HELP AGAIN! ASV or APAP?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
sleepinow
Posts: 457
Joined: Thu Apr 25, 2013 9:40 am

HELP AGAIN! ASV or APAP?

Post by sleepinow » Mon Apr 14, 2014 6:50 pm

Hi Cpaptalk community, my name is Mariusz Zoldak and I have been a Cpaper for almost a full year. I have been struggling with money, insurance (I did not have any but recently got medicaid) and my treatment for sleep apnea. I have been researching, reading threads, books, e-books, listening to advice from doctor and forum users, and never have I conquered my strong desire for a therapy that makes me feel like a human should feel. I have only met gradual improvements over a period of a year. Are these significant improvements? Yes, I can actually function well on some days. Am I satisfied by these improvements? No, I cannot stand transitioning going from tired on some days to almost well rested on other days. Here is a picture of me because I felt like posting it. Image Basically I am writing this because I feel like I have little options left from having a potentially good life, to living in a state of hopelessness...

Okay, to start things off, I have a small reserve of money left before I go completely broke. I do not have a huge chunk of time to get the career I want to get. And all I am requesting from any one of you, is your help. (Thanks for all the help that you have given me with my other requests for aid).

I have had four sleep studies/titration studies performed on me in total. In order, I had a home sleep study > An ASV Titration Study > Split Sleep/CPAP Titration Study. If you guys can please look carefully at these studies so you can have an idea of what to do with me.

Here are the results from the home study (The link provides a look at my results from a prior thread topic)

viewtopic.php?f=1&t=94936&st=0&sk=t&sd=a&start=30

Here are the results from my ASV Titration Study

Here are the results from my Split Sleep /CPAP Titration Study


I have removed the images and instead added a link below because it took too long to load


NOTE THAT TWO OF THE EIGHTEEN PAGES IN THIS GALLERY ARE DUPLICATES. Image < New Improved Link

Now I have grown very skeptical and very concerned from the results of the study, the sleep technician performing the studies, and also the Home sleep study. All of them seem to contradict one another. For example, my ASV Titration results were recommended at a MinEPAP of 6.0 and MaxEPAP of 10.0 PSMin of 6.0 and PSMax of 14.0. If I am not mistaken, that is an inspiratory pressure of 12.0. My other two studies recommended a starting pressure of 4.5 for the home study, and a 4.0 with the split CPAP Titration. That is a huge difference compared to the ASV Titration result. My home sleep study found Obstructive Apneas and No Central whilst my split study found mostly Centrals and One Obstructive and for some weird reason 0! Hypopneas on the Split Study. Heres my other issue; the Sleep technician looked extremely exhausted with big puffy dark eye sacs and he even told me so. (Who knows maybe he even has sleep apnea because he was overweight too!) When I asked him what my AHI was after the study he said he doesn't know yet because he has to "manually" score the AHI as opposed to it being automatically done on his reasoning that it would be more accurate. (Also my ASV Titration does not even display any AHI) So my question is WTH is going on with these test results? None of them make any sense to me.

Can anyone tell me what form of therapy I should take?

One last thing, my split study states that my sleep disorder breathing events were "significantly reduced" with a CPAP pressure of 6. (When the hell did CPAP ever eliminate Central Apneas?) So please, with all of this information, I beg for your help! You guys mean so much to me.

_________________
Mask: Quattro™ FX Full Face CPAP Mask with Headgear
Additional Comments: Trying my best to get quality rest. PR System ONE REMstar BiPAP Auto SV Advanced
Last edited by sleepinow on Mon Apr 14, 2014 11:30 pm, edited 4 times in total.
System One Respironics Bipap AutoSV Advanced Quattro Fx

Min EPAP: 13.0 CmH20
Min Pressure Support: 3.5
Max EPAP: 25.0
Max Pressure Support: 5.0
Max Pressure: 20.0
Flex Setting: Bi-Flex - 3
Backup Rate:Auto
Humidification Mode:off
Humidifier Setting:c5

User avatar
Todzo
Posts: 2015
Joined: Tue Apr 24, 2012 8:51 pm
Location: Washington State U.S.A.

Re: HELP AGAIN!

Post by Todzo » Mon Apr 14, 2014 7:23 pm

When I first started CPAP there was no data. I did use my own pulse oximeter and audio recording to see a bit more of what was going on.

The short of it, some good nights, some bad nights.

So I went after the bad nights with lifestyle changes.

Now I simply recommend that all being treated for OSA find themselves a dietitian and personal trainer and work with them for at least three years.

Result so far is a reduction of pressure by 46% of the highest on the doctor set it to with AHI running under 1.0.

You are using the best technology and that is all the doctors have for you. Pursue alternatives!!
May any shills trolls sockpuppets or astroturfers at cpaptalk.com be like chaff before the wind!

sleepinow
Posts: 457
Joined: Thu Apr 25, 2013 9:40 am

Re: HELP AGAIN!

