Respironics sv advanced data interpretation Please Help!

[jamadu]

Hello, I was diagnosed with severe OSA back in 2006 via an overnight home study. I was prescribed a cpap machine with a pressure of 16 and have felt terrible for the last 10 years(until now). I talked my VA pulmonary doc into a proper overnight titration study at a facility in order to find out why I was feeling so bad. My request was granted and the sleep study concluded that I needed another sleep study using a bipap instead of cpap. My doctor decided to put me on a Respironics sv auto bipap instead of having another overnight study. I wanted to know if anyone can help me figure out why I keep waking every 15 minutes or so(especially in the early morning hours). I will try to upload a few screenshots of my sleepyhead reports for the last few nights. I tried an experiment last night by turning off the auto BPM setting.
http://imgur.com/a/qSm2v

[Pugsy]

This forum format doesn't support doing attachments. Instead we use screen shots of the reports and put those images on a photo hosting website and the we link/embed the images in our posts.

Thread with some examples and instructions here
viewtopic/t103468/Need-help-with-screen-shots.html

and more detailed instructions for how to use imgur which is a photo hosting website here
https://sleep.tnet.com/reference/tips/imgur

[Sir NoddinOff]

Bump.

[robysue]

I wanted to know if anyone can help me figure out why I keep waking every 15 minutes or so(especially in the early morning hours). I will try to upload a few screenshots of my sleepyhead reports for the last few nights. I tried an experiment last night by turning off the auto BPM setting.
http://imgur.com/a/qSm2v

I'm providing an assist in posting the images of the data for jamadu.

Here's the first image:



The second image:



The third image:



And the fourth and last image:


Finally I'll add this: I'm not an expert at reading ASV data. But for what it's worth, here's my opinion about the data:

The first two images of full night data show that there are a lot of residual hypopneas on both nights. There's also a lot of snoring on the night of May 3, and that's the night it appears you reduced your min EPAP by quite a bit: On April 22, the data shows a min EPAP = 12 and on May 3, the min EPAP = 5. Given the increase in snoring, I think you reduced the min EPAP by way too much.

On both nights, the ASV algorithm is kicking in during the clusters of hypopneas. In other words, the machine is increasing the IPAP quite drastically during the hypopnea clusters in an attempt to normalize the size of the inhalations so that you don't start developing a CO2 undershoot/overshoot cycle. When the hypopneas are tightly clustered, it also appears that the machine is increasing the EPAP pressure in case those hypopneas have an obstructive component to them. This is quite pronounced in the May 3 data when the min EPAP = 5.

The third image seems to be for the full night of data from May 4, but the min EPAP = 7, which is 2cm higher than it was on the night of May 3. The AHI data is great on this night: There are 3 events scored in almost 8 hours of usage. But if you were waking up every 15 minutes or so, that great AHI is not particularly meaningful. The flow rate data shows two big gaps---presumably they are when you turned the machine off and took the mask off for a bit. The pressure and leak graphs are not showing up correctly on this night. And that's a shame. I don't know if it's a SleepyHead bug or if there was some problem the machine had with writing the data to the card. I wonder what this data would look like in Encore Pro or Encore Basic.

The fourth image is a close-up of some data from May 4: It sure looks like periodic breathing, but for some reason, it does not have the usual green background that shows up when a PR machine scores PB. Again, it's not clear if this is a SleepyHead bug or if the data on the card is somehow corrupted. It would also be useful to know just how long this pattern extends in both directions since it's got all the earmarks of classic Cheney-Stokes respiration. One good question is why the middles of the cycles were not flagged as Hs. (There's a tiny breath in the middle of each "apnea" part that is probably just enough to prevent the machine from scoring these things as CAs.)

I have no idea why you're waking up every 15 minutes or so when you're using the PR autoSV advanced machine. There's nothing in this data that screams out "Here is what's triggering the wakes". It is puzzling that the data for May 4 appears to be incomplete. Does the pressure and leak data from May 5 also appear to be incomplete?

