ASV - Feedback on SH Data Please

Ogeo · Post by **Ogeo** » Wed Nov 19, 2014 1:33 pm

I thought I'd post a few nights of my graphs to see if anyone sees anything I should tweak a little. I no longer have to get up at night to use the bathroom. My headaches are gone. I still don't have a lot of energy but it is gradually getting better some days are better than others. My leaks don't look bad but sometimes they wake me up and I have to move the pillows a little (always on my left nostril). I go to sleep on my left side but usually always wake up on my back. I use a chin strap with a hole cut in it and thread it through the mask hose to help hold the mask on my nose. It seems the only way that I've found to keep the mask from flying off with my high pressure. I saw a post of someone reporting the pressure of 18 as being very high pressure. It made me laugh since mine starts at 21.

Some nights I have excessive Timed Breaths - What exactly does that mean as far as my therapy goes?

Anyway, anyone care to comment on my charts?

This one is from a few nights ago. Every so often, more apneas will show up. I'm not concerned with the centrals because both of them were when I was awake. Sometimes I have to turn off the machine and take my mask off and reseat it to stop it from leaking. It is the noise it makes when it leaks that either wakes me up or my hubby.

cnaumann · Post by **cnaumann** » Wed Nov 19, 2014 7:23 pm

I would say everything is looking good.

I would not worry to much about the timed breath index. On auto, the machine tries to match your breathing so if you are a little delayed in taking a breath, the machine will take the initiative. You could switch over to the timed backup rate mode and select a lower rate and you probably would not see as many timed breaths. I don't think it really matters.

I have gone from an index of over 500 timed breaths per hour to 36 timed breaths per hour depending on the back up rate settings. I think that for me, a lower respiration rate is better, my heart rate stays lower and there is no difference in spO2. In that regard, I seem to be having better results using a timed backup rate. I am still struggling to find settings that keep my ahi below 5 constantly. Most of my issue seem to happen in the first hour and a half of sleep.

Ogeo · Post by **Ogeo** » Wed Nov 19, 2014 11:38 pm

Thanks cnaumann for your comments. I'll have to read up on the backup rate.

Pugsy · Post by **Pugsy** » Sat Nov 29, 2014 9:59 am

Ogeo wrote:Some nights I have excessive Timed Breaths - What exactly does that mean as far as my therapy goes?

Beats me but giving your question a bump up and maybe someone will see it that knows what it means.

Is timed breaths explained in the Encore explanation pdf?
EncoreGuide link this will show you examples of what you will see.
http://www.healthcare.philips.com/pwc_h ... _Guide.pdf
I don't see it but I just glanced at it. Generally sometimes SleepyHead reports data points that Encore doesn't and if Encore doesn't show it then I don't know what to make of some stuff. If Encore doesn't report it then I assume that it isn't a critical data point to keep an eye on.

Ogeo · Post by **Ogeo** » Sat Nov 29, 2014 11:02 am

Pugsy, I also checked the Encore Guide and Manual without seeing anything about timed breaths. I was just curious about them.

How do my graphs look? Should I change any settings? I will post some new ones since using the P10 mask. It has drastically changed my pressures. I'm not sure why but my 90% IPAP is closer to 22 instead of 25 since using the P10 on most nights.

Pugsy · Post by **Pugsy** » Sat Nov 29, 2014 11:14 am

I see no need to change any settings. When it comes to ASV therapy I am pretty much of the opinion "if it ain't broke don't go trying to fix it".
How would you rate your sleep quality and how you are feeling in general?

With your current minimum EPAP and your minimum PS your IPAP has to be 21 or there abouts.
That's how come not much movement with min EPAP line because your IPAP max of 25 won't let it move much.
Not a big deal though. Seems to be getting the job done. Part of the reduction in AHI with the new mask might just be a general adjustment to this therapy and might not be related to the mask at all.
When it comes to ASV therapy the "give it time" advice is especially important. Often things settle down on their own without changing anything at all.

Ogeo · Post by **Ogeo** » Sat Nov 29, 2014 12:39 pm

Thanks Pugsy!

Some mornings I wake up very alert and ready to go and some mornings I'm very sluggish. I get aprox an hour less sleep per night while using the machine than before. It's hard for me to judge because I never had some of the same symptoms that are typical of sleep apnea. It was only discovered as a problem when I wasn't responding to asthma medicine. I was tested for sleep apnea as a result of problems breathing in the daytime. They tried asthma medicine then checked my heart and lungs and then allergy testing and a sleep test. I started my allergy shots at the same time as starting on the AutoSV. My lung capacity has increased over the last 3 months but is not yet where it should be. How much is due to the fewer foods I can eat and the allergy shots vs. how much is from the AutoSv is hard for me to tell.

