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

[Jas_williams]

If you can zoom right in on one of the hypopnoeas to see what's happening to the flow and mask pressure at that time it may give me a clue what to suggest it may not

[Smargie]

Jas, here you go. This seems like a "real" one:

ASV H.PNG (69.85 KiB) Viewed 2101 times

How is mask pressure different from other pressures and what does it tell us? I remember you saying that it could be more helpful than flow rate on ASV.

Also, why doesn't EPAP increase after a hypopnea the way IPAP does after a central?

The general rule of thumb for bilevel settings is
EPAP for OAs and IPAP for hyponeas

IPAP isn't for centrals?

[Pugsy]

PS is for centrals. Increased IPAP during PS burst is a byproduct of PS.

One lone anything obstructive is unlikely to trigger the algorithm to increase the minimum pressure. Now if you had several within a certain time frame (we are never told that time frame) or in really close back to back kind of thing...yeah maybe.

Think of your machine doing 2 things separately but at one time.
EPAP and IPAP adjusting as needed for the obstructive stuff per that algorithm. Not much different than it would if you were using a regular auto adjusting bilevel.
Then PS kicks in when centrals pop up. If no central pops ups...PS doesn't kick in with the burst.

[Smargie]

Thanks for explaining that. It sure is complicated...Im going to have to read it over a few more times for it to really sink in. How is an ASV different from other bilevel machines? Why do people use bilevel instead of auto cpap? I think I'm on ASV because of Complex Apnea, but I don't want to assume anything.

[Pugsy]

How is an ASV different from other bilevel machines?

Assuming you mean the regular bilevel machines that are more common...ASV has that back up rate available where PS jumps in and gives you a big breath when you don't initiate a breath on your own...that's the central apnea.
Overall it simply can respond more quickly than the regular bilevel machines. It responds to everything faster.

Why do people use bilevel instead of auto cpap?

Maybe they like more exhale relief than regular cpap/apap machines can offer...maybe they need more pressures than the cpap/apap machine can go to. Maybe they have bad aerophagia and just have to have a wider difference between inhale and exhale just to keep the belly issues tamed.

You are on ASV because the cpap therapy you first started with for your OSA triggered central apneas.
When people have both OSA and central apnea (no matter what the cause) it's called complex sleep apnea.

[idlewire]

Hi Smargie, could you re-post your zoomed chart and start it around 3 minutes before the hypopnea and include Minute Ventilation in the chart.

[Smargie]

Okay... And now maybe I'll get to learn about minute ventilation

ASV Snips.PNG (135.57 KiB) Viewed 2060 times

Is this how you wanted it? I'm not sure what's important to include for ASV anymore (I'm assuming that this Minute Ventilation trace is an exception). I think Jas said to replace the pressure graph with the mask pressure one.

[ajack]

when you are ready, you will see your doctor, you are still being lead down the garden path here.


pugsy, If you read the titration guide, you will find that the ASV is different to normal bpap. You raise the min epap for all obstructive events, including obstructive H. The ipap or max ps is default at 15 and is advised by lanky to set at the max the machine will go to. But why listen to a sleep tech. His opinion on what you are telling this person is "super super dumb"
https://www.youtube.com/watch?v=Jgzudnze0ck

[Pugsy]

Hey ajack....go fly a kite or take a long walk off a short pier...or whatever.
Just STFU please.
I admit I don't know everything.....something you can't seem to understand.
You are on my Foe list...that means I really don't bother reading much of anything you say.

OP is sleeping and feeling great....she can revisit those other pressure settings once she sees her doctor and he evaluates what has happened with the current settings that at least let her get some therapy and some sleep.
She will eventually be seeing him. She needs it for her insurance compliance thing anyway.
My whole thought was to get her to at least sleep with it so the machine wouldn't have ended up in the closet and that's sure where it was heading.

I never told her to never go back to her doctor. Geez.

[Jas_williams]

Okay... And now maybe I'll get to learn about minute ventilation



ASV Snips.PNG



Is this how you wanted it? I'm not sure what's important to include for ASV anymore (I'm assuming that this Minute Ventilation trace is an exception). I think Jas said to replace the pressure graph with the mask pressure one.

That’s one lone Hypopnoea there nothing to worry about and at that time your ASV was not trying to do anything to fix it as the mask pressure line was not at a high pressure as you did a long exhale then a small inhale. Your doing great on your ASV.

[Smargie]

Your doing great on your ASV

Thanks for the feedback and support, Jas.

when you are ready, you will see your doctor, you are still being lead down the garden path here.

