Requesting Sleep Report Analysis & Second Opinions

[SarcasticDave94]

Agreed on the Ramp. It isn't your friend. EPAP min 6 may be OK after all. It may just have been needing the EPAP range to be able to go after events. I think mostly now it's control of leaks, getting used to the ASV delivery, and I would focus on fine tuning EPAP overall to attack the FL. I'm meaning fractional adjusting now, meaning not whole number edits but .2 etc. I am guessing, but FL may be a driving factor yet. I'm just basing what I see on what I recall I could get on my ASV, and mine tackled all events, giving me sub 1 AHI frequently, but not always. I felt most comfortable around 2-3 AHI and events spread over the night. It is not necessary to get to a zero on any of this, but low enough to be under control and to maximize comfort.

[omariumprime]

I think Dave has given a pretty good lead. You might want to reduce EPAP min to 6.0 based on your original settings. Results look great, but you should expect it to take some time to fully adapt to the use of ASV.  When you tolerate it, turn off ramp or switch to shorter ramp time.  The few events you had were mainly during the ramp.

Great thank you very much for the input! I’ll try the EPAP change for tonight.

[omariumprime]

Hey all, so almost a week in and the two MAJOR challenges I'm still experiencing nightly are: 1) Severely dry mouth and waking up sometimes with air flowing into my mouth which is sealed tight, as if my throat fully collapses or, more likely, I simply stop breathing altogether and 2) Severe gas flowing through my intestines that I always have to spend the first 30-45min after waking up every morning trying to pass.

Especially with #2, is this a normal side effect of the ASV when it comes to higher inhalation pressures? I see the logic, I do feel like I breathe in “too much” air sometimes so I can understand the science behind that turning into built-up gas throughout the night, but yesterday I had to take the mask off after only a few hours with it as my intestinal gas was too pressured and started causing abdominal pain. I didn’t experience this issue with APAP months ago, then again my inhalation pressure weren’t as colossal My monitoring sleep tech is lowering the pressure for me for tonight to try and tweak things, and I have already raised humidity and temperature based on his recommendations, as well as drinking lots of water a few hours before bed. These recommendations seem logical, but I’m still concerned the dry mouth is related to a potential chin-tuck or some other faulty breathing pattern stopping a natural nasal breathing flow, and the built-up gas is backfiring.

Any input on the above from experienced users especially with the ASV would be greatly appreciated, thank you!

[Sleeprider]

Dry mouth and aerophagia are usually related to leaks and higher pressure respectively. For Aerophagia we will look at the Oscar charts and see where opportunities might exist to lower pressure or pressure support. Oscar also tells us if leaks might be a problem for dry mouth. So where is your chart?

[omariumprime]

Thank you for confirming my suspicion and elaborating! Attached below are charts for the past 3 nights, the data from last night apparently shows a lower leak rate than the previous 2 but higher AHI 

Oct 5 Night...
   

Oct 6 Night...
   

Oct 7 Night...
   

[Sleeprider]

Just my humble opinion but you can reduce EPAP min to 6.0 and EPAP max to 8.0, with PS 3.0 to 10.0. The mask leaks need to be worked on, but the lower pressure may help with the air ingestion. Ramp is not your friend for either events or mask fit. Try to minimize it or turn it off. Therapy is excellent and these settings simply reduce the upper-end pressures you may experience.

[SarcasticDave94]

Sounds like a good plan. I found that when leak rates went up the reporting accuracy went down. If we go with the lowered pressures, this may stabilize the aerophagia and leaks somewhat and give you time to adjust to the ASV. Then after use for a short period of time, we can consider dialing it up a bit at a time to combat any events thrown at it.

[omariumprime]

Thank you for the recommendations all! I will see how tonight goes after my sleep tech's lowered pressure settings and report back here on how tonight goes. Last night was another aerophagia punch in the gut (literally) as I woke up after only about 2.5h with the machine on to severe stomach gas, pressure, cramping and overall pain. For a good 20min after that I had to wait for this phase to pass before I went back to physical relief land. It's crazy how higher pressures like this turn the entire experience into a serious backfired pain session. I did some more research to try and connect my symptomatic dots and at this point it's very likely that, as already discussed, it's a mix of both my mouth-breathing tendencies and the insanely higher inhalation pressures that I'm definitely still not used to. Attaching last night's chart for your reference, please let me know if there's anything enlightening in what you see...

     

[Sleeprider]

Okay, if that was EPAP min to 6.0 and EPAP max to 8.0, with PS 3.0 to 10.0, then let's cut back things again.

New settings: EPAP min 5.0, EPAP max 7.0, PS min 2.0, PS max 8.0. Let's make this work. Please work on those leaks.

[SarcasticDave94]

The ole 1 2 punch treatment...crabby Dave sees Ramp activity for about 20 minutes in the pressure traces during the restart. See the Hypopneas at 2352? Assuming it was Ramp, it allowed them. Your starting EPAP is 6ish, Ramp needs to go.