ASV RESULTS and Charts - Success!

The Sheikh · Post by **The Sheikh** » Fri Aug 31, 2012 4:18 pm

Hi Folks -

After some initial tough sledding, my AHI has hovered around 0.0- 0.01 the last four nights! The pesky central apneas have been conquered. I feel great!

Some background....

Two months ago I started out with a sleep study showing an AHI of 39 with severe centrals activity. Some centrals were as long as 90 seconds with many lasting 60 seconds. I picked up an APAP S9 Auto and my AHI index doubled on bad nights, mostly all central apneas. Much worse, wrong machine used for OSA problems. See the charts below with the central close ups and full night's central activity.

I then spent my own money (again) and upgraded to a ResMed Adapt AVS machine designed to treat central apnea. The centrals have since dropped to AHI- 0.0 !! and I am tickled pink. However there is still some residual Cheyne-Stokes breathing patterns. I think the Adapt does not have the peak pressure needed to fully counteract certain breath nulls. I realize I have some mask leak issues, but if we look closely, we will see that even when the mask has zero leak, the pressure still flat tops trying to kick-start certain breaths.

John B., I wonder if you, and others, experienced with these charts, could take a look at the statistics on the left? I wonder how the tidal, res rate, minute and all the other parameters look to you. Again, I realize I have mask leak problems and still working on it... so we need to look thru this for now.

Take a look at some close ups and notice the mask pressure flat-tops at 10 or 15, depending on where the IPAP is set. Is SleepyHead's chart range incorrect or is the ASV pressure really being limited at peaks? I was using the prescription settings as recommended by the doctor.

Also, take a look at one of the hyponeas pictured. This shows a few breaths that are barely moving, even at full ASV mask pressure. BTW, I would have gladly accepted a few of those "H" designations compared to the centrals I normally have. Take a look at some of the long centrals before ASV! They are gaggers for sure.

All in all, I am so happy to be able to fall asleep now without worrying about suffocating. I can now sleep on my back, in the same position for most of the night and for the last few nights only got up only 1 time. I feel excellent during the day, more energy, etc etc. This is amazing to me even at this early stage in the treatment. I consider it a success so far.

The IPAPmin and PS min are at 3cm and 5 cm (minimum) and the IPAP max at 16 (max) From experimentation, the Cheyne-Stokes is lowest using the least minimum pressures.

Opinions?

Tom

Charts to follow...

The Sheikh · Post by **The Sheikh** » Fri Aug 31, 2012 4:20 pm

** Here is the S9 Auto before the ASV arrived. Notice the severe apneas. Notice that lower pressure seems to improve the centrals as expected. A CPAP was the wrong machine for me.

Here is a closeup sample of some LONG central apneas:

Now, the best night yet - this was last night, 7 hours, on the ASV... AHI = 0.0 - success! Finally, RESTFUL SLEEP with just ONE interruption

The ASV - notice the pressure flat topping while trying to restart the breathing - signs of some residual Cheyne- Stokes breathing, but almost canceled out, but not quite. ** Is this real mask pressure flat-topping or is SleepyHead having a chart vertical range problem?

Using ASV in stable, deeper sleep. Notice the smooth breathing. IS it too shallow?

The ASV working hard to stabilize the breathing. This sleep area would normally be FILLED with centrals and Cheynes-Stokes patterns without ASV:

greatunclebill · Post by **greatunclebill** » Fri Aug 31, 2012 4:27 pm

you can't upload here. you need to upload at an upload place and post the links here.

Pugsy · Post by **Pugsy** » Fri Aug 31, 2012 4:29 pm

Don't know about png images but I think that they are similar to jpeg files but larger.
This is how I do the posting of images...

Open the image to full size so it is easily read.
I use Vista snipping tool to create a screen shot and crop the image at the same time.
Prt/scr key will also take a screen shot if using XP. If laptop is used sometimes the Fn key has to be pushed at the same time as the prt/scr key
I think windows 7 Home Premium has the snipping tool, Basic may not.
Once the screen shot is created save it in jpg format.

Upload the image to a host site. I use Photobucket it is free, there are others.
Once the image is uploaded then copy the ENTIRE IMG address. Be sure to include the opening and closing IMG in brackets. Paste that copied address into a post here.
If you want to use Photobucket they provide a box with the various url addresses and you just choose the last one in the box.
Copy/paste that last line url address into the body of your post. You see it in code until you preview or submit the message.
Use the preview button. If you can't see the image try again because if you can't see it we can't.

The Sheikh · Post by **The Sheikh** » Fri Aug 31, 2012 5:55 pm

Thanks Bill and Pugsy. I finally figgered out how to host the pictures.

