ASV user with a couple questions

[Grand-PAP]

Can any of you experience xPAP users provide insight?

For 281 nights, I have used a PR System One BiPAP autoSV Advanced with excellent results. For the past SIX MONTHS I have had the following results:

AHI: .7
Obstructive: .2
Clear Airway: .1
Hypopnea: .4

I am totally comfortable with ASV therapy, the machine, the mask and hose management. I sleep as comfortably as if I were not masked. However, lately I am having TWO ISSUES that confuse me and I hope some of you more experienced users can help me to understand them.

1: Occassional "strange" breathing pattern. Take a look at the first two pics below. The first one is a graph showing 30 minutes of what my Encore graphs look like probably 95% of the evening. The second is a 30 minute graph that is totally confusing to me. Any insight regarding what this might mean?

2: Events WHEN AWAKE. Four times last night, I awoke -- I don't know if the ASV pressure woke me or if I awoke and the machine was pulsing, but I KNOW I was awake, because I was "struggling" to sync my breathing with the machine. I'm lying there and the machine is repeatedly pulsing MAJOR pressure pulses. Finally, I give up and all FOUR TIMES TURNED THE MACHINE OFF. The ASV restarts calculating my breathing pattern and I go back to sleep.

Take a look at the THIRD pic below. At the end of the 2nd line, at about 1:18AM, I am CLEARLY breathing, as a matter of fact as the graph depicts, I am breathing DEEPLY, trying to stop the pulses. I can't stop the pulses, so as with the other three times last night, I turned the ASV off. But, look at the third line, within the next three minutes, I had TWO CAs and one Hypopnea. There is NO WAY I was back asleep that quickly. All three of these events were AFTER I turned the machine off. Occassionally, I might have an event or two just PRIOR to turning the machine off. Again -- I'm POSITIVE I was awake!

I am baffled by this -- all you experienced xPAPers -- any ideas?

(By the way, these results were with a new mask, so that would have no impact.)







NOTE: In response to 4better02, I have posted this pic of the SleephyHead Graph for the same time as the above Encore graph:

[Pugsy]

Second image...wonder if you were in REM sleep??? Though it also looks like a good bit of SWJ (sleep/wake/junk).
How's the time frame for maybe being in a REM stage???

Last image with the 2 CAs and the hyponea and your are dead sure you were awake. You probably were and the machine just recorded a little awake breathing irregularity as an event. You know that these machines can and will flag some awake pauses in breathing as some sort of event. I see it often during the 30 minutes to an hour before I actually get up and turn the machine off.
I lay there thinking about getting up but don't...and see a good bit of events getting flagged when I was awake.

[Nooblakahn]

Aww I hoped these machines would help with that get out of bed feeling. Sorry I don't have any help for you. New to this whole thing and checked in since your s new user of what I believe I will be on shortly. Good luck too you!

[JohnBFisher]

Greetings!

The first graph appears to show a tendency toward a rise and fall in your breathing. It's not so much that the Resscan software thought it was periodic breathing. But it sure looks as if it's headed that way. I would not worry about it, since it may just indicate you had reached deep sleep and had a rise/fall in your respiration rate. (Some periodic breathing is pretty normal).

I also agree that the second graph seems to show breathing during REM state. It's possible you had some REM Behavior Disorder .. that is you were acting out some of your dream. For example, if you were talking in your sleep and/or reacting to your dreams it might cause that type of odd pattern. I tend to see that fairly frequently. But I would not want to rate my sleep as normal, even on good nights.

Finally, in the third graph it appears you were falling asleep. You might not have been asleep, but you were headed there. Why do I think that? You will note that your respiration rate started to slow pretty dramatically. That's often a precursor to falling asleep. Unfortunately, since the machine had been tracking your breathing it would think you were having problems with apneas. I tend to do the same as you when this happens. I take off my mask, make a trip to the bathroom, have some water to wet my mouth and throat .. and start all over again.

Anyway, that's the way I would tend to interpret graphs like that if I had them. Hope that helps.

[Grand-PAP]

Thanks folks! That's helpful.