Post by sleepinow » Mon Apr 14, 2014 8:06 pm

I just need a better understanding of my results, not an alternate therapy

_________________
Mask: Quattro™ FX Full Face CPAP Mask with Headgear
Additional Comments: Trying my best to get quality rest. PR System ONE REMstar BiPAP Auto SV Advanced
System One Respironics Bipap AutoSV Advanced Quattro Fx

Min EPAP: 13.0 CmH20
Min Pressure Support: 3.5
Max EPAP: 25.0
Max Pressure Support: 5.0
Max Pressure: 20.0
Flex Setting: Bi-Flex - 3
Backup Rate:Auto
Humidification Mode:off
Humidifier Setting:c5

User avatar
Julie
Posts: 19898
Joined: Tue Feb 28, 2006 12:58 pm

Re: HELP AGAIN!

Post by Julie » Mon Apr 14, 2014 8:47 pm

Your results are unreadable (too small even on clicking pgs) and you need to get hold of your AHI. None of the upper pix came out at all btw, only the second set. Can you try again to get better pix here - use Photobucket or some other similar thing.

sleepinow
Posts: 457
Joined: Thu Apr 25, 2013 9:40 am

Re: HELP AGAIN!

Post by sleepinow » Mon Apr 14, 2014 9:03 pm

Sorry, here is a better view of the images. http://imageupper.com/g/?S020001004E13975307271035045

These images offer a better resolution and if you click on them they zoom in on the page. Thanks

Edit: I do not know if photobucket allows multiple uploads at once, so I went with imageupper

_________________
Mask: Quattro™ FX Full Face CPAP Mask with Headgear
Additional Comments: Trying my best to get quality rest. PR System ONE REMstar BiPAP Auto SV Advanced
System One Respironics Bipap AutoSV Advanced Quattro Fx

Min EPAP: 13.0 CmH20
Min Pressure Support: 3.5
Max EPAP: 25.0
Max Pressure Support: 5.0
Max Pressure: 20.0
Flex Setting: Bi-Flex - 3
Backup Rate:Auto
Humidification Mode:off
Humidifier Setting:c5

sleepinow
Posts: 457
Joined: Thu Apr 25, 2013 9:40 am

Re: HELP AGAIN! ASV or APAP?

Post by sleepinow » Mon Apr 14, 2014 11:26 pm

Bump

_________________
Mask: Quattro™ FX Full Face CPAP Mask with Headgear
Additional Comments: Trying my best to get quality rest. PR System ONE REMstar BiPAP Auto SV Advanced
System One Respironics Bipap AutoSV Advanced Quattro Fx

Min EPAP: 13.0 CmH20
Min Pressure Support: 3.5
Max EPAP: 25.0
Max Pressure Support: 5.0
Max Pressure: 20.0
Flex Setting: Bi-Flex - 3
Backup Rate:Auto
Humidification Mode:off
Humidifier Setting:c5

User avatar
kaiasgram
Posts: 3568
Joined: Sat Jun 02, 2012 2:08 pm
Location: Northern California

Re: HELP AGAIN! ASV or APAP?

Post by kaiasgram » Tue Apr 15, 2014 12:32 am

Mariusz, I wish I had some ASV experience to help you out with, but at least I can give you another *bump* up. Hopefully some knowledgeable folks are looking over the material you posted. I could see there's a lot to review, so maybe it'll take a bit of time.

Hang in there, this community always comes through for good people.

_________________
Machine: AirSense 10 AutoSet with Heated Humidifer + Aifit N30i Nasal Mask Bundle
Mask: Aloha Nasal Pillow CPAP Mask with Headgear
Additional Comments: SleepyHead-now-OSCAR software on Mac OSX Ventura

sleepinow
Posts: 457
Joined: Thu Apr 25, 2013 9:40 am

Re: HELP AGAIN! ASV or APAP?

Post by sleepinow » Tue Apr 15, 2014 1:07 am

Thank you very much for making me feel more hopeful. I will definetely remember everyones great help that they have given me. I don't know where I would be if it weren't for other people willing to help me. Well I'm going to bed I have work tomorrow

_________________
Mask: Quattro™ FX Full Face CPAP Mask with Headgear
Additional Comments: Trying my best to get quality rest. PR System ONE REMstar BiPAP Auto SV Advanced
System One Respironics Bipap AutoSV Advanced Quattro Fx

Min EPAP: 13.0 CmH20
Min Pressure Support: 3.5
Max EPAP: 25.0
Max Pressure Support: 5.0
Max Pressure: 20.0
Flex Setting: Bi-Flex - 3
Backup Rate:Auto
Humidification Mode:off
Humidifier Setting:c5

User avatar
robysue
Posts: 7520
Joined: Sat Sep 18, 2010 2:30 pm
Location: Buffalo, NY
Contact:

Re: HELP AGAIN! ASV or APAP?

Post by robysue » Tue Apr 15, 2014 9:08 am

sleepinow,

I read through the thread you linked to (
viewtopic.php?f=1&t=94936&st=0&sk=t&sd=a&start=30) and read the whole 4 page thread.

I've also read through the entire set of data from both titration studies.

And all I can say is that I'm confused since there's a lot of stuff that seems inconsistent in the various studies. And I agree with a lot of sludge's comments on that other thread.

