Still struggling with cpap ASV

[otterley]

Hello

I have been under CPAP for 5 years now, 4 years witch Resmed 10 Airsense, and one year with Resmed ASV. Move to ASV was a little success at the beginning compared to normal CPAP, but last weeks my sleep quality has fallen.

Last night my ASV setting were fix epap 9.4, PS min 4.2, PS max 11. I tried auto cpap 8-11 4-10 yesterday with similar results.

Here are the Oscar charts :

https://imgur.com/a/S74aUrE

https://imgur.com/a/q9rjTEh

What do you think ? How can I improve my deep sleep, and avoid fragmentation which is very high.

Thanks a lot
Serge

[musculus]

well, the pressure goes as high as 19cm and it could not fix the flow limitation. You got the best equipments for PAP treatment..

something you can try:
1. try fixed high pressure I/E such as 20/16 cm
2. sleep position control - reduce supine sleep as much as you could
3. weight loss if overweight, though it might not help 100% as thin people could have narrow airways too

[otterley]

what do you mean by such as 20/16 cm, epap fixed 16 and ps min 4 ?

[Nocibur]

what do you mean by such as 20/16 cm, epap fixed 16 and ps min 4 ?

Yeah I'd like to know what that means too.

[Nocibur]

I've been diagnosed with sleep apnea by the end of 2020 when I did polysomnography which showed 27 AHI. No desaturation.

Well that's a neat trick.

IIWY I'd get a hold of the original, complete studies and find out exactly what needs to be fixed.

If anything.

[Nocibur]

I wonder why I sleep so bad. Maybe it is not apnea but depression after all ???
Or Sertraline side effet...

YA THINK!!???

[otterley]

Sorry I am not sure to understand, you mean you want to see my sleep study ? but it's in french

[otterley]

I wonder why I sleep so bad. Maybe it is not apnea but depression after all ???
Or Sertraline side effet...

YA THINK!!???

Of course my anxiety is a problem but I have now Quetiapin drug which works for me.

[otterley]

I've been diagnosed with sleep apnea by the end of 2020 when I did polysomnography which showed 27 AHI. No desaturation.

Well that's a neat trick.

IIWY I'd get a hold of the original, complete studies and find out exactly what needs to be fixed.

If anything.

Here is a IA translation of my last PSG with cpap december 2023, they told me to set EPAP at 12 but finally I got ASV :

Summary of Polysomnography Report for Serge (Recording Date: 14-12-2023)
Patient Information:

Name: Serge
Height: 176 cm
Weight: 78 kg

Sleep Analysis:

Total Sleep Time: 423 minutes out of 548 minutes in bed, resulting in a sleep efficiency of 77% (normal: ≥85%).
Sleep Latency: 0 minutes (normal: ~30 minutes).
Deep Sleep (N3): 59 minutes (14.1% of total sleep time, below normal: 98-100 minutes).
REM Sleep: Latency of 70 minutes (normal: ~50 minutes), comprising 27.8% of total sleep time (normal: 20-25%).
Intra-sleep Wakefulness: 75 minutes (normal: ~40 minutes).
Sleep Fragmentation: 27 micro-arousals per hour (normal: <10/hour).

Respiratory Parameters:

Apnea-Hypopnea Index (AHI): 12 per hour (normal: <5/hour), with 6 per hour in the supine position.
Snoring: Minimal, with 1 event (0 per hour), cumulative duration of 0 minutes (0% of total sleep time).
Oxygen Saturation:

Average: 93%
Minimum: 90%
Awake: 98%
No time spent with SpO2 <90%.
68 desaturations (0 per hour, average amplitude: 3.3%).


Cardiovascular Parameters:

Average Heart Rate: 58 beats/min (standard deviation: 2.6 beats/min).
Range: 51–79 beats/min.

Periodic Limb Movements:

Total: 68 (7 per hour), with 40 during sleep (4 per hour).
Micro-arousals related to limb movements: 4 (1 per hour, normal: <5/hour).

Positional Analysis:

Supine: 0%
Right lateral: 54%
Left lateral: 46%

Conclusion:

Subjective sleep quality reported as fairly good, with one awakening at 00:45.
Polysomnography conducted under fixed CPAP at 10 cm H2O.
Poor sleep efficiency with short sleep duration and frequent intra-sleep awakenings (72 minutes).
Sleep macrostructure shows 4 sleep cycles with multiple wake phases.
Significantly reduced deep sleep, normal REM sleep, and high sleep fragmentation (27 micro-arousals/hour).
Persistent moderate sleep apnea syndrome (SAS) with an AHI of 12/hour under CPAP, alongside numerous flow limitations (total index: 23/hour).
No significant snoring or desaturations below 90%.
Regular sinus heart rhythm, no arousing periodic limb movements.
Increased REM sleep may contribute to fatigue.

