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AHIs
#31
RE: AHIs
Ajack,

Well, I've been a little reluctant to say anything, however... 
 
The last four nights I've used the cervical collar and my results have greatly improved with only one CA being flagged and no OAs.  Still having hypopneas with AHIs under 5, with the exception of one night - it was 6.84 - Amazing !   The cervical collar is foam (not very soft), it'll take some getting used to it. 
We changed my EPAP min back to 8.0 for a couple of nights and after seeing the graphs, we bumped the EPAP up to 8.5.  I guess you could say we're going to sneak up on the right setting.  Tonight we'll bump it to 9.0 and give that a couple of nights, if there are still hypopneas, we'll start adjusting the PS per robysue's suggestions. 

I'll also take your recommendations and try the new pressure settings and incorporate recommendations from robysue and QAL.

QAL - We did look up the titration settings in the PR manual.  That was definitely interesting though I'm not sure what I need to do with that info right now.  I saved it future reference for sure!


robysue - 
Quote:I'm guessing that you were put on an ASV because of either central sleep apnea or complex sleep apnea. It's possible that many (maybe even most) of the Hs are central Hs and some (maybe even most) of the OAs are actually CAs that have been misscored as OAs.

I don't know much about PS settings on ASV machines, except that getting them set up right is critical for treating 
central events. Were you ever titrated on an ASV? And are your min PS = 3.0, max PS = 15.0 derived from an ASV titration? Or are they just defaults or guesses?

Since increasing the min EPAP appears to have made things worse, it may be worth experimenting with changing the min PS setting. You might want to see what increasing the min PS to 4 does. You might also want to see what decreasing the min PS to 2 does. If one or the other of these gives (slightly) better results, then we would have an idea on which way that min PS should be adjusted.

I was originally diagnosed with Central sleep apnea and put on ASV at that time.  I've had 3 titrations on an ASV machine and the last 2 recommended settings were July 5, 2013:  PS 3-15 with auto rate and EPAP of 8.0 and Sept 15, 2016:  EPAP 6.0 with PS 3-15 with auto rate. My wife and I have questioned the doc about the hypopneas and she did say that it was possible that the hypopneas could be either Obstructive or Central but without being wired up, as in sleep study, would not be able to tell the difference.  We agree with you on that.  
I want to Thank all of you for your help.  It's comforting to know you are out there for me !!!   Thanks
- Dreamless
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#32
RE: AHIs
wow, that's great to hear. I am taking note of the cervical collar idea and am pleased that seemed to have solved your issues.
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#33
RE: AHIs
after going to several doctors and getting the runaround for 5 years. I can understand you not wanting to say something and jinks it.. from 30 down to 5 ...That is a huge difference and all for the price of under $20 . Don't thank me I got it from the forum and passing it on.
But do you want our helpers group paypal number  Dielaughing  Grin


You are fixed now and can just fine tune from here on. I would play with the settings and use sleepyhead to see what changes it makes, but then I'm like that.
If your OA are fixed at epap:8, you can stay on epap:8, lift the min PS:4 and see how the H are. or lift the epap:9 and keep the min ps:3
the end result is the same, the min IPAP is raised 1cm. If you see what I mean. In the ASV manual they say to raise the epap till the oa and h go to good numbers. For the ST they say to fix the oa with epap and raise the ps for H. I don't know why the difference?


It would really help if you get another chart up, to look at your tidal volume, minute vent. If it's low that can be helped with increasing the minimum PS


Sleep-well
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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#34
RE: AHIs
Ok, 
Question for you, are there any other 'parameters' you want included in the chart other than minute vent and the tidal volume ?  I will reorder some of the graphs to include anything else.  
Tonight we have bumped up the PS min to 4.0 and left the EPAP at 9.0, we'll let that go for a couple of nights.  Crazy.  This whole week there was only one night over 8.0 AHI.  

Dreamless
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#35
RE: AHIs
awesome good news story, for sure.

continue in peace.

QAL
Dedicated to QALity sleep.
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#36
RE: AHIs
You should be starting to feel a bit better soon, too. you might even get some vivid dreams as the rem sleep kicks in.
without the pie chart and the calendar, all the median data and basic machine settings will be able to be seen. The actual charts of breath rate, tidal volume and minute ventilation would only be needed if there was an issue. But those are important for you to check as you scroll through your zoomed on sections, to see where and if they drop too low.