My next step is to get an oximeter to make sure my oxygen level is remaining in the 90's. (It dropped into the 70's during the AutoSv titration) I tried to get my sleep doc to prescribe one but he didn't so my regular doctor said he would if I can't get it otherwise. I need to do some research first to know which one I want and whether my insurance will pay for it.

Thanks again!

sawinglogz · Post by **sawinglogz** » Sat Nov 29, 2014 2:46 pm

Just saw your lament in another thread about not getting much feedback. I'm a fellow ASV user, but I'm not always around.

Your graphs look fairly good. The one thing to work on is the leaking -- whenever your PS starts to go up, you start hitting large leak territory. But it's nothing catastrophic, just something to fiddle with as you acclimate. (Try not to think too much about it or you'll wake yourself up from being hyper-alert.)

I'm a little surprised you're using nasal pillows at your pressures. I think I recall seeing the max rated pressure (at least for the Swift FX) in the manual of 20 cmH2O. I think it's generally OK to cheat that a little bit, but you might consider trying a FFM or nasal mask, if you can tolerate having something over your nose. (I think nasal masks are rated higher; I know FFMs are.)

For nasal leaks on my hybrid, I've found that pulling the pillows to the side a little bit (away from center of the nose) helps me. For some reason when they're dead center, it's easier for air to slide down the side, but when they're a little offset, they leak less. (My big leak issues are usually around my mouth.)

And for patient-triggered-breath percentage, if you have complex apnea, I'd expect to see PTB% drop whenever pressure rises. My percentage averages above 90% per night, usually camping out near 100% most of the night, with crashes down near 0% when the pressure bumps up to avert an apnea.

Ogeo · Post by **Ogeo** » Sat Nov 29, 2014 3:20 pm

Thanks for your response sawinglogz!

sawinglogz wrote:Just saw your lament in another thread about not getting much feedback. I'm a fellow ASV user, but I'm not always around.

Your graphs look fairly good. The one thing to work on is the leaking -- whenever your PS starts to go up, you start hitting large leak territory. But it's nothing catastrophic, just something to fiddle with as you acclimate. (Try not to think too much about it or you'll wake yourself up from being hyper-alert.)
The dotted line on my leak rate is set for my mask I was using. My machine itself has never showed any high leaks so I wasn't too concerned with the 9 to 13% on my 90% leak rate. I don't quite understand all of that yet but I'm learning.

I'm a little surprised you're using nasal pillows at your pressures. I think I recall seeing the max rated pressure (at least for the Swift FX) in the manual of 20 cmH2O. I think it's generally OK to cheat that a little bit, but you might consider trying a FFM or nasal mask, if you can tolerate having something over your nose. (I think nasal masks are rated higher; I know FFMs are.)
I tried 4 different FFM at first and ending up having less sleep while using them than before starting therapy. Both my hubby and I were so tired of being woke up all night with the farting noise of the mask elevating off my face from the high pressure. Thanks goes out to Pugsy for having me try pillows. They have been a life saver. There are a few pillows made for higher pressure, the pilairo Q for one. I loved it cuz it didn't leak but after 3 weeks of usage, the pillow would not stay attached to the frame. I've tried 4 different pillows too. My favorites so far are the Nuance Pro and the P10. With the nuance, I had to use an additional strap to hold it on my face. With the P10 I don't. I get a little leakage early in the morning that wakes me up but none compared with what FFM did to me. And sometimes my hubby taps me on the shoulder if my mouth should part. I usually sleep through that.

The contour of my cheek bone and having narrow set eyes makes using a FFM unwise. They would press on my eyeballs when pressure went up and leak out blowing into my eyes. I already have dry eyes from having lasik surgery so don't need the extra dry eye. I have not tried nasal mask because I think my cheek bone would cause the same problem.

For nasal leaks on my hybrid, I've found that pulling the pillows to the side a little bit (away from center of the nose) helps me. For some reason when they're dead center, it's easier for air to slide down the side, but when they're a little offset, they leak less. (My big leak issues are usually around my mouth.) I will have to check that out and pay more attention. Thanks for the suggestion.

And for patient-triggered-breath percentage, if you have complex apnea, I'd expect to see PTB% drop whenever pressure rises. My percentage averages above 90% per night, usually camping out near 100% most of the night, with crashes down near 0% when the pressure bumps up to avert an apnea.

Thanks again. It is good to know who the ASV users are.

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