[mollete]

Second image...wonder if you were in REM sleep??? Though it also looks like a good bit of SWJ (sleep/wake/junk).

Given what's happening in the pressure channel:



"IMHO" that looks like machine chatter, which would make it simply "junk".

[Pugsy]

"IMHO" that looks like machine chatter, which would make it simply "junk".

To be honest that is what my first thought was and why I added the note about it looking a lot like SWJ to me.
But admittedly I have a lot to learn about what junk looks like so I wasn't sure.
Nice normal sleeping..that's real easy to spot on the flow graphs. Other stuff I am just not comfortable with yet.
I am getting a little better at recognizing probable semi awake junk on my own reports. Just not comfortable enough to say with any certainty when viewing someone else's graphs what might be happening when the flow lines look so oddball.
Do you have any reference material (that is simple and easy to understand ) that I could look over that might help clarify what we see in these flow graphs?

[mollete]

Do you have any reference material (that is simple and easy to understand ) that I could look over that might help clarify what we see in these flow graphs?

Still looking, doesn't seem to be a lot out there demonstrating SW or JPJ.

[Bons]

I do the same thing John does: when my ASV "goes rogue" on me and ups the pressure and keeps surging, I turn it off for a second and start over.

And don't forget that the ASV isn't Santa Claus - it doesn't know when you are sleeping and when you are awake. So it thinks you are asleep and reacts accordingly.

My acting out during dreams can really cause the ASV to go nuts - it probably thinks I am dying, when in reality I am thrashing or muttering.

[JohnBFisher]

Bons makes a good point. Some of the "junk" can actually be due to talking in sleep - or when awake. I've seen both in my sleep graphs.

[4betterO2]

2: Events WHEN AWAKE. Four times last night, I awoke -- I don't know if the ASV pressure woke me or if I awoke and the machine was pulsing, but I KNOW I was awake, because I was "struggling" to sync my breathing with the machine. I'm lying there and the machine is repeatedly pulsing MAJOR pressure pulses. Finally, I give up and all FOUR TIMES TURNED THE MACHINE OFF. The ASV restarts calculating my breathing pattern and I go back to sleep.

I'm having the same problem. What is your backup rate RX, and your Ti setting?
As to how they feel to you, are the pressure pulses sudden and unique, or do they come in a group of higher pulses for a while?
Do you have any nose problems right now with your airflow, like sinus problem or congestion, including congestion from cold air? Reduced airflow could trigger the machine to use higher pressure than when your nose is 'OK'.

Seems there are not many people on the forum using the PR ASV, I hope you will indicate yours in your profile or your signature, so other users can see how closely targeted the questions or answers are. It is a very good but also really tricky machine, I have not sorted out or solved the problems I'm having with it.
I have a feeling the PR ASV machine does not work the same as the corresponding Resmed machine, though similar, and we need brand-machine-model-specific info, so I'm following your topic with great interest! Hoping other PR ASV users will pitch in too.

Apart form graphs - Please detail how do you actually feel the bakup/machine-trigggered breaths? I have thought they come in as just 1 IPAP point higher than the "time-surrounding" pressure; I have gottem those normally, but have also gotten sudden overshoots of pressure. Do you feel the major pulses you are talking about are machine-triggered, and does anyone know what pressure they are supposed to use, on the PR ASV, a "shock" pressure close to the max Rx, or, close to the "time-surrounding" pressure?

what Encore version are you using? can you show the actual numeric stats, not just the waves? what was your max IPAP?
Could you try SleepyHead and compare? I found reports are much clearer with SleepyHead.
With SleepyHead I can clearly separate waves for IPAP and EPAP. How come your graph shows only 1 pressure measurement? What is that measurement of, IPAP, EPAP, PS? (Sorry, I'm a newbie)

[JohnBFisher]

... What is your backup rate RX, and your Ti setting? ...