Recommendations:

Increase CPAP pressure to 12 cm H2O.
Improve CPAP compliance to address persistent SAS and fatigue.

[musculus]

what do you mean by such as 20/16 cm, epap fixed 16 and ps min 4 ?

sorry, I meant IPAP 20 cm EPAP 16 cm

[musculus]

I wonder why I sleep so bad. Maybe it is not apnea but depression after all ???
Or Sertraline side effet...

YA THINK!!???

usually it's the other way around, poor sleep causes depression like symptoms. Also, the stress will lower the arousal threshold of neurons which makes you more susceptible to RERAs.

[Nocibur]

I wonder why I sleep so bad. Maybe it is not apnea but depression after all ???
Or Sertraline side effet...

YA THINK!!???

usually it's the other way around, poor sleep causes depression like symptoms. Also, the stress will lower the arousal threshold of neurons which makes you more susceptible to RERAs.

Please stop.

[Nocibur]

sleep efficiency of 77% (normal: ≥85%).

Sleep Latency: 0 minutes (normal: ~30 minutes).

REM Sleep: Latency of 70 minutes (normal: ~50 minutes), comprising 27.8% of total sleep time (normal: 20-25%).

Sleep Fragmentation: 27 micro-arousals per hour (normal: <10/hour).

68 desaturations (0 per hour, average amplitude: 3.3%).

Polysomnography conducted under fixed CPAP at 10 cm H2O.

Do you have the original sleep study (without CPAP)?

Do you have the graphs of both (and any other) sleep studies?

What drugs were you on at the time of this study?

Desaturations are confusing. If there were 68 it can't be 0 per hour.

Whose idea was it to start ASV? And what are you basing set parameters on?

How much of this stuff you got:

Excessive daytime sleepiness
The primary symptom of narcolepsy is excessive daytime sleepiness. You may feel tired during the day even though you had a full night’s sleep. This sleepiness is difficult to prevent and may vary over the course of the day. After a brief nap, you may feel alert, but the sleepiness will return after an hour or two.

Hallucinations
Some patients with narcolepsy have vivid sleep-related hallucinations, either when falling asleep or waking up. These hallucinations are usually visions that someone or something is present in your bedroom. It can feel very real and trigger feelings of fear or dread. Other common visions may include being caught in a fire or flying through the air. These experiences are mainly visual, though they may also involve your senses of sound, touch, taste and smell.

Sleep paralysis
You might lose the ability to move and feel paralyzed when you are falling asleep or waking up. This usually lasts a few seconds or minutes. This can be frightening, but it is not associated with an inability to breathe. Sleep paralysis can sometimes be paired with hallucinations, which are especially upsetting.

Fragmented sleep
About half of people with narcolepsy have problems sleeping through the night. You may wake up frequently and have difficulty falling back to sleep.

Memory problems
You may have trouble remembering things that people tell you because you were not fully awake at the time. Memory lapses also happen when sleepiness sets in as you are doing activities that do not require much thought.

Sudden loss in muscle tone (cataplexy)
This only occurs if you have narcolepsy type 1. Cataplexy occurs when you have a sudden episode of muscle weakness that is triggered by a strong emotion. This can happen when you are surprised, elated or even intimate with a partner. You may slur your speech or lose control of your limbs, or you may become completely paralyzed.

Narcolepsy with cataplexy is frequently linked to increased weight, sometimes obesity. Those with narcolepsy may have other psychiatric disorders or precocious puberty. It is possible to have narcolepsy along with another sleep disorder, such as sleep apnea or REM sleep behavior disorder.

[otterley]

Here are my last night Oscar reports with higher pressure, this morning I feel ok. Of course it's not first time, but I am looking for steadiness

screenshot-20250808-082724.png (564.1 KiB) Viewed 1610 times

[otterley]

sleep efficiency of 77% (normal: ≥85%).

Sleep Latency: 0 minutes (normal: ~30 minutes).

REM Sleep: Latency of 70 minutes (normal: ~50 minutes), comprising 27.8% of total sleep time (normal: 20-25%).

Sleep Fragmentation: 27 micro-arousals per hour (normal: <10/hour).

68 desaturations (0 per hour, average amplitude: 3.3%).

Polysomnography conducted under fixed CPAP at 10 cm H2O.

Do you have the original sleep study (without CPAP)?

Do you have the graphs of both (and any other) sleep studies?

What drugs were you on at the time of this study?