Tom

Todzo · Post by **Todzo** » Fri Aug 31, 2012 6:50 pm

The Sheikh wrote:Hi Folks -

Some background....

Two months ago I started out with a home sleep study showing an AHI of 39 with severe centrals activity. Some centrals were as long as 90 seconds with many lasting 60 seconds. I picked up an S9 Auto and my AHI doubled on bad nights, mostly all centrals. Much worse. See the charts below with the central close ups and full night's central activity.

I then spent my own $ (again) and upgraded to a ResMed Adapt AVS machine. The centrals have since dropped to AHI- 0.0 !! and I am tickled pink. However there is still some residual Cheyne-Stokes breathing patterns. I think the Adapt does not have the peak pressure needed to fully counteract certain breath nulls. I realize I have some mask leak issues, but if we look closely, we will see that even when the mask has zero leak, the pressure still flat tops trying to kick-start certain breaths.

John B., I wonder if you, and others, experienced with these charts, could take a look at the statistics on the left? I wonder how the tidal, res rate, minute and all the other parameters look to you. Again, I realize I have mask leak problems and still working on it... so we need to look thru this for now.

Take a look at some close ups and notice the mask pressure flat-tops at 10 or 15, depending on where the IPAP is set. Is SleepyHead's chart range incorrect or is the ASV pressure really being limited at peaks?

A good friend (you know who you are - thanks!) is sending me a PR System one SV advanced ASV- so I will be able to ramp up the pressure to 25 cm to see what it does. I also need to tinker with the breathing rate to slow it down - the Adapt does not have this adjustment... sigh.

Also, take a look at one of the hyponeas pictured. This shows a few breaths that are barely moving, even at full ASV mask pressure. BTW, I would have gladly accepted a few of those "H" designations compared to the centrals I normally have. Take a look at some of the long centrals before ASV! They are gaggers for sure.

All in all, I am so happy to be able to fall asleep now without worrying about suffocating. I can now sleep on my back, in the same position for most of the night and for the last few nights only got up only 1 time. I feel excellent during the day, more energy, etc etc. This is amazing to me even at this early stage in the treatment. I consider it a success so far.

The IPAPmin and PS min are at 3cm and 5 cm (minimum) and the IPAP max at 16 (max) From experimentation, the Cheyne-Stokes is lowest using the least minimum pressures.

Opinions?

Tom

Charts to follow...

Hi Tom,

You have some of the most unstable breathing I have seen!

High pressure can cause you to "stroke out" - probably not something to play with at all!!!

In many labs they go to the more complex machines when the pressure goes above 15 to reduce the tendency to have unstable breathing. What happens if you reduce the max pressure to 15?

I think that any adjustment you make - espicially if it is in a good direction so your body is healing - will take some time to get used to - and - over time will change your body so tends to become no longer valad as time goes by. In my case extra stress and weight gain caused a need for an increase in pressure - now - with stress and weight reduced - and with a body ten years older than with the original sleep study - I am finding myself taking the pressure down, down, down - in steps at least two weeks apart and carefully considering each day and my daytime feel before deciding to try the next setting. This should be a very, very, slow tritration process. FWIW each step reduced both AHI and periodic / unstable breathing. I also remain committed to working toward my 10,000 steps a day (now with interval training sets using my local hills) eating half veggies, and reducing stress which seems to be the most important thing to do.

What I try to do for the "long term" is find a setting that is close and then use lifestyle to keep my body so the setting continues to work well.

FWIW

Todzo

The Sheikh · Post by **The Sheikh** » Fri Aug 31, 2012 7:13 pm

Todzo wrote:[I think that any adjustment you make - espicially if it is in a good direction so your body is healing - will take some time to get used to - and - over time will change your body so tends to become no longer valad as time goes by.
Todzo

Hi Todzo,

Looks like you are making some good progress there! Yes, it does take a lot of work to get optimum results. I see some folks here very focused and it is well worth it.

Yes, my breathing pattern was not ideal and we needed some extra effort to get it right. But now, with the ASV machine, it is quite regular compared to the "normal" person.

Well, eventually, I'd like to ramp down the pressure in small increments and see how low I can go without disturbing the excellent results I'm getting presently. My ASV machine normally operates at very low pressure, like 3-4 cm/H2O until an apnea occurs or it needs to reinforce breathing. It changes pressure at a breathing rate, up and down. If I stop breathing (central) it will almost instantaneously deliver a pulse of air and slowly increase it until the lungs start breathing again. Unlike a CPAP, the ASV maps out our breathing and tries to keep the same rhythm into the future. It is a brilliant idea and matched my needs like a glove. Right now I don't miss a single breath all night (I have checked breath by breath) and my health is quickly getting back to peak. It's amazing to me considering there are no meds or surgery involved. ASV is not a solution for everyone, cuz most folks have obstructive apnea. I have mainly central apnea and the ASV is tailor made for us...

