Should one even care about the FL graph on ASV machine?

[Michaely6]

Hi Michael, 

To answer your original question.  "Should one even care about the FL graph on ASV machine?"

I think that depends on the User and how much help they need trying to sort out what is going on at a detail level through the nights.   

So people just get great results and don't have a lot of funny events that they need to spend time sorting out.  

Others find the Flow Limit chart valuable.  

The Flow limitation chart to me, outside of the forced/timed/backup breathing is an indication that flow limitations are occurring and to look deeper while initiating treatment (typically higher pressure support).  The detailed view typically shows far more flow limitation than the FL chart.  Never chase the flow limits themselves if they are not causing an issue.  

First, I really like how Bonjour put it here.  

I will add that I use the FL chart in these ways:

• As another view of the Flow Rate chart filtered to just show Flow Limits the Flow Limit chart makes OSCAR easier to read and understand without needing to zoom into 3-min segments of time.
  
• Sometimes zoomed mid-way or zoomed into 2-3 min segments the Flow Limit chart is the last deciding vote, the final piece of the puzzle that clarifies an ambiguity in the Flow Rate Wave form or is the one single signal that explains why Minute Vent dropped even though Insp/Exp both showed no change, etc.     
  

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I have not seen the chart your speaking of.  I will just add that on an ASV the more spastic the FL chart looks the more likely Min EPAP would need to raise some in concert with Min or Max PS going up higher to address to beat the flow limits down to more reasonable number. 

Update:  I will add that at least some of the flow limits and even sometimes even some hyponeas you can completely ignore.

If the ECG device like a Dreem 2 or the 5 second updates to your HR and your SpO2 from your Pulse-Ox showed zero change, zero variation then what is reported in OSCAR may not have happened or if the event did happen it was a complete 'non-event' and did not disrupt your sleep in any way.  


WillSleep

According to Sarcastic Dave, his FL graph on his aircurve 10 asv is completely flat and on zero which is hard to believe because every member on here who uses the aircurve Asv Always has a crazy looking FL graph so a graph that is completely at zero FL is definitely something that I would love to see a picture of as well as the zoom in on the flow chart graph.

Increasing the EPAP min on the ASV based on the FL graph seems to possibly do more damage than good at times due to the introduction of expiratory pressure intolerance that it and also aeorophagia.

I guess I'm still a little confused regarding the FL graph on the ASV based on the feedback that I'm getting on this post. Some say don't make pressure changes based on the FL graph and some say to increase EPAP. Atleast that's how I'm interpretting the feedback.

[sheepless]

other's please correct me if I'm wrong.

my understanding is that FL is treated by the difference between epap and ps/ipap. hence the use of EPR for that purpose. that suggests one can raise asv min ps and/or lower min epap to address FL. my sense is that most raise ps because some min epap is necessary to combat obstructives.

I wonder if Dave meant his 95% is flat zero?

[Gideon]

EPAP min does need to have a value that manages the obstructive apnea, Min PS should help with the other issues. The trick is to not get either so high that it interferes with the ASV's primary function, managing central/mixed apnea.

[sheepless]

"The trick is to not get either so high that it interferes with the ASV's primary function, managing central/mixed apnea."

bonjour, would you mind elaborating a bit? for example, some tell us that max ps needs to be unrestricted to combat ca.

[Gideon]

Pressure support for an ASV requires a difference to treat Centrals,  Yes the max should typically be unrestricted but if the min PS is high enough such that the difference is not large enough to effectively function. . . . 

Min EPAP = 8
Min PS = 12
Max IPAP = 25

that the min IPAP here is 20 doesn't allow enough room for the remaining possible PS to function.  Granted that these values are unrealistic and only here to demonstrate a point.
We also have to be aware that we are treating people who are different and have different requirements.  We have to be willing to adapt and make sure the therapy is working for them.

[sheepless]

"We have to be willing to adapt and make sure the therapy is working for them."

I'm with you there. just wanting to clarify and understand the fundamentals. thanks for the explanation.

[SarcasticDave94]

Note it is for 1 hour only, I have COPD and currently with bronchitis as well. That means my sleep schedule is toast right now. Below is charts for Flow Limit of 0 for min, med, 95%, and max and in the graph with flow rate viewed in default and zoom to about 2 min.


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[attachment=16567] [attachment=16568]

[Michaely6]

Note it is for 1 hour only, I have COPD and currently with bronchitis as well. That means my sleep schedule is toast right now. Below is charts for Flow Limit of 0 for min, med, 95%, and max and in the graph with flow rate viewed in default and zoom to about 2 min.

Wow this is as perfect of a graph for ASV that you can get. Zero FL and Leaks!

[SarcasticDave94]

Keep at it and you'll get there. BTW what's your current settings? I'm not necessarily suggesting you add them to your left panel info, but just wanted to see what your ASV is set to.

[Michaely6]

Keep at it and you'll get there. BTW what's your current settings? I'm not necessarily suggesting you add them to your left panel info, but just wanted to see what your ASV is set to.

Currently I have EPAP min 9,.EPAP max 15, PS min 6, PS max is set to the max setting.

I do better with a higher starting PS