Central & Obstructive - AHI always around 10 with ASV. Tweak Settings?>?

metsfan302 wrote: ↑

Tue Feb 05, 2019 7:14 am

ugg, Seems my CMS-50D won’t work / transfer data without using the orig cable it came with. I tried using a diff mini usb to usb and my comp did not see the pulse ox. Going to have to dig deeper or buy another cable.

The 50D+ does not use a USB cable, it uses a cable that *looks* like USB, but has active circuitry in the large end.

Metsfan.... I know this is still an ongoing battle with you, but if you get to the point where the old machine is redundant, I might be interested in it if the price is reasonable. I have the S9 ASV. The model I have does not have auto ASV (if that is right term). I think the 10's all do. I've always wanted to try it.

My machine is 6.5 years old but still works fine....

Tom.... I was def thinking of putting it up in a post for listing. With em being so expensive, I am just unsure what to price it at to be completely honest - Was letting the wife use it, but all's she needs is a auto cpap so i guess I could sell the ASV to get her an Auto Cpap..... I will let you know / give you first right of refusal once I do list it for sale.

Here is a refurb one I found - its $1,699
https://www.1800cpap.com/aircurve-10-as ... med-1.aspx

Well last night was def Better! Going to leave it on this setting for now to see how it continues

Epap - 13
Min PS - 3.0
Max PS - 12.0 (Highest it would let me set it too)
Epap highest it would go adjust wise to in the ASV Mode is still 15

This first screen is my longest stretch of sleep from like midnight till 4ish - Taking just that section and not the entire time period
My AHI shows as only 3.54


The few hr stretch toward the end of the night




The Entire "day"

My sleep dr appt got moved up to tomorrow! Guess we will go over the reports, talk about schedule sleep study and then my upcoming ENT appt.

Hopefully will get this all figured out.

Does a deviated septum effect apnea? How is that surgery?

I'd try even less MinPS...

When I had my septoplasty several years ago, it wasn't bad at all. They used the splints instead of packing my nose with gause. I was actually breathing better with the splints in place than I did before the surgery. Once they took the splints out, I almost hyperventolated. The first time I had ever been able to get that much nose through my nose at one time. I don't know if it had much effect on my apnea, but it sure made it easier to breathe.

Saw Sleep Doc Today, She was pissy I was changing the pressures but anywho -- She bumped up the Epap to 14,   leaving it on ASV mode.    returning in 2 weeks,   review reports then either ASV Tritration to see if other settings would be more optimal.

She did mention if ever needed more Epap it would be thru the Trilogy Ventilator but its super expensive,   but insurance would have to allow if its medically needed.   If I fail on the Trilogy then yea its over lol......   I guess the Trilogy  is more for well my pressures needs ? and end stage COPD -  I do have COPD but not end stage.   Just found out today there are stages lol.

https://www.usa.philips.com/healthcare/ ... ifications

Some of its Specs / Settings
Specifications
IPAP - 50 cm H₂O
CPAP - 4 - 20 cmH20 (passive leak port circuits) cm H₂O
EPAP/PEEP (a) - 0 - 25 cmH20 (active valve circuits) cm H₂O
EPAP/PEEP (b) - 4 - 25 cmH20 (passive leak port circuits) cm H₂O
Pressure support - 0 – 30 cmH2O cm H₂O
Tidal volume - 50 - 2000 ml
Breath rate(a) - 0 - 60 BPM (AC mode) beats per minute
Breath rate(b) - 1 - 60 BPM (all other modes) beats per minute
Inspiratory time - 0.3 - 5.0  -s Synchrony features
Rise time - 1 - 6 (relative scale)
Ramp start pressure (a) - 0 - 25 cmH20 (active circuits) cm H₂O
Ramp start pressure (b) - 4 - 25 cmH20 (passive circuits) cm H₂O
Ramp start pressure (c) - 4 - 19 cmH20 (CPAP mode) cm H₂O
Ramp time - 5 - 45 min
C-Flex - 1 - 3 (relative scale)
Flow trigger sensitivity - 1 - 9 l/min

Well not much change as far as AHI goes with the Adjustment she made to the EPAP in making it 14.

