ASV stats 1 week post adjustments

[Artimus60]

Hello all,

I’m hoping to get comments from any of you that have seen a trend in data similar to what my mom has been experiencing following adjustments made by her doctor to her BiPAP autosv advanced machine. She’s been using the machine for about 7 weeks and her AHI rating seemed to be staying up above 30 until the adjustments were made about a week ago ( the doc lowered the EPAP settings from 12-22 to 6-16, and adjusted PS from 3-10 to 5-10 ). The AHI has dropped in as in aggregate ( obstructive apneas + central apneas + hypopneas) but the ratio seems to have changed. Both her obstructive and central apneas have been trending down but this seems to be accompanied by an increase in hypopneas, especially the last couple of nights. Her % of patient assisted breaths also plummeted last night. As you can probably tell, I'm still endeavoring to understand what each of these measurements mean, and how the relate to each other. I’ve included screen shots of data captured using EncoreBasic and a card reader. The first the 3 shots are trend data from the last week and the last 2 are from last night.

Screen Shots of data compiled from 5/23 to 5/29







Screen Shots of last night's stats





If anyone has experienced similar symptoms or seen them in others I'd be interested in hearing about it, especially if they have thoughts on how to improve the situation. Thank you in advance for reading this message and for any thoughts you might have.

Artimus60

[JohnBFisher]

Your obstructive events have dropped pretty dramatically. I think if you excluded the first few days your AHI score would be much more acceptable. This is not all that unusual, since we've seen others tend to exhibit a better set of numbers as they become acclimated to the ASV therapy. So, it might be interesting what the second week (without this first week) looks like.

Additionally, your Patient Triggered Breathing appears low. An experiment for the future might be to try to use AUTO instead of 10 for you Breaths Per Minute (BPM) setting. That allows the unit to better follow your normal breathing pattern.

But don't make any changes for quite a while. Plus you might want to discuss this with your doctor before making changes.

[avi123]

It looks strange to me that your Mom's doc would change pressures, almost willy nilly, based on the data output from her home machine. My Sleep Doc who holds MDs in Internal, Pneumology, and Sleep Medicines, does not trust data from home XPAPs saying that it could be bogus. During the last two years since I know him he would prescribe changes in the settings or machine type change only after a Sleep Study in a Clinic, saying that it's the safest way to do it.

[JohnBFisher]

It looks strange to me that your Mom's doc would change pressures, almost willy nilly, based on the data output from her home machine. My Sleep Doc who holds MDs in Internal, Pneumology, and Sleep Medicines, does not trust data from home XPAPs saying that it could be bogus. During the last two years since I know him he would prescribe changes in the settings or machine type change only after a Sleep Study in a Clinic, saying that it's the safest way to do it.

Perhaps the OP's doctor read and believes the following:

In summary, this study demonstrates that self-titration of CPAP in patients with OSA is as efficacious as manual titration in a sleep laboratory, with similar subjective and objective outcomes, and CPAP compliance. Clearly, for this strategy to be successful, the patient must understand when and how to change the CPAP. ... Nonetheless, the findings from this study imply that routine overnight polysomnography is unnecessary for the purpose of CPAP titration in many patients with OSA, provided that the patient is given some basic education and support.

From the following study:

http://ajrccm.atsjournals.org/content/167/5/716.long

Some doctors are more accepting that by having data in front of patients the patient can then better manage their own therapy. I keep harping on this as a comparison to diabetes. There are a LOT more factors to consider with diabetes. But I don't wait on my doctor to tell me the dosage of insulin that I should take. Rather, my doctor insisted I have some basic training (via a certified diabetes educator), and she follows up my results via testing my hemoglobin A1c on a regular basis. A periodic review by the sleep doctor can accomplish a similar result for the CPAP patient.

Just my two cents into this discussion.

[squid13]

During the last two years since I know him he would prescribe changes in the settings or machine type change only after a Sleep Study in a Clinic, saying that it's the safest way to do it.