My own comments:

0) The phrase "sleep disordered breathing" includes both obstructive sleep apnea and central sleep apnea. Sleep disoredered breathing is usually abbreviated SDB.

1) It's not at all clear why or how you wound up with an ASV machine based on the home sleep test data. The home sleep study seems to have some potentially real issues on both distinguishing central apneas from obstructive apneas (see sludge's comments on the other thread). But clearly something was interfering with your sleep continuity that night since the arousal index was 43. But the arousal index includes arousals from any cause, not just sleep disordered breathing (SDB) incidents. So the home sleep test points to there being some potential issues in sleep continuity issues.

2) It's not at all clear why the doc agreed to an ASV titration. On the ASV titration study it is not clear how the settings were arrived at. It appears that the tech started you out with the settings that wound up being the recommended pressure settings---in other words, there were no events during the sleep time on the ASV titration study that needed to be responded to; hence the pressure settings remained at their initial setting throughout the night. Whether that's because the initial pressures are enough to "fix" the sleep disordered breathing (SDB) problems or whether that's because there's no real SDB to fix is not clear at all.

3) The split test results seem a bit odd. First there's the fact that all but one of the apneas scored are central rather than obstructive, but the diagnosis remains OSA. However, when you look at the hypnograph, it's pretty clear that a lot (maybe all?) of those CAs are being scored as you are transitioning to sleep, and perhaps the reason they disappeared during the treatment part of the study is that the addition of the positive air pressure allows your brain to reset the CO2 trigger for respiration more smoothly.

4) Spontaneous arousals: On the diagnostic home sleep test, the arousal index was 43, meaning that approximately 43 times per hour the "surrogate arousal indicators" showed that it was likely you had an EEG arousal, even though there's no EEG data. An arousal is not quite the same a a full wake, but you can loosely think of an arousal as a sudden change from a deeper sleep stage to a lighter one. Most of the arousals on the home sleep test were NOT associated with sleep disordered breathing. On the ASV titration, there was still a significant number of spontaneous arousals in spite of the ASV treatment (arousal index = 11.something). But on the split test, there were NO spontaneous arousals on either part of the night. And that seems just plain weird.

5) The sleep architecture seems pretty lousy on the in-lab tests; but it's not as bad on the home sleep test. The home sleep test's actigraph approximation of REM sleep shows it a bit lower than expected, but it is there. The overall sleep efficiency on the home test is pretty good, and the latency to sleep is not bad. But both the ASV and split study tests both showed a very long latency to sleep (111.5 minutes on the ASV test and 63 minutes on the split study test). The total sleep time on both of the in-lab tests was really abysmal, as was the sleep efficiency on those tests. The home sleep test's total sleep time and sleep efficiency were actually pretty good. Now some of the differences could be lab effect---it is more difficult to get to sleep in a strange place. But usually the effect is not going to be as pronounced as it is in your sleep tests. And there's no REM at all on the split study.

6) Recommendations from the sleep studies. While PAP (of some sort) is mentioned on all of the studies' recommendations for treatment, it is NOT the only recommendation. In particular:
  • Home sleep study indicates that the SDB is very mild and appears to be positional. It does say that alternatives to PAP such as an oral device are worth considering. Which raises the question: Did you consider an oral appliance or not?
  • The ASV study specifically mentions the overall lack of sleep and recommends "Sleep Hygiene Education." Which raises the question: Did anybody ever follow-up and ask you about your sleep hygiene and provide you with some sleep hygiene guidelines?
So where to go from here: You're still feeling miserable, but not as miserable you were:
I have only met gradual improvements over a period of a year. Are these significant improvements? Yes, I can actually function well on some days. Am I satisfied by these improvements? No, I cannot stand transitioning going from tired on some days to almost well rested on other days.
And you have no idea about where to go from here:
Basically I am writing this because I feel like I have little options left from having a potentially good life, to living in a state of hopelessness...

Okay, to start things off, I have a small reserve of money left before I go completely broke. I do not have a huge chunk of time to get the career I want to get. And all I am requesting from any one of you, is your help. (Thanks for all the help that you have given me with my other requests for aid).
And you've commented elsewhere that nights following days when you exercise are much worse in terms of sleep quality than nights following days you don't exercise. And you've commented (reasonably I might add) that you don't want to just give up on the exercise routine. Which raises the side question: Do you happen to recall if you exercised before any of the sleep tests? And didn't exercise before others???

Under ideal circumstances, I'd suggest starting over with a full in-lab diagnostic sleep test, preferably on a night that you can sleep. And I'd personally recommend starting over with a different sleep doc and a different sleep center. It's just that the sleep tests are all over the place and I think you actually need a proper in-lab diagnostic test based on more than 75 minutes of fractured sleep where it's clear that a large part of the problem on that night was getting to a sound sleep state. But I also understand that money is tight and that this starting point is probably NOT financially feasible.

I also think you need to be considering the sleep continuity problems as being caused by other things in addition to the SDB that you happen to have. It's important to understand that the CPAP and ASV treat only the SDB issues: they don't fix bad sleep that is bad for other reasons. And since the data you've posted from your ASV machine seems to indicate that whatever SDB you do have is well controlled by the ASV, it's time to start considering other things that you need to address.

