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What exactly does "blowing back" at an ASV reset?
#11
RE: What exactly does "blowing back" at an ASV reset?
Your desats aren't as bad as it seems. Yes, it drops to 88 but just briefly. If it were to stay at 88 or less for 6 or more minutes, that is the basis for supplemental oxygen.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#12
RE: What exactly does "blowing back" at an ASV reset?
Utah, why are the settings on your ASV so 'handicapped' with EPAP min 4.0, EPAP max 6.0, PS min 0.0 and PS max 5.0.  You clearly are not treating central or complex sleep apnea and appear to be simply using very low pressure with 0-5 bilevel pressure to even out the minute vent a bit.  If you want to improve SpO2, you need higher EPAP pressure,like minimum 6.0 maximum 8.0, and I would suggest a minimum PS of 3.0 and maximum PS of 8.0 or more.  Your AHI is fantastic, but this is not the common use of ASV.  The typical starting pressures for self-titration on ASVauto is EPAP min 4.0, EPAP Max 15.0, PS min 3.0, PS max 15.0. Since  you are using your ASV for some other purpose, it would help to review what your previous therapy was, understand the problems with it, and what you are trying to get from ASV.

[Image: attachment.php?aid=4210]
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#13
RE: What exactly does "blowing back" at an ASV reset?
(09-09-2021, 07:27 AM)Sleeprider Wrote: Utah, why are the settings on your ASV so 'handicapped' with EPAP min 4.0, EPAP max 6.0, PS min 0.0 and PS max 5.0.  You clearly are not treating central or complex sleep apnea and appear to be simply using very low pressure with 0-5 bilevel pressure to even out the minute vent a bit.

Okay, the history of these settings is laid out in this thread. The short form is, I have a lot of gastric/esophageal problems and simply could not tolerate the high pressures. It literally came down to using the ASV the way it is "commonly used", or eat -- but not both. The sleep doc I had been working with before I found this board had reduced the pressure to very nearly the same settings (EPAP 4-4, PS 1-6) we finally settled on in the thread as working well for both comfort and effect. My experience has also been that the hypopnea count actually increases with higher pressure settings (I have no idea why).

My CSA is the result of decades of opioid use for Willis-Ekbom, and consists almost entirely of central hypopneas. I thought I had uploaded my complete sleep study somewhere (might have been another board), but the technical summary section is posted in the thread referenced above. Since I cannot discontinue the medication, there is no "treating" this (in the usual "curing" sense); the goal is to keep it under control so I don't develop cardiac problems in the future. 

Since I have been using the ASV for a while and getting used to it, I am now ready to start slowly titrating upward to see what I can realistically tolerate in terms of pressure. Despite the gastric/esophageal problems when I first started out, what little sleep I did get on those higher pressures resulted in a significant increase in energy levels. That may only have been because I was already profoundly sleep-deprived, but I'm willing to pursue the idea that it may have been an increase in oxygenation from the higher pressures.

So, that's my story and I'm sticking to it!  Big Grin
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#14
RE: What exactly does "blowing back" at an ASV reset?
(09-09-2021, 07:27 AM)Sleeprider Wrote: Since  you are using your ASV for some other purpose, it would help to review what your previous therapy was, understand the problems with it, and what you are trying to get from ASV.

PS: there was no previous therapy. Occasional dyspneas began about 2 years ago when we were living at sea level in North Carolina, then became worse when we moved to Utah last year at 3,000 ft altitude. That's when my sleep doc recommended the study that revealed the central hypopneas and oxygenation issues.
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#15
RE: What exactly does "blowing back" at an ASV reset?
I guess I recalled the earlier thread and just lost track. We have dealt with using ASV to treat CSA with the complication of aerophagia, and it is a compromise. The critical thing seems to be to have enough pressure support to trigger a spontaneous breath even if the PS is not enough to fill the lungs on its own.
Sleeprider
Apnea Board Moderator
www.ApneaBoard.com

____________________________________________
Download OSCAR Software
Soft Cervical Collar
Optimizing Therapy
Organize your OSCAR Charts
Attaching Files
Mask Primer
How To Deal With Equipment Supplier


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#16
RE: What exactly does "blowing back" at an ASV reset?
It's definitely a compromise. I can't afford to lose any more weight, the gastric/esophageal issues (plus the fact that I've had no sense of taste or smell for two decades) makes it difficult enough to get food down as it is. Nobody knows what the problem is, they've pretty much chalked it up to autoimmune.
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#17
RE: What exactly does "blowing back" at an ASV reset?
(09-08-2021, 09:35 PM)SarcasticDave94 Wrote: OK copy. Despite being on ASV Auto mode, it's an EPAP of 4-4 and PS 0-5 currently.

If you would like a bit more air, 1 of 2 ways you can try. IMO they'll feel different so consider trying both, but not together. Whichever you do, include the OSCAR shot and tell us how you felt.

The 2 directions, add 1 or 2 to EPAP, or to PS Min. Since EPAP is static 4, you may have to increase the range maybe 4-6. Call this choice 1. Choice 2 would be adding 1 or 2 to PS Min. One of the 2 will feel better to you.

Choose one setting change are a time to determine the effects.

Okay, Dave -- I think we have a winner!!

The first setting I tried was EPAP 4-6, PS 0-5. I did that for 3 nights, to try to get an average result and consistent "feel". A tad less comfortable (unhappy esophagus that woke me up a few times) than the old rock-bottom settings, and I had a couple more hypopneas than I usually experience. Screenshot attached.

For the past 3 nights (with 2 nights off for Hubby's hernia surgery) I've been at EPAP 4-4, PS 1-6. It's actually quite comfortable, and oxygenation (not to mention hypopneas) is great! Oscar screenshot attached, and I've included the O2 ring's application screenshot so you can see its statistics. I've never seen them that good!

The 2 settings did feel slightly different -- sort of "undefinable", but the higher PS (with EPAP 4-4) did seem to feel better. So it looks like pressure support is the way to go if/when I need more air. 

Can you tell me exactly what the ASV is actively doing, at those two settings? Everything seems to be based on EPAP, I never could figure out how "pressure support" works with that!

Thanks


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#18
RE: What exactly does "blowing back" at an ASV reset?
When I used the same model ASV, I treated EPAP as my base air like a CPAP. If you had Obstructive Apnea, EPAP can take care of it the way I had mine set up. PS and corresponding IPAP take your Hypopnea and CA to task.

BTW Don't worry much on flow limits when on ASV. The ASV has other marching orders than FL combat.

I somewhat felt you'd like PS increase over EPAP as PS is of shorter duration.

SpO2 looks OK despite some low dips to 91. If it maintains that you should be OK with it.

You can't get better results than 0 AHI. Big bonus you are reasonable in comfort. Unless I missed something that is. I'd run that for a week or so unedited and monitor stats and look for good or bad trends. You can post a chart whenever something goes off your normal with a comment on what it is. But I'm thinking you got this on the right direction now.
INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEBSITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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