Considering AVS technology has not been around that long, I consider myself extremely fortunate to have one.

Tom

Todzo · Post by **Todzo** » Sat Sep 01, 2012 6:26 am

The Sheikh wrote:
Todzo wrote:[I think that any adjustment you make - espicially if it is in a good direction so your body is healing - will take some time to get used to - and - over time will change your body so tends to become no longer valad as time goes by.
Todzo
Hi Todzo,

Looks like you are making some good progress there! Yes, it does take a lot of work to get optimum results. I see some folks here very focused and it is well worth it.

Yes, my breathing pattern was not ideal and we needed some extra effort to get it right. But now, with the ASV machine, it is quite regular compared to the "normal" person.

Well, eventually, I'd like to ramp down the pressure in small increments and see how low I can go without disturbing the excellent results I'm getting presently. My ASV machine normally operates at very low pressure, like 3-4 cm/H2O until an apnea occurs or it needs to reinforce breathing. It changes pressure at a breathing rate, up and down. If I stop breathing (central) it will almost instantaneously deliver a pulse of air and slowly increase it until the lungs start breathing again. Unlike a CPAP, the ASV maps out our breathing and tries to keep the same rhythm into the future. It is a brilliant idea and matched my needs like a glove. Right now I don't miss a single breath all night (I have checked breath by breath) and my health is quickly getting back to peak. It's amazing to me considering there are no meds or surgery involved. ASV is not a solution for everyone, cuz most folks have obstructive apnea. I have mainly central apnea and the ASV is tailor made for us...

Considering AVS technology has not been around that long, I consider myself extremely fortunate to have one.

Tom

your data is simply unbelievable

JohnBFisher · Post by **JohnBFisher** » Sat Sep 01, 2012 8:33 am

Todzo wrote:... You have some of the most unstable breathing I have seen! ...

Well, feast your eyes:

Okay. Admittedly this was during a really, really bad night. Fortunately, I don't get them all that often.

But I also posted this to answer the question ... What about when you barely breathe? The point is that the machine DOES step in and support a minimal amount of respiration. It's not a true ventilator. However, it does allow enough respiration to occur to break the cycle of undershoot / overshoot during central apnea episodes.

The leaks are a real issue with ASV units. Most of us with ASV units find that we need to (a) use a full face mask, mouth leaks will occur over 15cm H2O, (b) maintain a clean face mask, (c) for guys, shaving is essential, (d) clean our faces before using wearing the mask, (e) use mask liners if all else fails, and (f) change the mask cushion MUCH more frequently than with other units (once a month is ideal).

And sometimes you just have to struggle with it. I have some nights that are quite difficult. But other nights I sleep like a baby. Still, the good nights seem to far outweigh the bad nights.

As to the statistics from your unit .. I really don't see anything that jumps out at me. It's clear from the numbers that your issue is not obstructive. The low EPAP pressure seems to work fairly well. The much higher IPAP indicates the machine intervenes pretty regularly. When looking at the numbers use the 95% column to get a good idea of your needs. If you make any adjustments, you don't want to set your maximum to less than that value.

But the good news is the therapy is making a difference for you. Hope that trend continues!

The Sheikh · Post by **The Sheikh** » Sat Sep 01, 2012 9:08 am

JohnBFisher wrote:
Todzo wrote:... You have some of the most unstable breathing I have seen! ...
Well, feast your eyes:

Okay. Admittedly this was during a really, really bad night. Fortunately, I don't get them all that often.

But I also posted this to answer the question ... What about when you barely breathe? The point is that the machine DOES step in and support a minimal amount of respiration. It's not a true ventilator. However, it does allow enough respiration to occur to break the cycle of undershoot / overshoot during central apnea episodes.

But the good news is the therapy is making a difference for you. Hope that trend continues!

Hi John,

Man, you sure got that machine working hard at times!.... I see your C-S breathing peaks are more pronounced than mine and the machine backs way off as it should. Very dynamic control.

Thanks for the look-over of my statistics. Guess I will continue to run it as-is for a while. I don't mind the high peak pressures at times. They seem to happen during normal falling asleep times when the centrals normally wreak havoc. Otherwise, it's a smooth 4-8 cm cycle of breahing most of the time. I will take your mask-leak suggestions to heart.

Now I got a new problem which I will post in a different thread. Getting a sour smell out of the machine - even after thoughly washing the mask and hose, etc. Feeling slight congestion from it. Might have to send it back.... sigh. Please see the new thread and comment, John.

