Smargie’s Therapy Thread...in Need of ASV Advice

Jas_williams wrote: ↑

Thu Jul 11, 2019 12:03 am

Smargie wrote: ↑

Wed Jul 10, 2019 8:06 am

Last night was very peaceful. No battling with pressure or leaks and I only woke up once to use the bathroom.

I never thought I'd see a chart like this:



I'm starting to think this isn't a fluke.

Well done just ignore ajacks ramblings labs make mistakes all the time. It seems to me they tried Apap in the lab and you had a lot of centrals, so they moved you to asv using the starting pressures as those setup on the APAP rather than a fresh titration on the ASV, that was wrong and the cause of your aerophagia and discomfort.

Smargie did have an ASV titration, min epap 10 min ps 6 max ps 15. the min epap 10 corresponds to the current median epap on the ASV. It is correct. As I said in my first post, they wouldn't have had min-ps6 for no reason, when the default is min-ps3. min-ps6 is also near what the machine is using for median PS, median PS 7. There is more to PS, but it indicates that min-ps3 isn't right. As to reducing the max ps to 8, I'm sure the doctor will set her straight

Smargie should refer back to the doctor, changing the script is a poor idea. The aerophagia needs to be investigated. It may be an inflammation of the sphincter muscle by GERD and treated with medication. It may, like in my case, settle over time by itself. Worst case it could be a growth of the sphincter, it shouldn't be ignored.

I think there is also a positional component that could be looked at. It may lower the used pressures

I don't expect the others to know anything. I thought you would be more aware of how the continuous backup and variable PS works. It is impossible for the machine to record any CSA as a UA. Other resmed bilevels in spontaneous modes, will record CSA as UA

Jas_williams wrote: ↑

Thu Jul 11, 2019 12:03 am

Smargie wrote: ↑

Wed Jul 10, 2019 8:06 am

Last night was very peaceful. No battling with pressure or leaks and I only woke up once to use the bathroom.

I never thought I'd see a chart like this:



I'm starting to think this isn't a fluke.

Well done just ignore ajacks ramblings labs make mistakes all the time. It seems to me they tried Apap in the lab and you had a lot of centrals, so they moved you to asv using the starting pressures as those setup on the APAP rather than a fresh titration on the ASV, that was wrong and the cause of your aerophagia and discomfort.

Another vote to ignore ajack... he rarely knows what's going on, reads lots of papers he doesn't understand, doesn't bother to read threads here, and posts very confusing stuff, and has admitted to posting while drunk.. best to just put him on your foe list and pretend he doesn't exist.

palerider wrote: ↑

Thu Jul 11, 2019 7:20 pm

Another vote to ignore ajack... he rarely knows what's going on, reads lots of papers he doesn't understand, doesn't bother to read threads here, and posts very confusing stuff, and has admitted to posting while drunk.. best to just put him on your foe list and pretend he doesn't exist.

please. slam him for being ignorant, but NOT for "posting while drunk".

alcoholism is a disease, not something to shame someone about.

My advice is and has always been, to go back to the doctor. I haven't suggested any changes from the script. It is the ones on the forum that is giving advice on settings. The blind leading the blind, but please continue.

zonker wrote: ↑

Thu Jul 11, 2019 7:25 pm

palerider wrote: ↑

Thu Jul 11, 2019 7:20 pm

Another vote to ignore ajack... he rarely knows what's going on, reads lots of papers he doesn't understand, doesn't bother to read threads here, and posts very confusing stuff, and has admitted to posting while drunk.. best to just put him on your foe list and pretend he doesn't exist.

please. slam him for being ignorant, but NOT for "posting while drunk".

alcoholism is a disease, not something to shame someone about.

My opinion of palerider is that he is a school yard bully, that never grew up. He gets off here. Pugs and pale are good for apap and perhaps vauto. They quickly get out of their depth after that.

No more personal comments please attacking or about members...that's going off topic and leaning towards another stinky mess.
Stay on topic and cease and desist with the personal stuff. It has no place in this thread and it will derail it and I will remove posts that are more along the personal attack whiny crap.

And yes...it's a judgement call on my part...and I get to make them. It is what it is.

