PLEASE help with settings for ASV coming tomorrow. OSCAR data attached.

[hopeforusall]

Hello and thank you for this forum!

Dealing with severe apneas and endless SpO2 desaturations (Hypoxia/Severe Hypoxia) constantly since last year in which Resmed 10 Autoset has not helped.
I am getting a Resmed 10 ASV tomorrow. The Resmed 10 Autoset has provided the OSCAR data attached. SpO2 data can be uploaded upon request.

Can the community please offer any guidance about the inital settings of the Resmed 10 ASV unit coming tomorrow (with F20 full mask) as well as any other insights or guidance about the OSCAR readings? The only thing I know is that it is almost all central and that the CPAP did very little to help.

Thank you all!!

[Sleeprider]

Lucky you! An ASV will cut your AHI to less than 2 with default settings.  Based on these charts, you should start with EPAP min 4.0, EPAP max 8.0, PS min 3.0 and PS max 15.0.  Please post the detail chart after the first night, and your qualitative evaluation of how you feel and we will fine-tune from there.  Don't know how you scored ASV, but I think your problem is solved already.  This is the ASV titration protocol and I have recommended standard settings except for EPAP max because you don't need the higher pressure. See you soon...sleep well.

[hopeforusall]

This is Excellent Sleeprider!!!
Ordered the ASV used for relatively cheap but still more than hoped. Really did not have a choice...either get it or lose the battle. Hope it actually lasts for a while.
Just wondering if your guidance is for 99% Central apneas with high AHI as detailed in the attachments? Was my Oscar data typical for what you see here with central?

Anyway, thank you soooooo much!!

[Sleeprider]

Normally, we would seek history on central apnea, such as whether it was apparent during diagnostic tests and some other details to determine if it is therapy onset or endemic. In reality, it doesn't matter because your issues with CPAP are far and away concerned with central events. The periodic breathing and wide distribution of events throughout the night speak to the fact you need to resolve this issue to get a decent sleep. Your events are not really even mixed with CPAP pressure. When someone has to fight for ASV therapy against insurance and sleep medicine criteria, it just takes forever of tolerating the kind of efficacy you showed in 3-charts. Your decision to self-treat and buy a machine simply short circuited all the second guessing. I'm 99.999% confident your first night results will prove my confidence correct because I've seen it so many times before...well done! You just found out how to give the medical mafia the middle finger and get instant results. No need to guess who is number-one and a self advocate. In one day you will have demonstrated what the professionals would fret and guess about for months. It's not that they don't know better, but they have been second guessed by insurance and a system that does not let them use their professional intuition to solve problems quickly and efficiently. What a shame this is what medicine has become. They are obliged to conduct tens of thousands of dollars of testing to prove what they probably already know, and delaying patient efficacy for months or years. Guess who this benefits?

[hopeforusall]

A powerful and sobering response Sleeprider!! Well said. Worthy of a sticky note. You should write a book about this stuff. I will buy the first copy.
I would also like to give you a donation even if I do not meet your expectations of a positive outcome (although if this fails to work sleep attrition will soon have its final say). Do not have much, but if you have a donations liink, please attach it. Once I am back on my feet in the coming days (hopefully), I can give something for your troubles.
Thanks again!!

[stanleyjack]

you should get a welcome set of results hopeforusall, I switched to ASV from regular CPAP and immediately dropped from an AHI in the 20's to under 2. It's still early for me, but feel I am on the right path now.

[hopeforusall]

First, thank you very much stanleyjack. I am truly glad that it seems to be working for you, but please check your oxygen numbers as well. If you read on, you will see why...

TO SLEEPRIDER: You may have bet on the wrong horse (me). Got the ASV and set it up this morning.
While my AHI has gone down significantly, my terrible surges followed by hypoxia/severe hypoxia and tremors continues!
If you check the 3 attachments (1 awake, 1 asleep, 1 oxygen), you will see the SpO2 go down to the low 70's when awake, and perhaps not as low as before when asleep. What is very strange is that many of what the ASV labels as Hypopneas (not CA's) are not often reflecting in the data, unless I am just confused from months of this craziness. Spent about 5 hours trying to sleep but the surges stop that cold, until finally able to sleep, with many more desaturations throughout. Can you please offer any guidance?!!?

[Sleeprider]

I don't think you should draw conclusions based on 2-1/2 hours of sleep and awake breathing. For one thing, using the machine while awake is not reflective of a sleep disordered breathing problem, and we are not going to spend a lot of type analyzing it. If you feel the machine is running the show, blow-back, meaning take several breaths that let the machine know you are spontaneously breathing. We will probably need to look closer at the flow rates to better understand what is going on. Note on your Awake breathing statistics, your median tidal volume is a ridiculous 960 mL, resp rate of only 9.6 bpm and a minute vent of 9.6 L/min. How you managed a deep desaturation with this heavy breathing is beyond my comprehension. By comparison, the sleep tidal volume is only 360 mL, resp rate of 16.2 bpm and minute vent of 5.6 L/min looks pretty normal. The first drop in SpO2 is not reflected in the pulse rate or events, so I'm a bit skeptical it is real. I think on future charts the minute vent chart would be more useful than snores. For ASV I like to focus on Events, Flow Rate, Mask Pressure, Minute Vent, and then whatever you like.

Nothing alarming here for a first try. Keep at it, and we will look for more useful trends. Once thing is for sure, there are no CA events.

[hopeforusall]

I do not know if you ever rest Sleeprider, but I am so thankful either way.
I do not quite understand what you are saying about tidal volume or some of the rest, but 8 months of this can take a huge toll on one's ability to think.
In addition to the 'surges' at desaturation events, and in additon to a continuous O2 monitor, I also have a regular pulse oximeter with an alarm that was going off at 85% when I had it on (took it off after a while). Very confused about your statement of no CA events. In fact, I am stunned. With no OA and no CA, what is it that is destroying me?
I will try to get more than a couple hours of sleep again and am wondering if you would suggest altering any setting?
Thank you!!!!!!!!!!!

[Sleeprider]

If you experience pressure surges, blow back and take back control of the machine. We will need to zoom in on those events to see if we can find a cause, in order to suggest a possible solution.