A sleep log is one thing that might be useful. Track when you go to bed, when you get up, and estimates of how long you think it took you to fall asleep, how many times you woke up during the night, and how long you think you actually slept during the night. Since you think that exercise makes the sleep worse, you need to track that as well as how you (subjectively) about the sleep each morning.

It could be that you need to pay careful attention to when you exercise. For many people exercising too close to bedtime will make it more difficult to get to sleep and stay asleep. You might also find that too much intense exercise on one particular day is problematic, so you may need to cut back on how much exercise you do at any given time, but increase the number of days per week that you do something.

Also look at things like caffeine consumption. We tend to consume more caffeine than we realize and we tend to drink it later in the day than we think---particularly when we're feeling excessively sleepy or tired during the day.

And finally, it's worth considering other causes of the daytime sleepiness and fatigue. If it's been a while since you've had a full physical exam, it's time to set one up and have all the usual (non-SDB) suspects for daytime fatigue investigated: Get your thyroid checked and your vitamin levels checked in particular.

_________________
Machine: DreamStation BiPAP® Auto Machine
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Additional Comments: PR System DreamStation and Humidifier. Max IPAP = 9, Min EPAP=4, Rise time setting = 3, minPS = 3, maxPS=5

sleepinow
Posts: 457
Joined: Thu Apr 25, 2013 9:40 am

Re: HELP AGAIN! ASV or APAP?

Post by sleepinow » Tue Apr 15, 2014 10:58 am

1) It's not at all clear why or how you wound up with an ASV machine based on the home sleep test data.
Why? I felt the APAP that I was originally prescribed was not helping me at all (That may be because of a low prescribed settings of 4.5 and me not being fully adjusted to it yet). I bought an ASV instead and it actually helped on days where I had minimal activity
2) It's not at all clear why the doc agreed to an ASV titration.
It was more of a recommendation from forum users on here.
On the ASV titration study it is not clear how the settings were arrived at. It appears that the tech started you out with the settings that wound up being the recommended pressure settings
How can you tell? Because I can't. I could have sworn though that the pressure was low in the beginning and increased in time to counter the apneas I was having.
3) The split test results seem a bit odd. First there's the fact that all but one of the apneas scored are central rather than obstructive, but the diagnosis remains OSA.
I feel the same way about this. I think the sleep technician was too tired to function at that time.
However, when you look at the hypnograph, it's pretty clear that a lot (maybe all?) of those CAs are being scored as you are transitioning to sleep, and perhaps the reason they disappeared during the treatment part of the study is that the addition of the positive air pressure allows your brain to reset the CO2 trigger for respiration more smoothly.
Is it possible to make certain those were Central Apneas from the information given? Or can it be possibly true that the sleep technician mistakenly swapped Obstructive Sleep Apneas with Central Apneas on the First phase of the split study. I ask that because he seemed somewhat ill when I saw him.
4) Spontaneous arousals: On the diagnostic home sleep test, the arousal index was 43, meaning that approximately 43 times per hour the "surrogate arousal indicators" showed that it was likely you had an EEG arousal, even though there's no EEG data. An arousal is not quite the same a a full wake, but you can loosely think of an arousal as a sudden change from a deeper sleep stage to a lighter one. Most of the arousals on the home sleep test were NOT associated with sleep disordered breathing.
If I can remember quite clearly. My home sleep test was done on my back and without any support to raise my body too far from the mattress. Something that I did the opposite on in the Split and ASV Titration Study. Basically I had two pillows underneath me with one half folded to given me an even bigger boost off the mattress.And I slept mostly on my sides. This is what makes me believe that I have less arousals as compared to the Home Sleep Study. I have self performed raising my body and sleeping on my sides to notice a significant difference in my sleep.
On the ASV titration, there was still a significant number of spontaneous arousals in spite of the ASV treatment (arousal index = 11.something). But on the split test, there were NO spontaneous arousals on either part of the night. And that seems just plain weird.
Not to pick on the sleep technician, but is it possible that he just did not score things properly? Because I find it also weird that I have 0 hypopneas.
5) The sleep architecture seems pretty lousy on the in-lab tests; but it's not as bad on the home sleep test.
Lol I agree. I recall the sleep technician stating that something needed to be updated when I took the ASV Titration Study.
The home sleep test's total sleep time and sleep efficiency were actually pretty good. Now some of the differences could be lab effect---it is more difficult to get to sleep in a strange place.
Yes! On my Split Study, I noticeably had trouble falling asleep because the darn sleep technician coughed every now and then waking me up. I was falling asleep and then I heard his cough which raised my anxiety and woke me up. He definitely had a cold or something. Now, I normally wear earplugs to bed because I am sensitive to noise. I forgot my good earplugs at home but I had some that were a bit above average/average in my car. So while it cancelled out many of the noises, I still heard him cough and I had somewhat anxiety because my mind was racing and replaying things like (Oh no, You do not have your earplugs (the good ones). Your not going to fall asleep. Is that noise that I heard?) Eventually though, I did feel like my anxiety dropped after about an our or two. I normally fall asleep really fast especially at home so I guess I did have a bit on a in-lab effect. I forgot to mention, that during the ASV titration (this is not the study taken with the bad earplugs) it was hot as hell! At least to me it was. I had to take most of the covers off. But by morning I was freezing my ass off
But usually the effect is not going to be as pronounced as it is in your sleep tests. And there's no REM at all on the split study.
6) Recommendations from the sleep studies. While PAP (of some sort) is mentioned on all of the studies' recommendations for treatment, it is NOT the only recommendation. In particular:
  • Home sleep study indicates that the SDB is very mild and appears to be positional. It does say that alternatives to PAP such as an oral device are worth considering. Which raises the question: Did you consider an oral appliance or not?
I considered an oral appliance, yes, but I do not want to rule out CPAP/ASV therapy. I believe that I just need to find which machine to use, and under what pressure.
[*]The ASV study specifically mentions the overall lack of sleep and recommends "Sleep Hygiene Education." Which raises the question: Did anybody ever follow-up and ask you about your sleep hygiene and provide you with some sleep hygiene guidelines?[/list]
I believe that my sleep hygiene is better than 90% of all people (At least in the US).
So where to go from here: You're still feeling miserable, but not as miserable you were:
Correct