[Pugsy]

RobySue....when I was trying the 960 I didn't have any issues with SleepyHead but I know someone who had intermittent issues but none caused an absence of just a couple of graphs...instead just whacko graphs all over the place.
At some settings SleepyHead worked fine and at some settings it didn't and we simply couldn't figure which was what or why. For the whacko times we just relied on Encore Pro. Might need to do that with the May 4th data that I am curious about.

I am also scratching my head as to why the May 4th flow rate didn't earn a PB flag...I can only suppose something was lacking in the flagging criteria or it very well could be related to that known (but not understood) bug with SleepyHead. He's using the newer SH version which I would have thought/hoped would have had that bug resolved but maybe not. Maybe the bug was partially fixed...hence the pressure graph only seeming to be affected and going AWOL.
This may be a situation where it would be helpful to use Encore and see if we get lucky and Pro would still give us the old wave form. I know Encore Basic wouldn't because it isn't the most recent night but sometimes that older wave form is still a choice when using Pro.

Otherwise I think I would continue to use the machine at the settings that appeared to give (at least from what we see here) the best results and that was the May 4th settings. See if SH shows up properly on other nights at those settings.

I don't think having Auto BPM on or off would be the trigger but I suppose it wouldn't be impossible. I don't remember if we ever explored that particular setting when trying to figure out why SH worked well at some settings and not others.

[jamadu]

Thanks for your input. I'm just trying to figure out why I've been miserable for the last 10 years. I've been on an apap until a couple of weeks ago and am new to bipap sv. I'm waking even more frequently than when I was on cpap, but now I'm dreaming like crazy and am waking up several times per night. I do feel better than I have in 10 years but am concerned with more frequent
arousals. I wanted to see if the BPM setting would make a difference in the frequency of the awakenings and when I got up in the morning and checked the info on the machine, it showed an ahi of 17 and pb was 7%. When I downloaded to sleepyhead the Ahi showed a different number. Half the info was missing but when I zoomed into the flow chart it showed the Cheyne Stokes breathing pattern. My recent sleep study was with apap and my doctor decided to change my machine to a bipap sv. Here are some
snaps of my sleep study.
http://i.imgur.com/Xwc7c6s.png
http://i.imgur.com/3K7YuQx.png
http://i.imgur.com/cATpPxU.png

[Pugsy]

To avoid confusion...I have see the sleep study images and commented in OP's other thread that was started before this thread had any real activity.
viewtopic/t111816/Waking-up-every-15-minutes-ASV.html

[Sleeprider]

Jamadu, it's interesting that the two nights have rather comparable results in spite of significantly different minimum EPAP. The increase in snores at the lower EPAP of 5.0 is an indication your over-shot the ideal. I have observed people using ASV with similarly active machine induced breaths, and unresponsive Hypopnea, sometimes improve with a lower minimum PS of 2.0.

If we were to increase min EPAP to about 7.0, and reduce min PS to 2.0, you should see obstructive events resolve a bit, and the pressure support of 2.0 will be reasonably comfortable. The machine will increase IPAP pressure when you fail to take a breath, and that will show as a non-event, or may continue to show up as a Hypopnea, but sometimes it seems the machine initited breaths are more effective, when they contrast with the minimum PS a bit more.

Anyway, that is my suggestion to try. No promises, but I have seen this work for some other members like "Uncle Flapp".

[jamadu]

Hi Sleeprider, thanks for your suggestion! I'm new to the ASV world and am hoping to find that sweet spot someday. I believe I was originally misdiagnosed with obstructive sleep apnea because it seems my apneas are more central than OA. I looked at some of my nights on APAP and noticed that their were very few obstructive events. I tried to convince 3 different doctors that something else was going on and the response was always the same.. "CPAP is the solution" my last pulmanary doctor told me that my Cheyne Stokes breathing could be caused by a slow thyroid.

[jamadu]

Hi Sleeprider, thanks for your suggestion! I'm new to the ASV world and am hoping to find that sweet spot someday. I believe I was originally misdiagnosed with obstructive sleep apnea because it seems my apneas are more central than OA. I looked at some of my nights on APAP and noticed that their were very few obstructive events. I tried to convince 3 different doctors that something else was going on and the response was always the same.. "CPAP is the solution" my last pulmanary doctor told me that my Cheyne Stokes breathing could be caused by a slow thyroid.