*Both* titrations were a fluke?

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justinjustin
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*Both* titrations were a fluke?

Post by justinjustin » Thu Jul 24, 2014 12:23 pm

Hi everyone,

I think my titrations were totally incorrect. Is this possible?

I've been on ASV for two weeks now after moving from CPAP to APAP to BiPAP, now to ASV. Always using same face mask.
Previously my APAP pressure was 8-12. After my two nights of titrations with Dr. Krakow, My ASV pressure is EPAP 8, PSmin 6, PSmax 14.

Before ASV, I was consistently compliant with xPAP for ~8 hr/night. Now, I am unable to stay asleep for more than 2 hrs on ASV. Usually around 2-3am I wake up and can't get back to sleep unless I stop using the ASV. My average compliance is 20%. I'm also getting aerophagia and feeling completely exhausted in the morning.

The weird thing is that during the titrations in the lab, I slept 8 hours with zero awakenings and has good REM/consolidation. Now, it's a nightmare.

Any ideas?

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robysue
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Re: *Both* titrations were a fluke?

Post by robysue » Thu Jul 24, 2014 1:07 pm

Justin,

If I recall correctly, Krakow's lab is at significant elevation. Do you live at a similar elevation? It may be that the change in elevation may be part (but certainly not all or most) of what's going on.

Also "lab effect" can work in both directions: While most people sleep far worse in a lab, a few people do sleep better. I can't imagine why as someone who has consistently slept far worse on all of my sleep studies, including the four titration studies.

And finally, there is also something qualitatively different about trying to make the equipment work at home in your own bed when there's no professional around and things just plain seem different than they did on the in-lab sleep study.

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Mary Z
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Re: *Both* titrations were a fluke?

Post by Mary Z » Thu Jul 24, 2014 1:31 pm

None of my three titrations were effective at producing a working IPAP/EPAP. If you have a ramp feature enable it when you wake up, perhaps that will make it easier to go back to sleep. Maybe try Tylenol PM if you are not opposed to meds. I gradually tuned my ASV to very narrow changes in pressure by watching my average PS and EPAP over a month and moving the settings closer to the pressures I was using. Makes the ASV seem totally in tune with my breathing. I also have biflex engaged, though I don't use ramp.
Good Luck.

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palerider
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Re: *Both* titrations were a fluke?

Post by palerider » Thu Jul 24, 2014 1:52 pm

justinjustin wrote: I've been on ASV for two weeks now after moving from CPAP to APAP to BiPAP, now to ASV. Always using same face mask.
Previously my APAP pressure was 8-12. After my two nights of titrations with Dr. Krakow, My ASV pressure is EPAP 8, PSmin 6, PSmax 14.

Before ASV, I was consistently compliant with xPAP for ~8 hr/night. Now, I am unable to stay asleep for more than 2 hrs on ASV. Usually around 2-3am I wake up and can't get back to sleep unless I stop using the ASV. My average compliance is 20%. I'm also getting aerophagia and feeling completely exhausted in the morning.
I'm confused, weren't you going round and round with sludge a few days ago about how the asv was the most wonderful thing ever to happen to you, or has my vpap been sucking in paint fumes again?

regardless, are you in asv or autoasv mode? why are you at 6ps? default is 3, maybe it's a bit much for you to handle?

perhaps a lower minepap, or even going to autoasv and letting the machine float with you would help?

(I could swear I typed this out once, must be the paint fumes, or pugsy's aliens stole my post)

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justinjustin
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Re: *Both* titrations were a fluke?

Post by justinjustin » Thu Jul 24, 2014 2:21 pm

palerider wrote:
justinjustin wrote: I've been on ASV for two weeks now after moving from CPAP to APAP to BiPAP, now to ASV. Always using same face mask.
Previously my APAP pressure was 8-12. After my two nights of titrations with Dr. Krakow, My ASV pressure is EPAP 8, PSmin 6, PSmax 14.

Before ASV, I was consistently compliant with xPAP for ~8 hr/night. Now, I am unable to stay asleep for more than 2 hrs on ASV. Usually around 2-3am I wake up and can't get back to sleep unless I stop using the ASV. My average compliance is 20%. I'm also getting aerophagia and feeling completely exhausted in the morning.
I'm confused, weren't you going round and round with sludge a few days ago about how the asv was the most wonderful thing ever to happen to you, or has my vpap been sucking in paint fumes again?

regardless, are you in asv or autoasv mode? why are you at 6ps? default is 3, maybe it's a bit much for you to handle?

perhaps a lower minepap, or even going to autoasv and letting the machine float with you would help?

(I could swear I typed this out once, must be the paint fumes, or pugsy's aliens stole my post)
I wrote earlier that CPAP hasn't worked and using ASV during the titration at Krakow's lab made me feel much better than CPAP ever did. But now I can't seem to use ASV for more than 2 hours when I'm at home, which is frustrating to say the least.

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palerider
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Re: *Both* titrations were a fluke?

Post by palerider » Thu Jul 24, 2014 2:33 pm

justinjustin wrote:
palerider wrote: regardless, are you in asv or autoasv mode? why are you at 6ps? default is 3, maybe it's a bit much for you to handle?

perhaps a lower minepap, or even going to autoasv and letting the machine float with you would help?

