What is a good AHI with ASV? Revised

[palerider]

9.6

ah, well, then, time to upgrade, see below.

I have tried to update several times and it keeps telling me the downloads are not available right now. Any suggestions?

again, see below. the 'are there upgrades' button doesn't work.

[palerider]

with a leak rate above the acceptable threshold 28% of the time,

there's *nothing* wrong with the leak rate reported there. nothing at all.

respironics machines report *total* leak, not excess leak. if it was a resmed machine, your comment would be valid.

That was my original confusion -- Sleepyhead is reporting that 28% of the time the machine was above leak "threshold". If there is nothing wrong with that, then there is something wrong with the logic that decided what the threshold was going to be. Or maybe the settings are set wrong and confusing the machine or Sleepyhead.

the 'threshold settings are something that are user controlled. unfortunately, SH isn't quite smart enough yet to automatically turn that off for respironics machines.

was was mentioned elsewhere, the threshold for pr machines changes based on pressure, and is 2x the expected leak at that pressure.

[palerider]

Here is the link to last nights report. It's better than the previous night.
https://www.dropbox.com/s/nkf80hwlrtqi9 ... M.jpg?dl=0

now, that leak line looks borderline bad... but consistent. for those pressures your leak should be closer to 50lpm.

next time, please turn off the calendar, it obscures useful detail data on the left (hit the ^ by the date).

[cnaumann]

Out of curiosity, how did you arrive at an ASV therapy? Had you tired CPAP and BiPAP? Were the results similar? ASV does wonders for certain types of apnea (like you stop breathing for no known reason or you get into a cycles of periodic breathing) but is not a universal solution to all types of apnea. It does not replace auto-CPAP or auto-BiPAP.

Are you seeing any machine-initiated breathing? What is the backup rate set to?

[EMTunit31]

I GOT THE DOWNLOAD AND FLAGGED THE ONES YOU SUGGESTED BUT THE GRAPH LOOKS TERRIBLE. WHAT HAPPENED?
https://www.dropbox.com/s/lt7yeko8t5jp8 ... 5.png?dl=0

[palerider]

I GOT THE DOWNLOAD AND FLAGGED THE ONES YOU SUGGESTED BUT THE GRAPH LOOKS TERRIBLE. WHAT HAPPENED?
https://www.dropbox.com/s/lt7yeko8t5jp8 ... 5.png?dl=0

well, first, your capslock is stuck.

second, you've got too many graphs all scrunched up on the page... try making them a bit larger. draggy droppy and resizey... you know how that works, right?

[EMTunit31]

Maybe I'm tired. Something has made me not want to mess with this graph any more tonight. I'm not having very good luck with it. I'll post what I came up with.
https://www.dropbox.com/s/jyw6ldrdlclsz ... 5.png?dl=0

[EMTunit31]

Out of curiosity, how did you arrive at an ASV therapy? Had you tired CPAP and BiPAP? Were the results similar? ASV does wonders for certain types of apnea (like you stop breathing for no known reason or you get into a cycles of periodic breathing) but is not a universal solution to all types of apnea. It does not replace auto-CPAP or auto-BiPAP.

Are you seeing any machine-initiated breathing? What is the backup rate set to?

My sleep doctor decided on ASV after 1 home sleep study and 2 in-lab studies. Cpap was not working so she switched me to ASV and she didn't notice any more issues that night. I did have an auto CPap unit for about 3 months. Never tried BiPap. I can't answer about machine-iniated breathing or back up rate because I'm very new to ASV. Only 2 days in.

[cathyf]

One of the simplest things that you can do with the graphs is right-click on the y-axis and override the values for min and max. Sometimes QT does a great job at auto-fit, while other times I'm left scratching my head wondering just what it is thinking. When you have more data, one of the things that you can do is to set the y-axis on your graphs and click from day to day watching how they evolve over time. If the axes keep changing, it doesn't work.

[EMTunit31]

One of the simplest things that you can do with the graphs is right-click on the y-axis and override the values for min and max. Sometimes QT does a great job at auto-fit, while other times I'm left scratching my head wondering just what it is thinking. When you have more data, one of the things that you can do is to set the y-axis on your graphs and click from day to day watching how they evolve over time. If the axes keep changing, it doesn't work.