The Resmed ASV units (both the older S7 version and the S9 version) do not have the ability to set a BACKUP RATE or T1 setting. For most people the automatic settings on them suffice. However, if someone needs finer control the PR ASV units provide many more bells and whistles. Even so, in general, I tend to recommend people start with the AUTO setting, since it seems to do the trick for most people. However, there are some members of this forum who breathe VERY slowly, who find that AUTO does not work for them. They then require setting the BACKUP RATE as low as possible.

... As to how they feel to you, are the pressure pulses sudden and unique, or do they come in a group of higher pulses for a while? ...

You know, I've been using xPAP therapy for so long that I never notice the pressure pulses anymore. If I have a central apnea, I will sometimes awaken and notice that the unit is trying to breathe for me. Eventually, I realize it's trying to get me to breathe. But that's about the only thing that I notice anymore.

... Do you have any nose problems right now with your airflow, like sinus problem or congestion, including congestion from cold air? Reduced airflow could trigger the machine to use higher pressure than when your nose is 'OK'. ...

Really good point. Been there and had it happen.

... Seems there are not many people on the forum using the PR ASV, I hope you will indicate yours in your profile or your signature, so other users can see how closely targeted the questions or answers are. It is a very good but also really tricky machine, I have not sorted out or solved the problems I'm having with it. ...

I have both an older S7 Resmed ASV unit and a PR System One AutoSV Advanced unit. One is beside my recliner and the other is beside my bed. So, even if I conk out when reading, I can mask up and drift off to a pleasant sleep.

... I have a feeling the PR ASV machine does not work the same as the corresponding Resmed machine, though similar, and we need brand-machine-model-specific info, so I'm following your topic with great interest! Hoping other PR ASV users will pitch in too. ...

They are a bit different. The best way I have to describe it is that the Resmed unit has a much "tighter" feel in how it follows my breathing. The algorithm is much more aggressive at having me breathe correctly - or what it thinks is correctly. Think of the Resmed unit as having a tight steering of a sports car. The Respironics unit has an algorithm that encourages the patient to breathe on their own. So, it has a far "looser" feel to how it follows your breathing. Though it will start to insist that you breathe, it is far more likely to allow more time to pass before it becomes insistent. Think of the Respironics unit as having the "looser" steering of a luxury car.

In reality, the Respironics unit has FAR more controls that can be tweaked. However, like everything else, it's usually best to take defaults and let the machine do as much as possible. But you can tweak it more than the Resmed unit if you need it.

... Apart form graphs - Please detail how do you actually feel the bakup/machine-trigggered breaths? I have thought they come in as just 1 IPAP point higher than the "time-surrounding" pressure; I have gottem those normally, but have also gotten sudden overshoots of pressure. Do you feel the major pulses you are talking about are machine-triggered, and does anyone know what pressure they are supposed to use, on the PR ASV, a "shock" pressure close to the max Rx, or, close to the "time-surrounding" pressure? ...

It seems to depend on several factors. If I've just stopped breathing (which I do from time to time), the machine will pretty quickly ramp up toward full inhalation pressure (25cm H2O). I will sometimes awaken when this happens. It makes the mask feel as if it is pulsing on my face. An odd feeling, to say the least. There are also small puffs of air that I never feel that test to see if my airway is open. If yes, it knows the apnea is central. If no, then it assumes the apnea is obstructive. The PR ASV unit will adjust the exhalation pressure as needed to fight obstructive apneas.

... what Encore version are you using? can you show the actual numeric stats, not just the waves? what was your max IPAP? ...

I use Encore Basic. It has several report formats including the detailed wave format. My maximum IPAP is 25cm H2O - the maximum for the unit.

... Could you try SleepyHead and compare? I found reports are much clearer with SleepyHead. With SleepyHead I can clearly separate waves for IPAP and EPAP. How come your graph shows only 1 pressure measurement? What is that measurement of, IPAP, EPAP, PS? (Sorry, I'm a newbie)

For some reason, SleepyHead does NOT work with my PR System One AutoSV Advanced unit. So, I only use Encore Basic. And it does not work with my S7 Resmed ASV unit, so I use Resscan for that one. I agree that SleepyHead is a really good tool. It just doesn't work for me - at least the last time I tried it.

Hope all that helps.