And you've commented elsewhere that nights following days when you exercise are much worse in terms of sleep quality than nights following days you don't exercise.
Yes, I have personally tested myself many times doing this.
And you've commented (reasonably I might add) that you don't want to just give up on the exercise routine.
Yes! Exercise is my life. I loved it when I did it.
Which raises the side question: Do you happen to recall if you exercised before any of the sleep tests?
Yes. During both the ASV Titration and Split Study, I did exercise but not too much. It was much more exercise than I usually do. (I usually have zero or near zero forms of exercise (I will not even lift or carry heavy things) every damn day except for the days I masterbate) But compared to other people, it is considered highly minimal. For example, on the ASV Titration Study, I changed all four of my tires and masterbated. And didn't exercise before others??? I do not remember the Home Sleep Study, but I would believe that I might have exercised there too because it was around that time where I actually did exercise like normal people exercise e.g running a mile or two and going to the gym. Overall I purposefully exercised more before the tests because it disrupts my sleep more because maybe it brings me to a more relaxed state when trying to sleep. I did this because I wanted a titration number that is in line with when I exercise, because I plan on exercising until I can no longer. But please note that I do not overexercise. It is weird but I think that since exercise is highly related to deep sleep, that it will trigger more apneas because it makes my throat more relaxed. But who knows?! Right?
Under ideal circumstances, I'd suggest starting over with a full in-lab diagnostic sleep test, preferably on a night that you can sleep. And I'd personally recommend starting over with a different sleep doc and a different sleep center.
Yes. I am willing to do another test, but I need a good sleep center. Are there any good recommendations that you or anyone reading this may have in the northeastern region of New Jersey?
It's just that the sleep tests are all over the place and I think you actually need a proper in-lab diagnostic test based on more than 75 minutes of fractured sleep where it's clear that a large part of the problem on that night was getting to a sound sleep state.
Personally I think it was the low level of the pressure on the Split Study (A starting pressure of 4.0? Really? I am better off breathing without the machine!) in conjunction with the damn coughs in the beginning of my study that showed the low fractured sleep. Also the ASV Titration little sleep because of the high pressure and the warm temperature. When I am at home, I do dream. How do I know? Because I remember having them, and on some rare occasions, on days where I have not had exercised I feel more well rested.
But I also understand that money is tight and that this starting point is probably NOT financially feasible.
Yes I have spent thousands of dollars already and I am still stuck.
I also think you need to be considering the sleep continuity problems as being caused by other things in addition to the SDB that you happen to have. It's important to understand that the CPAP and ASV treat only the SDB issues: they don't fix bad sleep that is bad for other reasons. And since the data you've posted from your ASV machine seems to indicate that whatever SDB you do have is well controlled by the ASV, it's time to start considering other things that you need to address.
Yes, but as someone suggested before, that my ASV data shows a pressure support throughout the data and that it may cause my wakefulness.
A sleep log is one thing that might be useful. Track when you go to bed, when you get up, and estimates of how long you think it took you to fall asleep, how many times you woke up during the night, and how long you think you actually slept during the night. Since you think that exercise makes the sleep worse, you need to track that as well as how you (subjectively) about the sleep each morning.
While this requires effort, I will do. But I can also act on memory because I usually sleep near the same time and it usually does not take long for me to fall asleep. 10-15 minutes most nights. The differences I can draw from exercising vs not exercising is that I wake up many more times when I exercise and notice/wake up from my dreams much more. Usually exercising one day requires for me not to exercise about three days consecutively for me to feel well rested. I have experimented myself in this situation many times and it indeed is true. I definitely also breathe harder during these three days which might mean that I need a higher pressure from my machines because my breathing is too strong for the weak 5.5 EPAP pressure that I have. I notice that usually on the second day and third day after exercise that I feel really tired. This may possibly be because the first night after exercising I am not as terribly sleep deprived that it would take another full night for me to feel its effects, because as I did mention, I feel somewhat okay if I do not exercise for longer than three days.
It could be that you need to pay careful attention to when you exercise. For many people exercising too close to bedtime will make it more difficult to get to sleep and stay asleep. You might also find that too much intense exercise on one particular day is problematic, so you may need to cut back on how much exercise you do at any given time, but increase the number of days per week that you do something.
I exercise on very good times. I have done my research of many things related to exercise and read a great book on the science part of it. I definitely do not do intense exercise anymore, but even a little will disrupt my sleep.
Also look at things like caffeine consumption. We tend to consume more caffeine than we realize and we tend to drink it later in the day than we think---particularly when we're feeling excessively sleepy or tired during the day.
I had Zero caffeine (No chocolate, coffee, soda, tea, etc.) for over two years
And finally, it's worth considering other causes of the daytime sleepiness and fatigue. If it's been a while since you've had a full physical exam, it's time to set one up and have all the usual (non-SDB) suspects for daytime fatigue investigated: Get your thyroid checked and your vitamin levels checked in particular.
I eat very healthy food so my vitamins are definitely good. Better than many people. As for thyroid, I will get that checked too along with a physical exam. But that would have to be after school semester ends in May. In conclusion, I still do think that I need to know what proper settings and machine to use because the ASV has helped me a lot. This raises a question that I have. What is the downside of having a slightly higher CPAP or ASV setting than is needed? Will it cause harm? If so, how and why?

