finally on ASV 0 AHI but restless

[wilsonintexas]

I finally got my S9 VPAD ADAPT machine yesterday. I spent a few hours on the machine watching TV before I went to sleep...... it really makes sure you are breathing.

Overall results: my AHI was 0..... My 02 moved up from the 90 rang dropping down to 85 up to the 95 rang dropping to 90,, with a few dips to 88..... not bad

I woke up 3 times that I can remember, about normal for me since I started this CPAP adventure 140 days ago.....

My leaks are not to bad at all with 95% around 7.4.....

I can tell when I wake up, because the pressure drops and settles down for a while..... the best example is between around 3:30 - 4:00

I still needed a nuvigil this morning.... will start a thread on that in a few minutes....

My air flow is better, since it never goes top 0 any more. You can certainly tell when the machine is working.... I will wait until this friday and try a sleeping pill and see if I can get rested.
zoomed in on the flow patterns



2-4 when I was awake and it settled down....



thanks for all of the su[pport getting me to this point.
the entire night...

[JohnBFisher]

It appears the ASV therapy will make a big difference for you. It takes time for your body to fully adjust to the therapy. It might take some time before you start to feel more energetic during the day. It may also require some exercise (walks) to get there. But you appear to be off to a good start. Hope things continue well for you!

[MAXDRI]

Hello Wilsonintexas,
I believe there are only a few of us using ResMed S9 VPAP Adapt. I have found out that the names of the machines are tricky. If you put the "Adapt" before VPAP, it is a different machine. I have had mine since the end of June. The doctor let me lower the top pressure, and I haven't reached 20 since then. What are your settings? I have not used Sleepy Head, but I think I will. I put my results into ResMed and it would only let me look at the Summary Graphs, not the Detailed graphs. Have you looked at the daily reports available before noon each day? Some one on this forum helped me find those results, for which I will be forever thankful.

[old64mb]

Glad to see you're finally on SV. It's actually really impressive you made it all the way through the night on the machine on your first night.

Your numbers show what I think is often typical of central-predominant patients in otherwise ok shape - a low base EPAP, but a wildly varying IPAP because the machine has to really crank it up at times to convince you to breathe.

The improvement in SpO2 numbers is a pretty good reflection that the treatment is doing what it is designed to do. I wouldn't worry too much about an 88% nadir unless it ends up being that way for a few minutes in a row, and even then pulmonary types will probably say it's acceptable.

I'd suggest holding off on a sleeping pill for the first week if you can actually get to sleep with the machine without insomnia, which it looks like you did last night. Once you settle down a bit, trying for say 8-9 hours of sleep also might be a good thing rather than the 7:30 you ended up with. You've got (literally) a lifetime of sleep debt to catch up on, and as John and others have pointed out it can also take a while for your body to adapt to the SV.

As you're discovering, Sleepyhead is probably not the best reporting software for an SV device - the pressure line in particular is almost impossible to read. It varies so much during the course of a few minutes that we get an idea of you being at 14 for a while but without the supporting data necessary to figure out why it settled in at that level. Resscan is somewhat better at this if you can get your hands on a copy, although I really wish they had a patient triggered breathing graph the way Encore does.

Anyway, keep it up, good luck, and try to get a week's worth of data!

[The Sheikh]

Wilson,

Congrats on such outstanding results!

I am a believer that an ASV is truly a miracle machine for those of us with centrals, CSR and periodic breathing problems. I have both an Adapt and PR AutoSV Advanced. I love both dearly. My health keeps getting better week after week.

Anyway, your breathing waveforms look quite acceptable - especially your AHI readings, of course, being at zero. Keep looking at the expanded/magnified flow rate to see what's going on in there. I see signs of suppressed hypopneas, but they are harmless now that the machine is correcting your individual breaths.

My AHI is usually at zero too, on the ResMed Adapt. BUT, on the PR AutoSv ASV, I find I have some flow limitation events, a few vibratory snore events and even an ocassional periodic breathing event. These are no worry cuz my O2 stays up above 94% all night. The PR Auto Advanced seems more senstive.

Another parameter NOT reported by the Adapt is the "PTB" or patient triggered breathing. 100% is when you inintiate all breaths. 50% is when the machine initiates 1/2 of your total breaths. A desirable number is 100%, of course, meaning the machine is hardly working. The first night on the PR AutoSV, I used the same pressure settings as the Adapt - and the PTB was only about 76%. I also had some other minor issues. By tweaking the pressures and other numerous PR settings, I was able to get a compromise between good AHI and good PTB. PTB is now about 95% for the night. The point I'm making is that my Adapt wasn't telling me the whole story. I have since transfered these PR tweaks over the the Adapt.

So, don't let AHI alone tell you what's happening. Get a Zeo sleep monitor, Oximeter and see how you feel each day to fine tune the Adapt's data output. As others have found, you may even find that a slightly higher AHI produces a better feeling the next day. It's all about trial and error to tweak it in. There's no way a doctor or DME has the time or interest in tweaking you in like that. You must do it yourself to optimize results.

Again, good job getting the ASV and making it work for you!

BTW, my Adapt pressure numbers worked best with EPAP min at 4 and IPAP breathing peaks at 8. These lowest pressures kept the CSR at its best levels while barely suppressing any OSA.

Tom

[wilsonintexas]

Thanks for the comments, I will try to get my profile updated, but it will have to be later...

My current machine settings are: EPA 6, PSMin 4 PSMax 14... The graph from today looks much like last night. It is obvious when the machine is working and adjusting to what would have been periodic breathing and centrals.... Then there ar the periods where it goes very quiet and stable...... I am pretty sure that these are when I am waking up.....


Second night of 0 ahi, which is fine. At this point I am not as much worried about the ahi, it is obvious that the machine it finally handling them. I really want some good uninterrupted sleep..... I remember waking up once last night. This is an improvement. On BIPAP I was typically waking up at least 3 times that i was aware of, and often it was more.

My problem continues to be sleep disruption,for now I am using nuvigil during the week to be able to function at work.
I am holding off on the sleeping pills until this weekend, in case I have problems waking up.

If I can get up in the morning, I plan to use sleeping pills for 2-3 weeks and then try it without them.. At least that is the plan for now. My sleep DR prescribed 30 of them for me to try. For some reason I like the idea of sleepy pills than wakey pils...... I think it is because I like to solve the root cause, which is I am not sleeping well.... so let's try and fix that.

My copay for the ASV was lower that I was expecting (only 250) so I am going to use the money I had set aside for a zero.

I fully expect that it will take 3-4 months before I adjust to the machine.....

In fact, I am going online to do it now....