescription to use is needed.

I'm of the belief that the sleep specialist wants the Afib issue sorted before he tackles any change to his initial recommended 6-20 APAP settings, but I've tweeked that a little after 4 days of trying the idea put to me by Sleeprider without success, to currently 6-18cmH2O, and EPR on Full Time and at maximum level 3. He agrees that the heart doctor/s will be the ones to best steer the sleep specialist in the direction of ASV, and has offered to provide research material to reinforce the argument I'll hopefully be putting to him...once the LVEF % is established.

Having understood what Sleeprider was offering, I'm sleeping better at present and the readings are better too...but I'm still experiencing all 3 types of apneas (OSAs; CAs and CSR periods). My oximetry reader hasn't arrived yet, but should be here this week I'm assured...so patience is the name of my game at present.

I have one question you may be able to quickly answer:

What do the numbers on the side of the pressure graph mean...
...the two in the middle in particular...
...in these examples attached?

Why are they changing in these two examples?

I'm presuming the 17 and 18 on the top indicate to what maximum pressure was reached...
...but the 8.3 and 12.7 as against 8.7 and 13.3?

Thanks 

poppypete

[Sleeprider]

Pete, are you referring to the number on the Y-axis from 4 at the bottom to 17 or 18 at the top? That is pressure in centimeters of water (cm H2O). The Sleepyhead graphs are self-scaling unless you set the Y-axis by right-clicking over those numbers. The pressure graph shows the changes of pressure through the session, in your case there is a LOT of variation. I think it might be good to limit that fluctuation a bit.

[poppypete]

Sleeprider...

Thanks for the right click clue...and other:

re:
1): "...are you referring to the number on the Y-axis from 4 at the bottom to 17 or 18 at the top?" Yes...and what intrigues me is what do the numbers between the top and bottom ones tell me...on those attached graphs, the 8.3 one night, 8.7 the next; and 12.7 vs 13.3?
2): "That is pressure in centimeters of water (cm H2O)." I understood that. 
3): "The Sleepyhead graphs are self-scaling unless you set the Y-axis by right-clicking over those numbers." I have right clicked as you suggested, and see what I can further obtain. The 95th percentile figure/line is helpful, certainly in the context of what we've previously been discussing about my issues. 
4): "The pressure graph shows the changes of pressure through the session, in your case there is a LOT of variation." Yes, you are right...a lot of variation. My deep sea diving (ha ha) effects/training (or my failing heart?) kick in after I fall off to sleep, and usually before I have an event which registers, the pressure begins to increase from the 6cmH2O at which it was set in ramp time of 20 minutes. I agree with you now, in thinking this should be set higher as one step in this process of staying on doctor's recommendation to this point...to persevere with CPAP auto until Afib issue resolved.

5): "I think it might be good to limit that fluctuation a bit." Putting aside my Afib issue temporarily: My understanding is that too high a pressure increases Centrals, while too low a pressure increases OS's, so the art in my case is to somehow balance the settings to reduce these, by meeting the pressure required to do that. The presumption that auto responds appropriately doesn't satisfy me (as some would suggest it should...and I know you have explained to me why this is a false belief for my circumstances), so I'm trying to get an idea of what is my best maximum based on the 95th percentile figure clinicians and CPAP staff use in 'normal' circumstances. You may have given me the final clue to how to find it through the SleepyHead data...but if you have a further comment on these replies above, that would be appreciated.

Cheers...and thanks yet again! 

[Sleeprider]

You're good! The analysis becomes easier once you learn how to use the graphs. My favorite is the flow rate chart where you can add a dashed line at zero using the right-click trick. Zero is where inhale and exhale meet, and it allows a completely different analysis of respiration. The Y-axis and dotted lines let you customize these chart to make them a lot more meaningful and personal.

In the Sleepyhead menu, you can change the statistical significance to the 90th percentile (file/Preferences/CPAP, look halfway down the right column for the upper percentile). Most professionals actually use the 90th percentile rather than the 95th. If you're familiar with statistics you know this is the value exceeded only 10% of the time, rather than 5%. It just tends to be a useful metric in treatment targeting, especially with datasets with a higher variance or standard deviation.

[poppypete]

Sleeprider...

re:
1): "The analysis becomes easier once you learn how to use the graphs." I have downloaded RobySue's Beginner's Guide to SleepyHead and printed out some relevant pages to assist me to do this...but obviously as newbie still, I'm a little at sea still.

2): "My favorite is the flow rate chart where you can add a dashed line at zero using the right-click trick." Have right clicked on flow rate chart (attached image)...but what/how to set it to achieve = Zero is where inhale and exhale meet, and it allows a completely different analysis of respiration." ???

3): "The Y-axis and dotted lines let you customize these chart..." I'd value your advice on how I might best customise my charts, given my situation at present: "to make them a lot more meaningful and personal." to me.

Thanks again...  poppypete

[jaswilliams]

Sleeprider...

re:
1): "The analysis becomes easier once you learn how to use the graphs." I have downloaded RobySue's Beginner's Guide to SleepyHead and printed out some relevant pages to assist me to do this...but obviously as newbie still, I'm a little at sea still.

2): "My favorite is the flow rate chart where you can add a dashed line at zero using the right-click trick." Have right clicked on flow rate chart (attached image)...but what/how to set it to achieve = Zero is where inhale and exhale meet, and it allows a completely different analysis of respiration." ???

3): "The Y-axis and dotted lines let you customize these chart..." I'd value your advice on how I might best customise my charts, given my situation at present: "to make them a lot more meaningful and personal." to me.

Thanks again...  poppypete

For point two in the screen shot of the flow rate settings click the zero box to get the dotted line at zero flow rate as discussed 

Jason

[poppypete]

Thanks Jason...

As you can see I've now done as you and Sleeprider suggest (see attachment)...

...now how to interpret???

poppypete 

[poppypete]

Another attachment for review