So the Settings are

ASV Mode - non-Auto
EPAP - 14
Min PS - 3.0
MAx PS - 11.0

Think I am getting mask leaks now all of a sudden showing large leak events

She wants me to not touch the settings and see her again in like 10 days.... Ugg -- She said if this did not work she would send me in for the ASV Tritration. Not sure how that is going to help but maybe it will show us some helpful data, who knows. This is getting so frustrating.

I do have an appt with a really good ENT on the 13th - maybe she will be able to see whats up as far as the "flow limitation/ obstruction etc" While I have used the P-10 Pillow Mask for a few years now, I do think I have air flow issues with my nose. I think when I exhale it only feels like air is coming out of one nostril. Maybe its the hole in my septum or i dunno - the sleep doc seems to think that it does not matter I have that as the ASV should take care of that?./ Unsure if switching back to a full face mask I have in the bin would be helpful in all this or if masks dont matter.

I did request a referral to a local pulmonologist, my family dr sent it over along with my records. I am thinking the pulmonologist might be able to see also whats up with my inhale/exhale issues, and also since he I think also deals with sleep medical I will have a second person over seeing my ASV / reports etc. (Might be why my current non-pulmonologist sleep doc has not recommended me going to a pulmonologist).

An Overview of Last Night


My AHI Shoots up fast as I sleep?


Large Leaks and event summary

Have you tried using a full face mask and seeing what happens to those UA events? If you have one laying around, maybe worth a shot.

My wife just reminded me that back in October when I was in the hospital for 2 nights after my Robotic Assisted Vertical Sleeve Gastrectomy, They required me to use my ASV and they ran Oxygen thru it.

I just looked at my sleep reports from those two night, man they are my lowest AHI's Ever! The 2nd night is really fragmented as they kept waking me every hour damn near for one reason or another - taking blood, checking whatever etc

I hope Oxygen is not the missing link with my Therapy......

If different screens are helpful, let me know!

Night 1


Night 2

metsfan302 wrote: ↑

Thu Feb 07, 2019 2:42 pm

Saw Sleep Doc Today, She was pissy I was changing the pressures but anywho -- She bumped up the Epap to 14,   leaving it on ASV mode.    returning in 2 weeks,   review reports then either ASV Tritration to see if other settings would be more optimal.

She did mention if ever needed more Epap it would be thru the Trilogy Ventilator but its super expensive,   but insurance would have to allow if its medically needed.   If I fail on the Trilogy then yea its over lol......   I guess the Trilogy  is more for well my pressures needs ? and end stage COPD -  I do have COPD but not end stage.   Just found out today there are stages lol.

https://www.usa.philips.com/healthcare/ ... ifications

Some of its Specs / Settings
Specifications
IPAP - 50 cm H₂O
CPAP - 4 - 20 cmH20 (passive leak port circuits) cm H₂O
EPAP/PEEP (a) - 0 - 25 cmH20 (active valve circuits) cm H₂O
EPAP/PEEP (b) - 4 - 25 cmH20 (passive leak port circuits) cm H₂O
Pressure support - 0 – 30 cmH2O cm H₂O
Tidal volume - 50 - 2000 ml
Breath rate(a) - 0 - 60 BPM (AC mode) beats per minute
Breath rate(b) - 1 - 60 BPM (all other modes) beats per minute
Inspiratory time - 0.3 - 5.0  -s Synchrony features
Rise time - 1 - 6 (relative scale)
Ramp start pressure (a) - 0 - 25 cmH20 (active circuits) cm H₂O
Ramp start pressure (b) - 4 - 25 cmH20 (passive circuits) cm H₂O
Ramp start pressure (c) - 4 - 19 cmH20 (CPAP mode) cm H₂O
Ramp time - 5 - 45 min
C-Flex - 1 - 3 (relative scale)
Flow trigger sensitivity - 1 - 9 l/min

I think more advanced units were mentioned in this thread.

metsfan302 wrote: ↑

Mon Feb 11, 2019 5:50 am

I hope Oxygen is not the missing link with my Therapy......

Why?

Just don't know if it would be covered by insurance etc..... kind of weird needing it at only 42 years old

metsfan302 wrote: ↑

Mon Feb 11, 2019 1:47 pm

Just don't know if it would be covered by insurance etc..... kind of weird needing it at only 42 years old

O2 is covered, but It would have shown up in your previous titrations, if you needed O2. There are too many variables on the hospital admission to draw conclusions. They may have just got your mask fit right is one thing.