[4betterO2]

Thanks for your replies! glad to see another PR ASV user!
Some of my questions were directed to the OP, hope he will reply to them, especially I wanted to see what was the max IPAP he used, the day he had the overshoots of pressure. I can't tell from the graphs since I don't know exactly, what the "pressure channel" shows, in Encore. What is it?

... Apart form graphs - Please detail how do you actually feel the bakup/machine-trigggered breaths? I have thought they come in as just 1 IPAP point higher than the "time-surrounding" pressure; I have gottem those normally, but have also gotten sudden overshoots of pressure. Do you feel the major pulses you are talking about are machine-triggered, and does anyone know what pressure they are supposed to use, on the PR ASV, a "shock" pressure close to the max Rx, or, close to the "time-surrounding" pressure? ...

It seems to depend on several factors. If I've just stopped breathing (which I do from time to time), the machine will pretty quickly ramp up toward full inhalation pressure (25cm H2O)

You are talking about your PR ASV here, not the Resmed, correct? so it would indicate the machine is not sending max pressure shoots for a central, it would start by sending a triggerd breath about the same pressure as you were otherwise using at the time, correct?

For some reason, SleepyHead does NOT work with my PR System One AutoSV Advanced unit

what version are you using? and under what Windows version?
did it load at all, and if so, did you try to import data?
Dit you have the "P-Series" directory in the root of the device (flashdrive reader, HDD, etc.) you were trying to import from?

[JohnBFisher]

...

... Apart form graphs - Please detail how do you actually feel the bakup/machine-trigggered breaths? I have thought they come in as just 1 IPAP point higher than the "time-surrounding" pressure; I have gottem those normally, but have also gotten sudden overshoots of pressure. Do you feel the major pulses you are talking about are machine-triggered, and does anyone know what pressure they are supposed to use, on the PR ASV, a "shock" pressure close to the max Rx, or, close to the "time-surrounding" pressure? ...

It seems to depend on several factors. If I've just stopped breathing (which I do from time to time), the machine will pretty quickly ramp up toward full inhalation pressure (25cm H2O)

You are talking about your PR ASV here, not the Resmed, correct? so it would indicate the machine is not sending max pressure shoots for a central, it would start by sending a triggerd breath about the same pressure as you were otherwise using at the time, correct? ...

Yes. Resmed ramps up right away. The Respironics tries to see if you will breathe on your own, including using a pressure pulse to see if your airway is open. Within a matter of a few (15 or so) seconds both machines will really start to ramp up the pressure. But Respironics takes a little longer ... It has a "looser" feel to how it follows your breathing.

...

For some reason, SleepyHead does NOT work with my PR System One AutoSV Advanced unit

what version are you using? and under what Windows version?
did it load at all, and if so, did you try to import data?
Dit you have the "P-Series" directory in the root of the device (flashdrive reader, HDD, etc.) you were trying to import from? ...

Yup. Now retired, but was a third level computer engineer. (Computer engineers that solved problems for other computer engineers would come to me for help with my area of expertise). I know how to work through most problems. This one just does not want to load into SleepyHead.

[4betterO2]

Yup. Now retired, but was a third level computer engineer. (Computer engineers that solved problems for other computer engineers would come to me for help with my area of expertise). I know how to work through most problems. This one just does not want to load into SleepyHead.

gotcha. But sometimes one needs help from a smaller technical level, for a small problem, due to absent-minded professorness,... that's why I asked the versions' question.
My SleepyHead does load my SD data, though there are bugs in the software and some days show as "no data".
I've read on a post that Encore deletes the data after reading it. I tried Encore Basic and after using it, even though I did not choose to "delete" the data, (I chose "return SD card to user"instead), as I was having trouble importing I did click on something like "restore indices", I wonder what that did? and now, previous data that I could see before in SleepyHead does not show on graphs, although I can clearly see in Windows explorer, that the individual files are there on the SD card... I recopied it anew but still have the same problem.
(Maybe you can help me on that one, what did Encore Basic do? your turn )
Sleepyhead does read the new data that came after trying Encore.