And by the results of these tests, there is no way to tell what machine I should be using under which pressure?

Edit: I would also like to thank for you looking at my data!

_________________
Mask: Quattro™ FX Full Face CPAP Mask with Headgear
Additional Comments: Trying my best to get quality rest. PR System ONE REMstar BiPAP Auto SV Advanced
System One Respironics Bipap AutoSV Advanced Quattro Fx

Min EPAP: 13.0 CmH20
Min Pressure Support: 3.5
Max EPAP: 25.0
Max Pressure Support: 5.0
Max Pressure: 20.0
Flex Setting: Bi-Flex - 3
Backup Rate:Auto
Humidification Mode:off
Humidifier Setting:c5

musculus
Posts: 221
Joined: Tue Feb 26, 2013 8:35 am

Re: HELP AGAIN! ASV or APAP?

Post by musculus » Tue Apr 15, 2014 5:43 pm

Since you cannot sleep very well in labs (you seems to be a very light sleeper and ~2 hours' sleep cannot give you good data), here is a bold suggestion: go to an ENT sleep doctor directly and have your anatomy screened for sleep disturbed breathing risks, e.g., small/recessed lower jaw, large/thick tongue, or long/thick soft palate/uvula. Remind him or her to perform a mueller's maneuver with laryngoscopy (http://en.wikipedia.org/wiki/M%C3%BCller's_maneuver).

For example, Dr. Park (http://doctorstevenpark.com/) at Bronx, NY is not very far from you and he is very good.

You can even check for yourself the Friedman Tongue Score (http://depts.washington.edu/ccor/studie ... 20UPPP.pdf).

And you always have the drug-induced sleep endoscopy as the last resort diagnostic tool.
sleepinow wrote:Hi Cpaptalk community, my name is Mariusz Zoldak and I have been a Cpaper for almost a full year. I have been struggling with money, insurance (I did not have any but recently got medicaid) and my treatment for sleep apnea. I have been researching, reading threads, books, e-books, listening to advice from doctor and forum users, and never have I conquered my strong desire for a therapy that makes me feel like a human should feel. I have only met gradual improvements over a period of a year. Are these significant improvements? Yes, I can actually function well on some days. Am I satisfied by these improvements? No, I cannot stand transitioning going from tired on some days to almost well rested on other days. Here is a picture of me because I felt like posting it. Image Basically I am writing this because I feel like I have little options left from having a potentially good life, to living in a state of hopelessness...

Okay, to start things off, I have a small reserve of money left before I go completely broke. I do not have a huge chunk of time to get the career I want to get. And all I am requesting from any one of you, is your help. (Thanks for all the help that you have given me with my other requests for aid).

I have had four sleep studies/titration studies performed on me in total. In order, I had a home sleep study > An ASV Titration Study > Split Sleep/CPAP Titration Study. If you guys can please look carefully at these studies so you can have an idea of what to do with me.

Here are the results from the home study (The link provides a look at my results from a prior thread topic)

viewtopic.php?f=1&t=94936&st=0&sk=t&sd=a&start=30

Here are the results from my ASV Titration Study

Here are the results from my Split Sleep /CPAP Titration Study


I have removed the images and instead added a link below because it took too long to load


NOTE THAT TWO OF THE EIGHTEEN PAGES IN THIS GALLERY ARE DUPLICATES. Image < New Improved Link

Now I have grown very skeptical and very concerned from the results of the study, the sleep technician performing the studies, and also the Home sleep study. All of them seem to contradict one another. For example, my ASV Titration results were recommended at a MinEPAP of 6.0 and MaxEPAP of 10.0 PSMin of 6.0 and PSMax of 14.0. If I am not mistaken, that is an inspiratory pressure of 12.0. My other two studies recommended a starting pressure of 4.5 for the home study, and a 4.0 with the split CPAP Titration. That is a huge difference compared to the ASV Titration result. My home sleep study found Obstructive Apneas and No Central whilst my split study found mostly Centrals and One Obstructive and for some weird reason 0! Hypopneas on the Split Study. Heres my other issue; the Sleep technician looked extremely exhausted with big puffy dark eye sacs and he even told me so. (Who knows maybe he even has sleep apnea because he was overweight too!) When I asked him what my AHI was after the study he said he doesn't know yet because he has to "manually" score the AHI as opposed to it being automatically done on his reasoning that it would be more accurate. (Also my ASV Titration does not even display any AHI) So my question is WTH is going on with these test results? None of them make any sense to me.