I will be seeing my doctor on Monday. The appointment was set up as soon as I got my machine, and it was scheduled to be close to but after at least 30 days of treatment, per insurance requirements. I have no idea how she will feel about my having changed the prescribed setting the way I did, ajack, but if she takes the trouble to review my chart before seeing me, she'll remember that she completely dropped the ball last time, leaving me much worse off than when I came to her for help. I don't think she was surprised that I did my own research and sought advice elsewhere given how awful my numbers were. I'm not going to ignore what she says if she is unhappy about my current settings--I will tell her that making the settings so much higher without warning me that it would be such a drastic change, and one that I might not be able to tolerate, left me in a very difficult position. If it weren't for this forum I would have simply quit the ASV. Not being able to sleep and feeling ill with the pressures prescribed did me no good at all. I don't know why this is impossible for you to understand, and it seems like you are really looking forward to the possibility of my getting a good talking to. Instead of offering solutions (other than "just get used to it"), you've been nothing but the voice of doom and gloom and it has been the opposite of helpful.

[Jay Aitchsee]

Good for you, Smargie. You've made remarkable progress since beginning your therapy and should be an inspiration to others. Don't worry about what your Doctor might think; remember, she works for you as part of your team. I'm sure she will be happy that you took control of your treatment. Keep up the good work and try not to worry about the small stuff.

[palerider]

Hey ajack....go fly a kite or take a long walk off a short pier...or whatever.
Just STFU please.
I admit I don't know everything.....something you can't seem to understand.
You are on my Foe list...that means I really don't bother reading much of anything you say.

OP is sleeping and feeling great....she can revisit those other pressure settings once she sees her doctor and he evaluates what has happened with the current settings that at least let her get some therapy and some sleep.
She will eventually be seeing him. She needs it for her insurance compliance thing anyway.
My whole thought was to get her to at least sleep with it so the machine wouldn't have ended up in the closet and that's sure where it was heading.

I never told her to never go back to her doctor. Geez.

Ajack has such a simple, black and white view of the world, whatever he has read, he thinks is the only way, and doesn't understand the myriad variables involved in actual human beings. To say nothing of how much bad information there is out there.

For example, something that came up the other day with a friend, if you look on the net for "flagyl and alcohol" you'll find that everybody seems to say NO NO NO!, But, if you dig deeper, you can find
https://www.ncbi.nlm.nih.gov/m/pubmed/25223673/ which concludes:
"INTERPRETATION: The warning against simultaneous use of alcohol and metronidazole appear to be based on laboratory experiments and individual case histories in which the reported reactions are equally likely to have been caused by ethanol alone or by adverse effects of metronidazole. Recent research does not confirm a clinically relevant interaction between ethanol and metronidazole."

So, like much of what ajack spouts, the"conventional wisdom" the easily found "information"... is wrong.

Ajack thinks his superficial "knowledge" is somehow the end all and be all of CPAP treatment, but he really is nothing but a fool, that we wish would forget how to use the computer,and this quit making life here more difficult for people correcting his rampant misinformation.

[Smargie]

Good for you, Smargie. You've made remarkable progress since beginning your therapy and should be an inspiration to others. Don't worry about what your Doctor might think; remember, she works for you as part of your team. I'm sure she will be happy that you took control of your treatment. Keep up the good work and try not to worry about the small stuff.

Thank you so much, Jay. You are always supportive and positive and I appreciate that. Also, it's good timing for you to remind me that my doctor works for me, since I'm seeing her soon and the "Uh oh, she's gonna catch me misbehaving" anxiety is starting up again. Hopefully she'll be so impressed by my AHI that she won't even notice how much I've changed the settings. Those settings were actually prescribed by another doctor since she was on vacation when my sleep study report was written. She hasn't handled my case well at all and I don't believe she really has a leg to stand on, but you know how doctors can be. Chances are she won't even have reviewed my chart before seeing me this time again, and will have to play a lot of catch up.

I don't know about me being an inspiration to others, though. I suppose if some future newbies whose treatment becomes complicated have the patience to read these 15 pages (and counting), they would learn that this is a site where (most) others truly want to help you and give great advice. Since being diagnosed with OSA and then CSA I feel like my life has been partly taken over by it, with all of the studying, asking for help on this forum, experimenting, etc. I can't believe how little some sleep doctors prepare you for what's ahead or even hint that the treatment might not start out smoothly.

[babydinosnoreless]

Hi Smargie,

I found this site when I was ready to throw my own bilevel machine out the window. I made the suggested changes from forum members and I sleep so much better now. The reason I am chiming in, is that I too was anxious about my doctors visit. I thought for sure he would be mad. I went in to my doctors appointment, he said your numbers look great I will see you in a year. If he noticed I changed my settings he didn't say a word. I'm not even sure he noticed.