I assume you got the clinical manual from the link at the top of the page, If you could post a screenshot picture of the settings available and then say what your settings are. I think the DS might have adjustable rise time? I don't know what else is different from resmed.
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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#37
RE: AHIs
ajack,
No I don't have the clinician's manual. But my machine does have rise time, the settings are 0 - 3 with '0' being the quickest setting to any event.  I have it set on '0'.  I took some screenshots of the last four nights.  Holy smokes, there have been 2 of the 4 nights that the AHIs are under 2 !!!  wow.  

My settings are EPAP 9.0, Max pressure 25.0, PS 4.0 - 15, Rise time is set to '0'

I tried to download the EncorePro and it keeps trying to install but then the computer has to restart . . . over and over and over.  I don't know what I'm doing wrong and btw, I'm not THAT computer savvy.  
Ok, here are the graphs with tidal volume and minute vent.

[Image: U5CtZDe.png]
[Image: IDuHQDZ.png]
[Image: YH6Na4d.png]
[Image: g7fRRat.png]

 - Dreamless
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#38
RE: AHIs
it looks like the machine is doing it's thing, keeping the minute ventilation up, and triggering breaths only when necessary.

QAL
Dedicated to QALity sleep.
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#39
RE: AHIs
sorry, I missed your post before, the forum software doesn't notify you if someone quotes you. I just saw it today as I was getting the link to show another ASV guy how you went.

I think that chart is excellent. The numbers are better than mine. Smile (other than those persistent H)

Confirm with your doctor. I think that PS is working for you, those numbers in the left sidebar minimum 480 tv and 5 mv, with the median 650 and 8 shows you are well ventilated. Here is a guide to the TV for size and ideal weight.
http://imgur.com/ciLBxT8

I had a look at the Script Conversion Guide page pdf # 20
https://onlinestore.resmed.com/images/pr...017278.pdf
from what I read, there are only 3 extra settings
I guess you have your back up breaths, BPM on auto?
The bi-flex is on page 19 and I've also see better descriptions on the forum.
With rise time, I think 0 is off and could be a default setting? You may want to leave it on O ..I found this function on the resmed ST can help with I:E ratio, but your's are ok. You could have a touch shorter inhale and longer exhale for ideal, but it's of no issue. Something you can play with on a rainy night.

along with the sidebar, the tidal volume, the minute vent charts look good. Although you can put the mouse on the name of the chart and right click, the go to y-axis settings, that will let you adjust the scale and make it easier to see.

If the H haven't settled by now. First I would zoom in on them and post some screen shots. Make sure the H look real and not following a deep breath or something. There could also be some left over positional cluster events, as they are grouping.
You could get a cms50f 24 hour o2 recorder off ebay $50, to see if your o2 levels are dropping with them. If you are concerned. I don't think I'd buy one just for that, although I do have one.
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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#40
RE: AHIs
ajack,

My turn to apologize.  I just now found your post !  Grr.  I will take a look at that page about the TV and MV.  Thank you.  
I have another question, maybe you can help me with... ?   I'm starting to see FL events and hadn't really ever seen them previously.  What does that mean ?  I've read on the Help Browser in Sleepyhead and still don't understand what the heck.  

Here's something I am noticing recently.  I have a had 3 or 4 nights of pretty bad sleep (insomnia).  A couple of nights ago, I woke up at 2:30 and could NOT go back to sleep.  I tried 2 or 3 more times to do so and Sleepyhead (and Encore basic) scored Hypopneas during those attempts, I thought I was just laying there awake.  I noticed that again on this mornings charts.  I woke up around 5:30 am and just laid there hoping to get a little more sleep then finally got up at 6:30.  Sleepyhead shows PB and H after 5:37 am.  ???   
I'm posting two screenshots from last night/this mornings charts, looking at the time shortly before I 'woke' up. A couple of those graphs MV and Resp Rate I have it showing the H events.  Thanks for telling me that, it beats running the chart up and down trying to figure out what time something happened !   - Dreamless

[Image: bHfgnEP.png]
[Image: t5sDI2E.png]
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