New AutoSV user needs help falling asleep and understanding settings

[cyeh01]

Hi all, I've lurked here on and off since 2018. Thanks to all the amazing contributors to this forum.

I got my Phillips Auto SV a couple days ago and I'm having trouble falling asleep because as many have previously stated, if you're not breathing on the machine's schedule, it feels like being blasted with a fire hose of air.

My current settings are:
Max IPAP 15, Max EPAP 4, Min EPAP 4, PSmax 11, PSmin 0, BPM Auto

I'm specifically trying to reduce my centrals. I have very little to no OA.

The challenge I've found is that a Timed Breath is introduced every 6 seconds. Eyeball average over a month of using a previous machine (CPAP) my median respiratory rate from a previous machine is ~13.5 and the median inspiration time is ~1.3 and median exhalation time is ~2.95. That's 4.25 seconds per breath which leaves about 1.75 seconds margin of error before a timed breath comes in. If you use the median respiratory rate of 13.5BPM, then it's 4.44 seconds per breath which leaves about 1.56 seconds margin of error before a timed breath comes in.

I tested this while awake and looked at the intervals between timed breaths on OSCAR.

Questions:
1. How does the manual BPM settings with the Ti settings affect the timed breath algorithm?
2. Is there any way to lengthen time between timed breaths (especially that first one)? It seems that timed breaths is independent of ramp?
3. What exactly does the manual BPM control because it doesn't seem to affect timed breaths?

Thank you in advance. I truly appreciate all your help and all your knowledge. Cheers!

[LSAT]

What machine were you using before this one? What was your diagnosis that caused you to get the AutoSv? Who prescribed those settings?

[cyeh01]

What machine were you using before this one? What was your diagnosis that caused you to get the AutoSv? Who prescribed those settings?

The last machine I had before this one was the Resmed VAuto. Below is the last study I have records for:

Screen Shot 2020-10-25 at 9.46.44 PM.png (778.17 KiB) Viewed 523 times

Here is an average night of sleep with the VAuto:

Screen Shot 2020-10-25 at 10.07.40 PM.png (236.28 KiB) Viewed 523 times

Pugsy forgive me but I couldn't find the turn off pie chart check box in Preferences>Appearance.

I used the Resmed VAuto for over a month. While the AHI's were generally around 5 and showed very little OA events, I did see a lot of CA events. Throughout the month it looks like I average about 10 minutes spent in apnea per night (I know this metric is not widely accepted as significant). I used to think my CA events were just SWJ but with some events lasting close to a minute at a time, I began to wonder about these events. Here's a 12 minute stretch where I have 3+ minutes of CAs.

ddd.png (69.78 KiB) Viewed 523 times

In short, when I asked the doctor about these CA events he conceded it didn't look good but didn't know what to do about it either really. At this point I pushed for an ASV or AutoSV and he obliged. The settings from my original post are mostly from the clinic though I lowered the PS to 0 to see if I could address the centrals specifically. Yes I'm dial-winging but I would really like to be able to get through a full night with the machine at this point.

I should mention that I had previously chimed in on another member's thread when he echoed nearly every symptom and experience that I had previously endured. I started with a whole body physical that included MRIs of the torso and brain. Nothing life-threatening emerged from the tests. I've been to the neurologist and tried to address the PLM's and bruxism with pills. I've seen several therapists/psychologists when I suspected maybe my mood swings, symptoms of depression and bi-polar disorder, and anger were psychological in nature. I pushed and beat myself up in athletics my whole life because I thought my lack of motivation and my fatigue was because I was lazy and weak-willed. Over the past two years I've developed an arrhythmia with no underlying cause. I've also lost lung function for some odd reason with symptoms akin to COPD even though I exercise regularly and don't smoke or live in a polluted environment. I'm pre-diabetic but every time I check my blood sugar, it's consistent. Pre-meal. Post-meal. No difference. I just run a couple points high. I've done food elimination experiments thinking maybe I was allergic to gluten, eggs, dairy (since those appeared on my IGG tests) to no avail. I thought maybe my gut bacteria was out of whack so I went to see a GI specialist.

I've even had an exorcism performed on me because apparently in a past life I killed 7 scholars out of jealousy when I made their carriage flip over on their way home from my house. Apparently the past-life me was upset that they were smarter than me after they out-debated me over dinner. But I repented for those sins and begged their forgiveness too.

I'm tired every day. I wake up with a dull headache and sometimes nauseous. Most days I have trouble sitting upright or even speaking at audible volumes since so much effort is required to move the diaphragm. I feel like I'm failing my work and worse my children who have to watch me lie on the couch all day unable to partake in their lives to the degree with which they deserve.

Is my issue necessarily central apnea? I don't know. I did try to consciously repeat the 12-minute stretch of CA events while awake and sitting on my bed. It was very difficult since there's no deep breath before or after the events. I did see an SaO2 drop from my little oximeter (which doesn't record), but honestly I couldn't recover from the first 21 second CA event to continue and see how the full 12 minute ordeal would feel. I'll be pairing a Contec oximeter soon to get overnight SaO2 data to see if it any drops coincide with my CA events.

Do I know what I'm doing? No. I have no clue what's going on. But in the absence of a better idea, a better diagnosis, a better medicine, I have no tree left to bark up but this one. Sorry I couldn't answer these questions better. And thank you to anyone who has read this far.

[Pugsy]

Can you post a detailed night report from the ASV machine?
The big picture along with a 5 minute segment zoomed in when you first start the machine and most likely are awake.
Are you ever actually able to sleep with the ASV machine?

As long as I can see the statistics I don't care if the pie chart is visible but if you go update your software with the latest version of OSCAR the pie chart is hidden by default. There's a sticky for download information at the top of the main topics section on the main page.

Per your sleep study...you have OSA but mainly hyponeas. I don't know what to make of the snippet from the ResMed AirCurve VAuto.
I can't see enough of the flow rate to know if you were asleep or not prior to all those centrals.

You are using some really screwy settings on the ASV machine. Essentially making it a fixed EPAP pressure with the ability to increase IPAP for centrals. Unfortunately awake breathing irregularities can and will fool the machine and cause it to respond to those breathing irregularities and likely the main cause of your issues with the pressure but I need to see the pressure graphs to get an idea what is going on.
Fixed EPAP at 4 cm is probably not the best way to deal with hyponeas anyway.