Can anyone tell me what form of therapy I should take?

One last thing, my split study states that my sleep disorder breathing events were "significantly reduced" with a CPAP pressure of 6. (When the hell did CPAP ever eliminate Central Apneas?) So please, with all of this information, I beg for your help! You guys mean so much to me.

_________________
Mask: Quattro™ Air Full Face Mask with Headgear
Additional Comments: sleepyhead

musculus
Posts: 221
Joined: Tue Feb 26, 2013 8:35 am

Re: HELP AGAIN! ASV or APAP?

Post by musculus » Tue Apr 15, 2014 5:53 pm

musculus wrote:Since you cannot sleep very well in labs (you seems to be a very light sleeper and ~2 hours' sleep cannot give you good data), here is a bold suggestion: go to an ENT sleep doctor directly and have your anatomy screened for sleep disturbed breathing risks, e.g., small/recessed lower jaw, large/thick tongue, or long/thick soft palate/uvula. Remind him or her to perform a mueller's maneuver with laryngoscopy (http://en.wikipedia.org/wiki/M%C3%BCller's_maneuver).

For example, Dr. Park (http://doctorstevenpark.com/) at Bronx, NY is not very far from you and he is very good.

You can even check for yourself the Friedman Tongue Score (http://depts.washington.edu/ccor/studie ... 20UPPP.pdf).

And you always have the drug-induced sleep endoscopy as the last resort diagnostic tool.
sleepinow wrote:Hi Cpaptalk community, my name is Mariusz Zoldak and I have been a Cpaper for almost a full year. I have been struggling with money, insurance (I did not have any but recently got medicaid) and my treatment for sleep apnea. I have been researching, reading threads, books, e-books, listening to advice from doctor and forum users, and never have I conquered my strong desire for a therapy that makes me feel like a human should feel. I have only met gradual improvements over a period of a year. Are these significant improvements? Yes, I can actually function well on some days. Am I satisfied by these improvements? No, I cannot stand transitioning going from tired on some days to almost well rested on other days. Here is a picture of me because I felt like posting it. Image Basically I am writing this because I feel like I have little options left from having a potentially good life, to living in a state of hopelessness...

Okay, to start things off, I have a small reserve of money left before I go completely broke. I do not have a huge chunk of time to get the career I want to get. And all I am requesting from any one of you, is your help. (Thanks for all the help that you have given me with my other requests for aid).

I have had four sleep studies/titration studies performed on me in total. In order, I had a home sleep study > An ASV Titration Study > Split Sleep/CPAP Titration Study. If you guys can please look carefully at these studies so you can have an idea of what to do with me.

Here are the results from the home study (The link provides a look at my results from a prior thread topic)

viewtopic.php?f=1&t=94936&st=0&sk=t&sd=a&start=30

Here are the results from my ASV Titration Study

Here are the results from my Split Sleep /CPAP Titration Study


I have removed the images and instead added a link below because it took too long to load


NOTE THAT TWO OF THE EIGHTEEN PAGES IN THIS GALLERY ARE DUPLICATES. Image < New Improved Link

Now I have grown very skeptical and very concerned from the results of the study, the sleep technician performing the studies, and also the Home sleep study. All of them seem to contradict one another. For example, my ASV Titration results were recommended at a MinEPAP of 6.0 and MaxEPAP of 10.0 PSMin of 6.0 and PSMax of 14.0. If I am not mistaken, that is an inspiratory pressure of 12.0. My other two studies recommended a starting pressure of 4.5 for the home study, and a 4.0 with the split CPAP Titration. That is a huge difference compared to the ASV Titration result. My home sleep study found Obstructive Apneas and No Central whilst my split study found mostly Centrals and One Obstructive and for some weird reason 0! Hypopneas on the Split Study. Heres my other issue; the Sleep technician looked extremely exhausted with big puffy dark eye sacs and he even told me so. (Who knows maybe he even has sleep apnea because he was overweight too!) When I asked him what my AHI was after the study he said he doesn't know yet because he has to "manually" score the AHI as opposed to it being automatically done on his reasoning that it would be more accurate. (Also my ASV Titration does not even display any AHI) So my question is WTH is going on with these test results? None of them make any sense to me.

Can anyone tell me what form of therapy I should take?

One last thing, my split study states that my sleep disorder breathing events were "significantly reduced" with a CPAP pressure of 6. (When the hell did CPAP ever eliminate Central Apneas?) So please, with all of this information, I beg for your help! You guys mean so much to me.
Also, I don't know why people say you got arousal index of 43 (that's very poor sleep), all I could see is 43 BPM event with index of 6 in your home study.

