Interpretation Questions - My OSCAR Data

[SarcasticDave94]

OK, I've got a few questions that I've not seen/can't find the answers in this thread. Notice: I had back surgery today and it could be my cognizant ability isn't the greatest in finding what I'm looking for.

Even if those sleep study reports are questionable, I think pre-existing CA may pop up on the next test.

How long have you been on APAP before creating those OSCAR charts: X weeks and/or X months?

I'm looking for a few things regarding your use of the ASV:

Can you state the name of your ASV? Example on my machine: I have a ResMed AirCurve 10 Series ASV.

Can or did you post an ASV OSCAR chart? If yes, where? If no, will you?

What settings did you use on the ASV? Include EPAP or it's min/max range, PS Min and Max and which Mode, CPAP (it's there but I'm sure you're not running ASV in CPAP mode) ASV or ASV Auto.

I'll get a awaiting these answers.

PS no offense, but those APAP charts are wonderfully, gloriously nasty ugly. So glad your OA was nice and low...

[ApneaQuestions]

OK, I've got a few questions ....
......PS no offense, but those APAP charts are wonderfully, gloriously nasty ugly. So glad your OA was nice and low...

Sorry to hear about the back surgery.  I hope the pain is tolerable after the meds wear off. 

Many of your questions are answered in this thread but let me bring them all together for you.

1) My entire PAP history can be encapsulated in a single summary.  It's in post #17 I think but it's also here attached.
In summary, I tried APAP for a month then tried ASV for a week then switched back to APAP for a week (plus or minus).
Jump to #17 here: http://www.apneaboard.com/forums/Thread-...#pid322915

2) My ASV machine is the same as yours and on the left in my profile
Resmed Aircurve Series 10 ASV.
I ran it in ASVAuto mode for just one week.
Settings are also on the left in my profile
Complete settings can be seen in the second attachment which is a daily picked at random that week

3) Don't worry about offending, I have no ego-attachment to my OSCAR data.... it's just data and facts. ;-)

4) By the way, I'd love to hear in detail why you say the initial APAP results (not the attached ASV results) are ugly and nasty.
That is getting to the essence of my initial question which is trying to understand how to interpret the data.
Also, if you get a chance to re-read my earlier attempt at an analysis I'd love to hear if my interpretation story was close to sensible.
It's all part of the learning process. Don't hold back the punches on that.
I've attached that image again here so you have it all available without hunting around.
My newbie interpretation was in post #13 jump to it here: http://www.apneaboard.com/forums/Thread-...#pid322906

5) I'd also love to hear your comments (ugly or otherwise) on the attached ASV daily report.
The AHI is so low that they may be unremarkable...  then again... maybe you will see something I don't know to look for.

Warning for anyone else reading this..... Some of my Graphs are using APAP and some are using ASV.  Check carefully to spot which are which.

[SarcasticDave94]

Thanks, I'll get more detailed on as many points as possible next post.

ASV settings I see:
EPAP 5-15
PS 3-15
BTW IPAP auto fills via machine algorithm so not needed to tell me this one

OK one more question for now. Which did you feel was better for your therapy, APAP or ASV? Why?

Numbers don't exist right now if you know what I'm getting at. Only feel counts right now.

Gimme a bit and I'll return, as my back is aching a bit.

[ApneaQuestions]

I also have attached a close up zoom on the single solitary hypopnea in that ASV chart.

Not sure why... maybe it will tell someone something.

[Gideon]

I'm going to stick my neck out and try my own version of an interpretation.
I love to learn and I love to be corrected when wrong... so don't hold back the punches.

For some reason I got out of bed for an hour between 5:40 and 6:40 (or maybe slipped the mask off?)
Once the mask was back on, the machine began gently due to the ramp option.
Shortly after 7:00 I started snoring
At about 7:10 those snores turned into OAs Actually you probally tucked your chin which resulted in the cluster of obstructive events. Not concerned about this unless you see more clusters.
The machine cranked up the pressures to stop the OAs and (as a consequence?) I started to get unstable as the CO2 dropped and the CAs kicked in These are Treatment Emergent
The machine backed off the pressures to try to resolve the CAs No, Pressure dropped because no more OA from tucked Chin
At 8am the pressures were lower and the CAs resolved
between 7:57 and 8:03 my flow rate dropped in amplitude so the pressure cranked up again (?)  No Flow Limits drove pressure up
The higher pressures triggered more CAs at 8:20 and they never fully resolved
Although the CAs did not fully resolve, they reduced in number (less frequent)  Higher pressures will drive a more efficient breathing and wash out more CO2
I finally woke up... feeling bad

It's a great story.... but is it sensible? reasonable? fictional? delusional?

