Is it the ASV or the Auto?

[deltadave]

DeltaDave's answer kind of went over my head...

I sincerely apologize for that. If PaceWave works the way I understand it, ASV should increase it's effectiveness in poor sleepers (where the aggressiveness of current technology may make ASV difficult to tolerate).

Sigh.

I guess people are more interested in Twinkies and Obama.

That's life!

It's all gonna end in a couple weeks anyway!

But I do have one question.

Why does it need to end on a Friday?

The irony.

"Looking forward to the weekend."

I'll bet not that one!

[JaxTom]

OK.... Thanks Dave. I'll assume it's the ASV that fixing me and not the variable pressure. And at least for AHI it's fixing things. Average for last seven days was 0.15.

[deltadave]

OK.... Thanks Dave. I'll assume it's the ASV that fixing me and not the variable pressure. And at least for AHI it's fixing things. Average for last seven days was 0.15.

I think you have to be a little careful about how you interpret AHI though. When ASV works, the breathing instability is fixed (at least after about 20 minutes or so). If you're still having dozens of ASV attacks, then the only thing that may be better is the AHI number itself.

[ignorant1]

DeltaDave,

As usual, you are OH SO RIGHT! (And brilliantly intuitive!)

An ASV machine can stabilize breathing, thus creating an extremely low AHI number. However, although SDB is stabilized/mitigated, sleep fragmentation (in some hypersensitive patients) may still be occurring due to the (necessary) pressure attacks. (Please correct me if any of this is wrong - I certainly do NOT want to disseminate incorrect information!)

In light of this, I would love to be able to identify where an "ASV attack" occurs in my data. Could you please explain what to look for in the waveforms to determine when an ASV attack occurs? It seems like it would be obvious, but some specific guidelines from you would be VERY helpful.

A million thanks in advance!

P.S. - The new "PaceWave" algorithym looks awesome. It's probably wishful thinking, but wouldn't it be great if existing ASV Adapt machines could be upgraded with a firmware flash? I'm not holding my breath waiting though. (ha ha...)

[deltadave]

In light of this, I would love to be able to identify where an "ASV attack" occurs in my data. Could you please explain what to look for in the waveforms to determine when an ASV attack occurs?

Look for areas where the Pressure Support rises above PSmin (assuming, of course, that PSmin does not equal PSmax).

In the aforementioned example, these are ASV attacks (BTW, they are all unsuccessful. From the example in ResScan).

[JaxTom]

Let's assume for a second that I am having lots of these ASV attacks which are being repelled. (I have SH data if you want to see it). Then I might be having sleep fragmentation leading to daytime fatigue, which I still have.

What do you do about the sleep fragmentation?

[deltadave]

Let's assume for a second that I am having lots of these ASV attacks which are being repelled. (I have SH data if you want to see it). Then I might be having sleep fragmentation leading to daytime fatigue, which I still have.

What do you do about the sleep fragmentation?

Sure, let's take a look at the data.

I think the first thing I would look for is to see if the current settings, and even machine, are correct. Your original settings showed an EPAP of 12.0 cmH2O and still having events which could very well have been obstructive. Lowering the EPAP to 9.0 cmH2O might REALLY allow a lot of obstruction to occur, and it's unlikely that PS would be able to blow through it regardless of Pmax.

If that's the case, it may be a good idea to consider an ASV with AutoEPAP if there's still a lot (or variable) obstruction underfoot. That would mean replacing this thing if PaceWave comes along or changing to AutoSV Advanced.

However, rather than dial and machine wingin', hoping the right settings are stumbled upon, it be more efficient to get the raw data from the most recent sleep study. That might go a long way to to objectively answer the obstructive-central question.

Then the cause of sleep fragmentation could be pursued.

[JaxTom]

IM off again


I don't have my last study. I'll see about getting it.

[deltadave]

[JaxTom]

Translation of Dave's charts? Stop taking naps dummy !!!



So.... I'm toughing it out in an attempt to get a better sleep pattern.I'm also going to attempt to take B12 in day to have better energy and have just ordered some Glycine for Wed delivery to attempt to sleep better thru the night.

[deltadave]

Actually there's a number of points that can be made here.

Overall, your visible sleep hygiene is fair to poor, which is certainly great news cause now we have something to work with. And if there are other factors that may generate poor sleep (excessive or ill-timed caffeine intake, sleep-destroying medications, etc.) then there's a LOT of material to work with:

• In re: the naps, you need 8 hours of sleep PER DAY. If you take a 2 hour nap during the day, that's going to take away from your nighttime block. This is especially so if the naps are late afternoon or evening. This is the point of the green line in the graphic above, as sleep pressure takes a big hit.
• There are a number of factors that contribute to sleep besides simply feeling tired. These factors are cyclical:
  
  
  
  So if your bedtimes are too late and inconsistent and sleep time variable, you will be working against these natural biorhythms.
• These biorhythms may collectively be referred to as the "internal clock". Further, it is not a 24 hour clock, it's about 24.19. Consequently, it needs to be reset every day to insure that your sleep block stays where you want it to be. This is done by getting outside and getting a healthy dose of Bright Light Therapy ("Sun") first thing in the morning.

[deltadave]

We can also add the sleepiness component here:



Taking all of these factors collectively, "I" believe there is a "window of opportunity" to initiate sleep, and believe this window is relatively small ("I" could also be out of my mind, but what the hey). However, if this is so (not the "out of my mind" part), it would underscore the need for consistent bedtimes.

Arguably, the above thought may simply be part of the "over-tired" myth, and easily explainable by other factors (a "micro-nap" occurred during the window and now the ability to initiate sleep has been upset, one was engaging in a mind-alerting activity when they should have been in bed and it is carrying over, they were staring at a computer screen and burning up their melatonin, etc.).

However, using the "window" theory may be a helpful tool to encourage sleep hygiene, and one should be decelerating as it nears (thus perhaps helping to create the window as well).

(BTW, if someone sees the Window of Opportunity Theory in print after about 2004 then they stole my idea.)