Get back on topic or simply shut up.

ajack wrote: ↑

Thu Jul 11, 2019 7:41 pm

zonker wrote: ↑

Thu Jul 11, 2019 7:25 pm

palerider wrote: ↑

Thu Jul 11, 2019 7:20 pm

Another vote to ignore ajack... he rarely knows what's going on, reads lots of papers he doesn't understand, doesn't bother to read threads here, and posts very confusing stuff, and has admitted to posting while drunk.. best to just put him on your foe list and pretend he doesn't exist.

please. slam him for being ignorant, but NOT for "posting while drunk".

alcoholism is a disease, not something to shame someone about.

My opinion of palerider is that he is a school yard bully, that never grew up. He gets off here. Pugs and pale are good for apap and perhaps vauto. They quickly get out of their depth after that.

step down, please. i was NOT defending you. i was calling attention to something i don't like.

and that is all.

Pugsy wrote: ↑

Thu Jul 11, 2019 7:47 pm

No more personal comments please attacking or about members...that's going off topic and leaning towards another stinky mess.
Stay on topic and cease and desist with the personal stuff. It has no place in this thread and it will derail it and I will remove posts that are more along the personal attack whiny crap.

And yes...it's a judgement call on my part...and I get to make them. It is what it is.

Get back on topic or simply shut up.

i'm sorry, i answered ajack before reading this post.

you are, of course, right.

Wow... I was sick yesterday and spent most of the day sleeping, completely unplugged. A lot seems to have gone on in the past 36 hours!

Since Pugsy checked with Jason, an actual sleep technician, about the minimum PS needed to take care of centrals and he said 10, possibly as low as 8, I'm feeling OK about these settings. I am an anxious person, and when some doubt was posted here it did shake me up a bit. Thank you to all who explained why these settings make sense. If only ResMed would say something definitive about UAs... But there isn't even a category for CAs on OSCAR probably because, as Jas W Points out, ResMed's claim is that this machine won't allow you to have any.

The good news is that my numbers continue to be very good.



Last night I didn't get much sleep because of all the day sleeping, but here is my less than four hour chart.




Seems like there's no longer a need to keep posting these unless something strange comes up. Many, many thanks for making it so that my machine did not end up in the closet!

Smargie wrote: ↑

Fri Jul 12, 2019 10:00 am

Wow... I was sick yesterday and spent most of the day sleeping, completely unplugged. A lot seems to have gone on in the past 36 hours!
<snip>
Seems like there's no longer a need to keep posting these unless something strange comes up. Many, many thanks for making it so that my machine did not end up in the closet!

whooo-hoooo!! wish i hadn't pulled out the tap dancing gif so early cuz i don't have anything better.

this is great news. and yes, please come back and let us know if anything goes wrong. but i'm keeping my fingers crossed that this is a trend.

I had another night of 0.0 and then things started to show up. I gave it a few days to see what would happen, and it seems like I'm now having increases in both hypopneas and centrals. Nothing horrible, but maybe this is a trend and an indication I need to adjust the min EPAP and max pressure?





And for some reason I can't load the 15th, so I'll try in a new post

The clusters that show up right after you have obviously turned the machine back on I bet are awake events getting flagged.
Those won't count. So things aren't quite as "bad" as you might think.
First thing I would look at is why the wake ups to start with....I see several breaks in therapy.

The 2 centrals from this morning happened while I was awake, or at least drowsy, so now I know what the puff of air feels like. It came right out of my mouth! So I'm not sure if they should be counted or not

But a few centrals have slipped by over the past 4 days and the hypops are increasing a little. Is it time to turn one or both settings up, or should I wait a little longer and see what happens?

Wow, you got in there quickly, Pugsy!

I always wake up 2 or 3 times (sometimes even more) per night. I drink a ton of water during the day, much more that my 8 glasses, so I wake up needing to use the bathroom a lot. Also, my husband snores (ironically, I don't) which sometimes wakes me up and I'll need to tell him to turn on his side. If I'm awoken it almost always means a trip to the bathroom. I never sleep the whole night through. I'm also a light sleeper and my daughter woke me this morning by closing her bedroom door a little roughly.

The machine can and will flag awake breathing irregularities as some sort of apnea event.
They don't count though. Only the stuff flagged while asleep matters.

The general rule of thumb for bilevel settings is
EPAP for OAs and IPAP for hyponeas
So what is the easiest way to get more IPAP....you can either add more minimum EPAP or you can add a little more PS (like change from 3 to 4 minimum PS)

I am not so sure that I would go changing anything just yet though. Some of those flags are awake flags and don't count.

Your choice though...you are a big girl now ...just remember....only one change at a time and make it a small change if you do it.
Anything we do to give you more pressure will maybe feed the aerophagia monster.