Thanks.

Tom

Xney · Post by **Xney** » Sat Sep 01, 2012 2:42 pm

Just wanted to say, John, that's some of the craziest breathing pattern I've ever seen!

The Sheikh · Post by **The Sheikh** » Sun Sep 02, 2012 9:23 am

Just to keep updated...

I think it's good to post good results in addition to poor results. The bad results can get us help and the good results can encourage us all to keep striving.

I want to report that according to SleepyHead, last night, and now for five straight nights, I have had almost ZERO apneas with an AHI score of 0.0 each night. (Actually one night showed 0.27 before tweaking the pressure) By bringing down the minimum ASV pressure and keeping the maximum at full, this has tweaked in the adjustments. I am finished with adjustments on the ResMed Adapt for now.

I plan to start a new thread that will take the next step. How do we measure and improve our sleep arousal index? I have reduced the sleep "wake-ups" by at least 80% so far, but how do we refine this more?

Sleep arousal thread:
viewtopic/t81678/Sleep-Arousals--how-to ... prove.html

Tom

archangle · Post by **archangle** » Sun Sep 02, 2012 10:33 pm

The Sheikh wrote:** Here is the S9 Auto before the ASV arrived. Notice the severe apneas. Notice that lower pressure seems to improve the centrals as expected. A CPAP was the wrong machine for me.

Something seems to be wrong with your data display there. Maybe some sort of SleepyHead glitch.

The flow rate waveform has to be centered around 0. The data is filtered by the machine to average out airflow and the average has to be zero.

By the way, it's centered around -30, so it's not even the leak rate. Negative numbers indicate airflow into the machine, not leaks.

Maybe there's some sort of data setting I'm not familiar with causing this bias in the data.

However, apart from that offset, it does appear that your new machine is working correctly. It does make me a bit concerned about the data, but I doubt any glitch is going to generate valid looking data like that.

You might want to try ResScan and see if it shows your airflow centered around zero instead of -30 lpm.

The Sheikh · Post by **The Sheikh** » Mon Sep 03, 2012 9:23 am

archangle wrote:However, apart from that offset, it does appear that your new machine is working correctly. It does make me a bit concerned about the data, but I doubt any glitch is going to generate valid looking data like that.

You might want to try ResScan and see if it shows your airflow centered around zero instead of -30 lpm.

Yes, I agree. There is something funky about SleepyHead's scaling on some charts. You pointed out the poor centering on the flow. Also, notice that the mask pressure peaks "flat-top" at 10, even though the statistics say they rise to about 15 or so. When I ran higher ePAP pressure previously, mask pressure then flat-topped at 15 and the statistics showed 19 peak.

But the acid test has been checking overall results with the O2 oximeter. It now stays in the lower to upper 90's all night - whereas before I had some brutal desats.

Also, the AHI reporting seems reasonable, cuz I can simulate apneas by holding my breath, etc., and they show up, as did the first charts with AHI =27 when the S9 auto was in APAP.

But I do have ResMed and will take a close look to compare as you suggested.

Last night was another good night at 0.0 AHI for 8.6 hours... ahhh.... Now it's time to determine the optimum duration for sleeping hours. If I sleep too much, I will occasionally get a migraine 30 minutes after awakening. Used to need 10 hours sleep, but now 7-8 seems optimum. Really pleased so far...

Tom

Pugsy · Post by **Pugsy** » Mon Sep 03, 2012 12:14 pm

The Sheikh wrote:Also, notice that the mask pressure peaks "flat-top" at 10, even though the statistics say they rise to about 15 or so. When I ran higher ePAP pressure previously, mask pressure then flat-topped at 15 and the statistics showed 19 peak.

Not sure why this happens sometimes but you can go into your Preferences/ graphs tab and try raising the upper limit to see if it will show the top number as it should.
I haven't had to do it but a few others have reported success by altering the setting.
Like this..

ASV RESULTS and Charts - Success!

ASV RESULTS and Charts - Success!

Re: ASV RESULTS and Charts - new user

Re: ASV RESULTS and Charts - new user

Re: ASV RESULTS and Charts - new user

Re: ASV RESULTS and Charts - new user

Re: ASV RESULTS and Charts - new user

Re: ASV RESULTS and Charts - new user

Re: ASV RESULTS and Charts - new user

Re: ASV RESULTS and Charts - new user

Re: ASV RESULTS and Charts - new user

Re: ASV RESULTS and Charts - Success!

Re: ASV RESULTS and Charts - Success!

Re: ASV RESULTS and Charts - new user

Re: ASV RESULTS and Charts - new user

Re: ASV RESULTS and Charts - Success!