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+--- Thread: [Pressure] TheWallofSleep's Therapy Thread (/Thread-Pressure-TheWallofSleep-s-Therapy-Thread)
RE: TheWallofSleep's Therapy Thread - cathyf - 08-11-2021
(08-11-2021, 05:45 PM)TheWallofsleep Wrote: I thought it would be a moderator action since we cannot modify or delete posts.
The exception is that you can delete attachments, which leaves weird holes in those threads and they become fairly incoherent without the pictures everyone is talking about.
You can get a free 2 GB dropbox account and host your attachments there, and then you don't have to worry about the space.
RE: TheWallofSleep's Therapy Thread - SarcasticDave94 - 08-11-2021
I use Imgur to host non Apnea images. Eventually your attachments will fill and the old ones here will have to be cut.
RE: TheWallofSleep's Therapy Thread - TheWallofsleep - 08-13-2021
Thank you cathyf.
As per Dave's suggestion, here is two nights with:
Epap Min: 6.0
EPAP Max: 13.00
PS Min: 3.0
PS Max: 14.0
Critically, I still feel tired. I am tolerating ASV fine with slight aerophagia, but at this point, thats par for the course. I am having a hard time waking up and I still feel heavy brain fog throughout the day. The FL still looks choppy. I plan on raising PS Min to 3.4, maybe up to 4.0 to see what happens. Any other suggestions? Other than the few HA and UA, which are negligible, it appears to just be FL. Leak rate looks fantastic.
I probably just need a few weeks on ASV regardless to see what happens. My personal opinion is that I had too many pauses in my breathing with APAP and VAuto that do not seem to be prevalent here. Obviously, my poor sleep is a fractured architecture problem and I think minimizing these pauses that were just short enough to not be flagged as an apneaic event is a step in the right direction.
As for Vt, it is far too early to establish a trend but it does appear to be increased and not at the cost of an increase of aerophagia. Again, I am not sure how important this is but it is a slight anomaly, and slight anomalies are exactly what I want to diminish.
RE: TheWallofSleep's Therapy Thread - SarcasticDave94 - 08-13-2021
Stats look fine to me. Leak rate decent enough for ASV to do its job. FL should be ignored on ASV, focusing on CA then other events is 1st place and they're inline for good treatment.
You could try adjusting min EPAP or PS to see if it'll feel better to you, Max is probably good as is.
RE: TheWallofSleep's Therapy Thread - TheWallofsleep - 08-13-2021
I'll try an incremental increase of PS min.
In general is it better to see the median minute vent and the 95% minute vent closer together?
RE: TheWallofSleep's Therapy Thread - SarcasticDave94 - 08-13-2021
I'm not in possession of an opinion. I never really bothered much with those stats for my time on an ASV. I turned the adjustment knob to tune for events and comfort, letting FL and minute vent, et al, fall where they may.
I do see pressures you list as:
EPAP 5-15 PS 3-12.
In your experimenting, consider this remix, moving numbers on Max only, despite what I said about leaving Max as is earlier, suggested for comfort gain attempt.
Edit suggestions
EPAP range to 5-12
PS range 3-15
Effectively moving 3 off EPAP Max onto PS Max
RE: TheWallofSleep's Therapy Thread - TheWallofsleep - 08-14-2021
I've been using slightly different settings. Last few nights have been EPAP 6-13, PS 3-14. I will gradually increase PS min to 3.4, then 3.6, etc. to see what will happen. I see some periodic breathing patterns I want to try and clean up.
RE: TheWallofSleep's Therapy Thread - TheWallofsleep - 08-14-2021
I have some technical questions regarding ASV titration, not only because I am still waking up groggy, with bad brain fog etc., even with good numbers, but because I am also curious about the mechanics of it. Here is last night, EPAP 6-13, PS 3.40-14. I am looking at the pressure chart and am trying to minimize unnecessary pressure swings for comfort and to achieve a more regular flow rate. I have two lines drawn for the 95% EPAP and 95% pressure levels. As you can see, the EPAP looks fairly close to the 95% mark and appears to be fairly stable throughout the night, does this mean that this setting is optimized? There does not seem to be much change and there does not seem to be much indication that much change is needed. However, the pressure seems very choppy at times, even somewhat consistently harmonic for ten to fifteen minutes at a time, as if the entire line needs to shift upwards. Is this indicative of a need for increased PS min? I would love some thoughts on that, I am just trying to understand the titration process better in general as well as learning the ability to better optimize my own therapy. To my eyes, it appears that my ASV is working too hard and can be tightened up a bit.
RE: TheWallofSleep's Therapy Thread - SarcasticDave94 - 08-14-2021
To me, when I look at unzoomed chart 1, I see most of the flow rate and pressure spikes correlate to flow limit spikes.
If you really want flow limits to lessen, increase Min PS OR Min EPAP. Min PS gives more separation between EPAP-IPAP. Min EPAP boost gives more base pressure to try to stabilize the airway. I stress choosing one or the other, I think boosting Min of both EPAP and PS may rob some comfort.
Try various combos and note which changes the chart results and affords comfort.
RE: TheWallofSleep's Therapy Thread - sheepless - 08-14-2021
the middle chart at 5:00-ish is your respiratory response to periodic limb movement. no amount of tinkering with apap, vauto or asv will resolve this. it's also likely to be the reason for your 'fractured' sleep and other complaints.