You lost me at Y

[EMTunit31]

EMTUnit-

It might be worth getting a recording pulse oximeter to see if those hypopneas are causing any blood oxygenation problems. If they are, you may need further treatment. If your spO2 looks good, then really comes down to how you are feeling. 20 is high, but AHI is just a number. I would rather have an AHI of 20 with all hypopneas than an AHI of 1 where once an hours I quit breathing altogether for 2 minutes.

My AHI with an ASV machine is typically 0.18 - 1.

I thought an O2 meter was an excellent idea so I ordered one. On my 2nd in lab study my sats were down to 60%. I'm surprised they didn't add oxygen to my treatment. They were in the 60's during the other 2 studies too. My doctor said I breathe shallow when she was trying to listen to my lungs.

[Uncle Flapp]

EMTunit31, I am no expert but happy to share my experiences and make a few recommendations.

First off, in Sleepy Head, you should expand the size of the more relevant graphs so we can get a better look. Click and drag (vertically) on the separator bars to expand the size. Graphs I care about are Event Flags, Flow Rate, Mask Pressure, Pressure, and Leak Rate. To save real estate, I turn all others off (from the Event Flags drop-down in the bottom right corner). I also make a preference change so that I can see the mean instead of median on statistics. This setting gives a better indicator on patient triggered breaths. To do so: File, Preferences, CPAP tab, and under Preferred Calculation Methods change Middle Calculations to Normal Average.

With that housekeeping complete, a comment about your numbers. For only the second night on ASV, I think they look pretty darn good. While an AHI >5 is not ideal, the total number only tells part of the story. Obstructive Apneas (OAs) was only 0.11; Clear Airway (CA) 0.68. The rest are flagged as Hypopnea, which is likely a result of an irregular breathing pattern. Some of us using the 960 have concluded that the machine is hypersensitive to something that gets reported as hypopneas and as long as OAs & CAs are under control, all is marvi. In your case, I would not be overly concerned and just keep an eye on it. My guess is that as you get more used to the machine, those numbers will drop.

Let us know what you find about your O2 sats. Like you, my levels repeatedly went down in the 60s during the sleep study but it was because I stopped breathing for well over a minute at a time. ASV corrected that.

- Flappy

[EMTunit31]

EMTunit31, I am no expert but happy to share my experiences and make a few recommendations.

First off, in Sleepy Head, you should expand the size of the more relevant graphs so we can get a better look. Click and drag (vertically) on the separator bars to expand the size. Graphs I care about are Event Flags, Flow Rate, Mask Pressure, Pressure, and Leak Rate. To save real estate, I turn all others off (from the Event Flags drop-down in the bottom right corner). I also make a preference change so that I can see the mean instead of median on statistics. This setting gives a better indicator on patient triggered breaths. To do so: File, Preferences, CPAP tab, and under Preferred Calculation Methods change Middle Calculations to Normal Average.

With that housekeeping complete, a comment about your numbers. For only the second night on ASV, I think they look pretty darn good. While an AHI >5 is not ideal, the total number only tells part of the story. Obstructive Apneas (OAs) was only 0.11; Clear Airway (CA) 0.68. The rest are flagged as Hypopnea, which is likely a result of an irregular breathing pattern. Some of us using the 960 have concluded that the machine is hypersensitive to something that gets reported as hypopneas and as long as OAs & CAs are under control, all is marvi. In your case, I would not be overly concerned and just keep an eye on it. My guess is that as you get more used to the machine, those numbers will drop.

Let us know what you find about your O2 sats. Like you, my levels repeatedly went down in the 60s during the sleep study but it was because I stopped breathing for well over a minute at a time. ASV corrected that.

- Flappy

Thank You Flappy for the software education. I don't understand a lot of it and I haven't had time to figure out how it works.
Here is last nights report. Slightly elevated but still acceptable, I think. I welcome opinions. That's why I'm here.
https://www.dropbox.com/s/ckfu8hfgys8ct ... 0.png?dl=0

[Uncle Flapp]

It is still really hard to see what is happening. The graphs are all scrunched up together and some flags are turned off. Try clicking on File, Preferences, Events tab, and ensure all your events are checked - like this:



In fact, you may just want to click that Reset Defaults button. Somehow the flags got turned off and we can't see a breakdown of events.

[EMTunit31]

I think I finally got it how it's supposed to be. Kinda hard getting all of it on the screen.
https://www.dropbox.com/s/qvl00hoo477fj ... 2.png?dl=0