_________________
Mask: Quattro™ Air Full Face Mask with Headgear
Additional Comments: sleepyhead

sleepinow
Posts: 457
Joined: Thu Apr 25, 2013 9:40 am

Re: HELP AGAIN! ASV or APAP?

Post by sleepinow » Tue Apr 15, 2014 7:17 pm

Thanks for your suggestion! I will review this information more thoroughly tomorrow since I am stuck at work at this time. If I have any further questions I will send a PM

_________________
Mask: Quattro™ FX Full Face CPAP Mask with Headgear
Additional Comments: Trying my best to get quality rest. PR System ONE REMstar BiPAP Auto SV Advanced
System One Respironics Bipap AutoSV Advanced Quattro Fx

Min EPAP: 13.0 CmH20
Min Pressure Support: 3.5
Max EPAP: 25.0
Max Pressure Support: 5.0
Max Pressure: 20.0
Flex Setting: Bi-Flex - 3
Backup Rate:Auto
Humidification Mode:off
Humidifier Setting:c5

User avatar
robysue
Posts: 7520
Joined: Sat Sep 18, 2010 2:30 pm
Location: Buffalo, NY
Contact:

Re: HELP AGAIN! ASV or APAP?

Post by robysue » Tue Apr 15, 2014 7:23 pm

sleepinow wrote:
On the ASV titration study it is not clear how the settings were arrived at. It appears that the tech started you out with the settings that wound up being the recommended pressure settings
How can you tell? Because I can't. I could have sworn though that the pressure was low in the beginning and increased in time to counter the apneas I was having.
Page 7 of the ASV test lists only ONE set of settings for the ASV titration and the total sleep time at that ONE set of settings is equal to the total sleep time for the whole test back on page 3 of the sleep test. If the tech had reason to change the settings, there would be one line for each set of settings that were tried. Ergo, the tech started you out at the settings that wound up being recommended coming out of this test since no other settings were tried.

Why those particular settings were the starting settings for the ASV titration I don't know. Perhaps someone with ASV experience can say something about how the initial settings on an ASV titration are arrived at.
3) The split test results seem a bit odd. First there's the fact that all but one of the apneas scored are central rather than obstructive, but the diagnosis remains OSA.
I feel the same way about this. I think the sleep technician was too tired to function at that time.
I really don't know how scoring is done, but I was under the impression that the initial scoring of a sleep test is often checked for accuracy after the test is done by going back through the data carefully.
However, when you look at the hypnograph, it's pretty clear that a lot (maybe all?) of those CAs are being scored as you are transitioning to sleep, and perhaps the reason they disappeared during the treatment part of the study is that the addition of the positive air pressure allows your brain to reset the CO2 trigger for respiration more smoothly.
Is it possible to make certain those were Central Apneas from the information given? Or can it be possibly true that the sleep technician mistakenly swapped Obstructive Sleep Apneas with Central Apneas on the First phase of the split study. I ask that because he seemed somewhat ill when I saw him.
It's impossible to tell whether an apnea was scored correctly from just the SUMMARY data, which is what you have. If the full data (all 16 channels of it + the video and audio recordings) are available, someone who knows what they're doing would be able to rescore the test. That's not me 'cause all I am is a math professor.

It may be worth asking the lab to rescore the sleep test on the grounds that the diagnosis and the data don't seem to be consistent. It may also be worth trying to see if the lab will give you the raw data so that you can provide that to another doctor. (Note that when I asked for my raw data on my sleep studies I got no where; the doc's office was simply unwilling to provide it to me in any form whatsoever.)

_________________
Machine: DreamStation BiPAP® Auto Machine
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Additional Comments: PR System DreamStation and Humidifier. Max IPAP = 9, Min EPAP=4, Rise time setting = 3, minPS = 3, maxPS=5

User avatar
robysue
Posts: 7520
Joined: Sat Sep 18, 2010 2:30 pm
Location: Buffalo, NY
Contact:

Re: HELP AGAIN! ASV or APAP?

Post by robysue » Tue Apr 15, 2014 7:36 pm

musculus wrote: Also, I don't know why people say you got arousal index of 43 (that's very poor sleep), all I could see is 43 BPM event with index of 6 in your home study.
Second page of the Home Sleep Study report clearly lists the AROUSALS/HOUR as 43. See the red rectangle in the (edited) version of sleepinow's Home Sleep Study report:
Image
The red rectangle is at the FAR RIGHT of the page by the Pulse Rate with Arousals Indicators graph. That's why sludge and I have pointed out that there are a lot of (non respiratory related) arousals on this home sleep test.

That said, it's true that the home sleep doesn't have an EEG channel. They're using other data to infer when the arousals happened and whether the suspected arousals are related to sleep disordered breathing.

_________________
Machine: DreamStation BiPAP® Auto Machine
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Additional Comments: PR System DreamStation and Humidifier. Max IPAP = 9, Min EPAP=4, Rise time setting = 3, minPS = 3, maxPS=5