Desaturations are confusing. If there were 68 it can't be 0 per hour.

Whose idea was it to start ASV? And what are you basing set parameters on?

How much of this stuff you got:

Excessive daytime sleepiness
The primary symptom of narcolepsy is excessive daytime sleepiness. You may feel tired during the day even though you had a full night’s sleep. This sleepiness is difficult to prevent and may vary over the course of the day. After a brief nap, you may feel alert, but the sleepiness will return after an hour or two.

Hallucinations
Some patients with narcolepsy have vivid sleep-related hallucinations, either when falling asleep or waking up. These hallucinations are usually visions that someone or something is present in your bedroom. It can feel very real and trigger feelings of fear or dread. Other common visions may include being caught in a fire or flying through the air. These experiences are mainly visual, though they may also involve your senses of sound, touch, taste and smell.

Sleep paralysis
You might lose the ability to move and feel paralyzed when you are falling asleep or waking up. This usually lasts a few seconds or minutes. This can be frightening, but it is not associated with an inability to breathe. Sleep paralysis can sometimes be paired with hallucinations, which are especially upsetting.

Fragmented sleep
About half of people with narcolepsy have problems sleeping through the night. You may wake up frequently and have difficulty falling back to sleep.

Memory problems
You may have trouble remembering things that people tell you because you were not fully awake at the time. Memory lapses also happen when sleepiness sets in as you are doing activities that do not require much thought.

Sudden loss in muscle tone (cataplexy)
This only occurs if you have narcolepsy type 1. Cataplexy occurs when you have a sudden episode of muscle weakness that is triggered by a strong emotion. This can happen when you are surprised, elated or even intimate with a partner. You may slur your speech or lose control of your limbs, or you may become completely paralyzed.

Narcolepsy with cataplexy is frequently linked to increased weight, sometimes obesity. Those with narcolepsy may have other psychiatric disorders or precocious puberty. It is possible to have narcolepsy along with another sleep disorder, such as sleep apnea or REM sleep behavior disorder.

No hallucinations
No sleep paralysis
Fragmented sleep viewed on Apple Watch but I don't rembember most of the time
Memory problems of course
No cataplexy

There was an error in translation of PSG, here is the good translation

Sleep Study Report
Patient: Serge
Date of Recording: 14 December 2023
Report Pages: 1/3

Summary of Findings
Apnea-Hypopnea Index (AHI): 12 events/hour

AHI + obstructive events (flow limitations): 20 events/hour

AHI + respiratory events (reductions): 23 events/hour

AHI in supine position: 11 events/hour

Micro-arousal index related to respiratory events: 0/hour

Sleep Architecture
Stage Duration (min) % of TST Apnea Count Apnea Index Hypopnea Count Hypopnea Index
N1 6 1.4% 2 20 2 20
N2 240 56.7% 13 3 43 11
N3 59 14.1% 1 1 3 3
REM 117 27.8% 12 6 12 6

Apnea duration (min / avg sec / max sec):

N1: 1 min / 15 sec / 16 sec

N2: 4 min / 16 sec / 25 sec

N3: 0 min / 21 sec / 21 sec

REM: 3 min / 14 sec / 27 sec

Snoring
Total episodes: 1 (0/hour)

Total duration: 0 minutes (0% of TST)

Average intensity: 93 dB

Oxygen Saturation (SpO₂)
Total desaturations: 68 (9/hour) — threshold 3%, mean drop 3.3%

Minimum / mean / wake SpO₂: 90% / 93% / 98%

Time with SpO₂ < 90%: 0% (0 min)

Time with SpO₂ < 85%: 0% (0 min)

Time with SpO₂ < 80%: 0% (0 min)

Hypoxic burden: 8 %·min/hour

By stage:

Stage Avg SpO₂ (%) Min SpO₂ (%)
N1 93 91
N2 93 90
N3 94 91
REM 93 90

Cardiovascular Parameters
Average heart rate: 58 bpm (SD: 2.6 bpm)

Min / Max heart rate: 51 / 79 bpm

Periodic Limb Movements (PLMs)
Total PLMs (wake + sleep): 68 (7/hour)

PLMs during sleep: 40 (6/hour)

Micro-arousals related to PLMs: 4 (1/hour)

Interpretation
Mild sleep apnea (AHI 12) with increased event frequency when considering additional respiratory events (up to 23/hour).

No significant oxygen desaturation burden (no time below 90% SpO₂).

Sleep architecture shows predominant N2 stage, reduced N3 (deep sleep).

Low snoring frequency but high average intensity when present.

Periodic limb movements present at a mild frequency.