Does this Doctor have an interest in the Sleep Clinic? If he does I can see why he believes that way.

[Artimus60]

John,

Thanks again for looking at my mom's data. Sorry for the late reply but I've been away from my pc for most of the week. I just looked at my mom' data for the last couple of days and it would appear that she's headed back in the 'wrong' direction (and I can tell that she's really fatigued). I'll post the most recent stats this afternoon.

artimus60

[deltadave]

It looks strange to me that your Mom's doc would change pressures, almost willy nilly, based on the data output from her home machine. My Sleep Doc who holds MDs in Internal, Pneumology, and Sleep Medicines, does not trust data from home XPAPs saying that it could be bogus. During the last two years since I know him he would prescribe changes in the settings or machine type change only after a Sleep Study in a Clinic, saying that it's the safest way to do it.

Perhaps the OP's doctor read and believes the following:

In summary, this study demonstrates that self-titration of CPAP in patients with OSA is as efficacious as manual titration in a sleep laboratory, with similar subjective and objective outcomes, and CPAP compliance. Clearly, for this strategy to be successful, the patient must understand when and how to change the CPAP. ... Nonetheless, the findings from this study imply that routine overnight polysomnography is unnecessary for the purpose of CPAP titration in many patients with OSA, provided that the patient is given some basic education and support.

From the following study:

http://ajrccm.atsjournals.org/content/167/5/716.long

Great article, John.

However, while there are 55 references to OSA, I don't see even one for CompSAS (although in all fairness, that article is pre-CompSAS discovery).

Some doctors are more accepting that by having data in front of patients the patient can then better manage their own therapy. I keep harping on this as a comparison to diabetes. There are a LOT more factors to consider with diabetes. But I don't wait on my doctor to tell me the dosage of insulin that I should take. Rather, my doctor insisted I have some basic training (via a certified diabetes educator), and she follows up my results via testing my hemoglobin A1c on a regular basis. A periodic review by the sleep doctor can accomplish a similar result for the CPAP patient.

IMHO the comparison to diabetes is not necessarily appropriate. Can patients understand this?

http://care.diabetesjournals.org/conten ... 1/S11.full

For the most part, diabetes treatment is simply an algorithm (if SMBG is this, then do this).

Further, that is born out of necessity. One cannot call up the MD 6 times a day for insulin dosage.

[deltadave]

I keep harping on this as a comparison to diabetes.

IMHO2, I think a better comparison would be to use epilepsy. Can somebody self-titrate without an EEG?

Sure!

Good luck with that!

[JohnBFisher]

DeltaDave, I think you (slightly) misinterpret my intentions. Yes, while the study shows that self titration is possible, you constantly see me advising what I do myself .. work with my doctor. And I offered that article to note that some doctors understand that active involvement by patients can yield surprisingly accurate titrations.

My primary emphasis is to use the data from the machines to bring information to the doctor to consider. And that never replaces the sleep study. Rather, those are tools to help periodically monitor effectiveness of the therapy .. until you do see the doctor and/or need a new sleep study.

Just as a diabetic uses blood glucose monitoring to monitor their own situation and (hopefully) help modify their behavior, the xPAP data can also help monitor the sleep progress and track down some obvious issues .. such as excessive mask leaks. But the periodic blood glucose monitoring does NOT replace the knowledge, experience, or more detailed testing provided by a doctor. Nor does it replace the objectivity that a doctor can provide. I try to find a doctor who will work with me - and not treat me as an idiot - since I insist that I be actively involved in my therapy.

But just as with diabetes, so it's true with sleep. Though I do monitor my sleep numbers, I try very hard to work closely with my doctor. I might bring up a concern that is not one for the doctor. If it does not otherwise impact my health, I will take his advice and not worry about it. However, if my doctor suggests another sleep study to better understand the data I see, then I am certainly open for that.

The key point is that the data (either for diabetes or sleep) help us better manage our therapy .. between the times we see our doctors - not as a replacement for the need to work with our doctors.