First night with ASV, need help interpreting data

[tomma]

Last night was my first night with my new Respironics DS950. My numbers are virtually unchanged, same AHI (12.1), same number of CA's, OA's and Hypopneas. Actually the CA's were higher than normal. I know it's only been one night, but I thought I would see at least a little difference!

Here's my setup:

Max Pressure 25
EPAP Min and Max are both 14
PS Min = 3
PS Max = 10

And here's one of the pages from last night's report:



I think my obstructives and hypops may have been a little lower than when I was on APAP. To keep them that low I had to use the ball in the shirt trick to keep me off my back, I did not do that last night because I wanted to start with a clean slate so to speak. So, those were lower, but the CA's, which is really what I need the machine for are worse.

[old64mb]

You're not running the machine as an ASV, which explains why you're having continued problems.

The backup rate is currently turned off, which is part and parcel of how the ASV deals with central apneas. Other settings can be tweaked later, but for now you need to have the backup rate turned on. I'd suggest setting backup on auto for a few nights to see where you end up before you tweak things further.

[tomma]

Ah, that would do it, wouldn't it......

Wonder why the doctor didn't prescribe it, or if she did, maybe the DME didn't see it when he set the machine up. In any case, I'm new to this whole ASV world, I don't see anything called backup rate, is it the BPM?

Thanks!!

[n0hardmask]

You're not running the machine as an ASV, which explains why you're having continued problems.

The backup rate is currently turned off, which is part and parcel of how the ASV deals with central apneas. Other settings can be tweaked later, but for now you need to have the backup rate turned on. I'd suggest setting backup on auto for a few nights to see where you end up before you tweak things further.

Howdy,
I've been on Resmed ASV for 6 weeks; and one observation is: ONCE you have it operating in ASV mode, it will likely take a few days or week or so for the machine to learn your breathing and begin to treat the CA's. At least that's my (limited) experience. Good luck on your improving treatment, especially those CA's.

[tomma]

Howdy,
I've been on Resmed ASV for 6 weeks; and one observation is: ONCE you have it operating in ASV mode, it will likely take a few days or week or so to learn your breathing and begin to treat the CA's. At least that's my (limited) experience. Good luck on your improving treatment, especially those CA's.

Understood. I'm at least used to having the mask on since I've been using APAP for around 3 months, so maybe that will help. I'll find out soon!

[old64mb]

Wonder why the doctor didn't prescribe it, or if she did, maybe the DME didn't see it when he set the machine up.

Got me. If you can get a copy of the original script you can find out.

Yes, BPM to 'auto' is the right setting.

[Sir NoddinOff]

Interesting thread, please keep us updated and also try to find out why your sleep doc dropped the ball so badly

[tomma]

So, after setting the backup rate to auto, last night was much better. The CA's were much, much lower, but there's still a bunch of hypopneas.



Am I reading the ' Avg % of patient triggered breaths' correctly, I breathed on my own only 40% of the night? Wow

Suggestions for getting the H's under control?

Have to wonder why I had a $4,000 titration study only to set the thing up myself. This whole 'industry' is a mess.

[Grand-PAP]

.

[old64mb]

I wouldn't worry too much about trying to get your numbers down for a few weeks.

Think of it this way: this is the first night in however many years where your body has actually gotten adequate oxygen while sleeping, since you've never had the central side of your complex SA dealt with. It's going to take some time for it to adapt. It's more important that you're able to sleep effectively on it, and that you're not leaking.

That's also why the 40% PTB number isn't particularly worrisome for a first night, along with how auto mode is somewhat more aggressive than fixed in how the machine determines sending pressure pulses to prompt a breath. (In a couple weeks, you'll probably want to set it to fixed mode instead.)

My advice? Let yourself settle in, and come back in a couple weeks and show us what it looks like then.

Congratulations on getting it set.

[tomma]

My advice? Let yourself settle in, and come back in a couple weeks and show us what it looks like then.

Yeah, understood, kind of. It's just that after 3 months of APAP/CPAP tweaking and then finally realizing I need the ASV I was really hoping to not have to start the process all over again. I have no problem at all playing around and getting dialed in over a few days or even a week, but man, I don't know if I have the fortitude for much longer. On the other hand you gotta do whatcha gotta do. I must say, seeing my centrals as low as they were last night is huge for me!

[Mary Z]

I never base anything on one nights data. I started on ASV one year ago and gave it six months to a year before I expected full benefit. It takes time for your body to adjust.
Don't despair. I know what it's like to get a new prescription and want to wake up the next morning with positive results, for me it's never happened.
Good luck.
Mary

[StillAnotherGuess]

Suggestions for getting the H's under control?

Dial in PS Max = 10.

[tomma]

Dial in PS Max = 10.

My PS Max is already set to 10, unless I am misunderstanding. My very first post in this thread has my settings in it.

I know everyone thinks I should wait a week or so to get used to things, but after my 3 month journey with APAP I just 'know' something is not set right, I mean, the thing wasn't even really performing as an ASV when I first got it, so I'm sure there's other things that just aren't right.

Maybe one our ASV experts can help me understand some of this.

So far what I've read around the net seems to indicate that I need a change in my PS settings, but not sure which one and to what. Right now min =3 and max = 10.

[old64mb]

So far what I've read around the net seems to indicate that I need a change in my PS settings, but not sure which one and to what. Right now min =3 and max = 10.

Right now you don't have nearly enough data to begin tweaking any other settings. I strongly sympathize with the frustrating wait to see if your treatment is actually effective, but let's put it this way - if you didn't catch that your backup rate was off, tweaking your treatment on a gut feeling is probably not a good idea.

Please don't take that as an insult. It's just that what help we can give here is based on seeing how your treatment actually works before suggesting changes, and when you have a more complicated sleep disorder you've got to be a lot more careful treating it than those with a straight-shot Dx of vanilla OSA. It could very well be you need a higher IPAP, but it could also be that those hypopneas are central and are an initial reaction to the first time in 35 or 40 years that you've overridden your nervous system's desire to shut down breathing. If it's the latter, it may go away on its own, and one night won't tell you the story.

One thing that will help would be to post a copy of your Bipap/ASV titration.

Cheers.