My comments in Bold Blue (bonjour)

[ApneaQuestions]

....OK one more question for now. Which did you feel was better for your therapy, APAP or ASV? Why?.....

To be perfectly honest they all feel universally awful.
I'd say my sleep feels worse on all of these treatments compared to no PAP at all.
This is not a magic panacea in my case. 
I'm trying to remain optimistic and hope that my sleep will improve and my daytime fatigue will get better.
After all... I'm really early into this process and I don't want to give in and potentially throw the baby out with the bathwater.
It's entirely possible that my fatigue is due to something else entirely.  I won't know until I've given this experiment a fair chance.
If I'd never stumbled into the fact that full-face masks exist.. I wouldn't even be trying this. 
I feel like the sleep lab let me down in 2011 by not recognizing my mouth-breathing.
Why bother to ask people if they usually have a dry mouth in the morning if they are not going to respond to that information?
Anyway... that's all spilled milk in the past.
I would summarize by saying that if I was still employed I would be very worried that I would be the next in line for a lay-off!
Sleep deprivation is a very bad thing as we all know.
Right now it doesn't matter too much... I can sleep or nap whenever I feel I have to. 
I try not to though in an attempt to keep my sleep hygiene under control.

Thanks for asking. :-)

[ApneaQuestions]

My comments in Bold Blue (bonjour)

Thank you times 5 million !!!!
That's exactly what I was looking for !!!
This is how we learn.  :-)

[SarcasticDave94]

OK I'll admit there's no magic in the APAP or ASV. But when I got my ASV set right, it was good and I knew it. Whereas for me being on a BPAP prior was very very bad in feel and numbers.

I'm going to say, you should keep at that APAP. Given there's the high likelihood of carbon dioxide imbalance due to washout as CA causation, and when bonjour mentions chin tucking I'd consider a soft cervical collar if you've not already tried it, if it happens more frequently.

Looking again at chart...I'd consider a pressure bump off the low as it goes 4 to 6 or eventually maybe even a bit higher, bringing it closer to your median low pressure. Most adults cannot get much air in the mask on 4.

Let's see if there's reason for or against from others.

Sincere best to your success. If you won't quit, we won't quit helping.

[ApneaQuestions]

PS no offense, but those APAP charts are wonderfully, gloriously nasty ugly. So glad your OA was nice and low...

How's that back treating you?

BTW... You've probably noticed by now.... maybe not....

I intentionally picked the WORST night when I created my initial screenshots.

I thought that would be the best one to teach me the most when learning how to interpret the charts.
I won't learn much by looking at a nice peaceful night. (Assuming I ever have one).

So no need to call 911 for me... yet.... ;-)

If you glance at the 6 week summary chart you'll see why I chose that one.

Tomorrow I have my next call with the sleep tech.
I'm expecting him to say that the last week is looking pretty good (from a pure numbers perspective).
I'm guessing he'll avoid mentioning that bad night... we'll see.
Because he doesn't have the breath-by-breath data, he wouldn't know what to say about it anyway.

For now, I'm thinking the best thing to do is to leave the settings alone for another week or two (as mentioned by @bonjour in post #29) and see if the CAs continue to drop.
If that happens.. I will conclude that I may be through the acclimatization phase and (hopefully) the treatment-emergent CAs will be behind me.
Once I get some repeatability with the numbers I'll start thinking about next steps as mentioned by everyone thus far.
It's a little too early to fiddle around tightening up the mins and maxes to get closer to the median.

[SarcasticDave94]

Not a thing wrong with that approach.

The back has an SCS electrical pain block device installed today. I'm doing OK for it being just done.