?

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Re: *Both* titrations were a fluke?

Post by bwexler » Thu Jul 24, 2014 2:38 pm

I am also on ASV since Oct. my AHI has generally been good even a couple zeros.
I still don't understand how my PRS1 Auto ASV settings are supposed to work. Mine is set amosite wide open. It kept everything under 14 cm for a while, but lately I have been seeing IPAP well over 24 cm. I have been playing musical masks and have currently settled on the Wisp with a chin strap. Which I was using when I hit zero AHI.
When you figure out the puzzle, please post the answers here.

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Bennnyp
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Re: *Both* titrations were a fluke?

Post by Bennnyp » Thu Jul 24, 2014 3:13 pm

I am also on an asv machine since may. when I was on bipap, I would sleep around 8 hours a night with maybe waking up once throughout the night, sometimes I would sleep straight through. I was not feeling better on the bipap and was also having a lot of centrals. I was using sleepyhead, so I went
to my doctor and told him I wanted to do another tritration with an asv machine. When I started with the asv I had a lot of problems with waking up about 3 to 6 times a night during an 8 hour period. This has been very difficult to say the least, but I have stuck with it because I am commited to making this work. My ahi most nights is zero and have never had a night over 1. But I still have not felt better. The machine is doing what it is supposed to be doing. Finally 4 days ago I started feeling better after 2 months of using this. I think my body and brain have just given up fighting my machine. My body was so used to operating in sleep apnea mode that it didn't want to accept that the machine was helping. My advice is that it might get worse before it gets better. I have had a lot of tests done and they can't find anything wrong with me.
I now only wake up once or twice a night. If your using sleepyhead post your data. You can do this. Good luck.

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justinjustin
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Re: *Both* titrations were a fluke?

Post by justinjustin » Thu Jul 24, 2014 3:58 pm

@Bennnyp - thanks for the encouragement; I feel like this is hopeless, so your story helps.

@Palerider - during titrations, the techs felt that I did better on standardsasv. Im at 6ps because they titrated me there. I'm going to drop the max and min ps tonight to see if that helps

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palerider
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Re: *Both* titrations were a fluke?

Post by palerider » Thu Jul 24, 2014 4:04 pm

justinjustin wrote:@Bennnyp - thanks for the encouragement; I feel like this is hopeless, so your story helps.

@Palerider - during titrations, the techs felt that I did better on standardsasv. Im at 6ps because they titrated me there. I'm going to drop the max and min ps tonight to see if that helps
I'd be hesitant to recommend dropping the max ps, if you crank it down, then the asv can't do it's job of powering you through centrals.

I started a friend who has heart failure and csr and compsa on an asv set at defaults, and he did pretty well with it, I later bumped up his min epap to help with ventilation, as well as adding in supplemental o2, he's doing well on it, mainly letting the machine have it's way with him. I don't pretend to be an expert, but the vpap adapt is a pretty smart box.

are you continuing to check your reports in SH or resscan? (I find SH to be easier to read since it's all pretty much on one screen.)

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Re: *Both* titrations were a fluke?

Post by Bennnyp » Thu Jul 24, 2014 4:12 pm

Justinjustin, What are your current settings now. I wouldn't change anything until we know what your current settings are now. Your machine is pretty smart, that's why your on an asv machine. What are your problems right now? Once we know your settings and problems then I think we can help you better. Can you post your charts from sleepy head? What were your rx settings originally?

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Re: *Both* titrations were a fluke?

Post by palerider » Thu Jul 24, 2014 4:48 pm

Bennnyp wrote:Justinjustin, What are your current settings now.
from the first post: My ASV pressure is EPAP 8, PSmin 6, PSmax 14.

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Re: *Both* titrations were a fluke?

Post by Bennnyp » Thu Jul 24, 2014 4:53 pm

Sorry yes I see that now. I meant to ask what his original settings were. I think Justin has changed his settings. I think I remember that from a previous post of mine.

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justinjustin
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Re: *Both* titrations were a fluke?

Post by justinjustin » Thu Jul 24, 2014 8:52 pm

Bennnyp wrote:Sorry yes I see that now. I meant to ask what his original settings were. I think Justin has changed his settings. I think I remember that from a previous post of mine.
Originally I was on CPAP 8cm. APAP would go 8 - 11cm. I'm changing my ASV tonight to PSmin 5, PSmax 10, EPAP 8 (unchanged) to see what happens.

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Re: *Both* titrations were a fluke?

Post by Bennnyp » Thu Jul 24, 2014 9:17 pm

What were your original settings when you got your asv? Epap and your ps settings? The reason I ask is my original settings were epap 7 and ps min 3
and ps max 15. I messed around with epap and also ps. I was up to min ps of 6. Thinking I was going in the right direction. I also was up to 10 on epap.
I changed back to original settings and now am finally feeling better. When you were on cpap 8-11 that would be on an asv of 8 epap and min ps 3 and max ps can be up to 17 it will only go that high if it needs to. I'm not a doctor but just trying to help. so really need to know original settings, and data from sleepy head if you have it.

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