BiPAP ASV - Different, but still not great results

[Tonk]

Hi Guys -

I was on straight CPAP for 7 yrs (old style - smartcard system). Wasn't sleeping as well last year as in the beginning with CPAP so I had the card read - running over AHI 11.

Doc ordered an new Auto-CPAP with SD card in January. Slight improvement but hard to tolerate constant high pressures & had Centrals. BiPAP titration showed improvement, so got new Auto-BiPAP machine and used it until BiPAP ASV titration in August. Each change in machines has improved my overall AHI by 1-2 events per hour, but I'm still not consistently getting AHI under 5 and still having SPO2 fluctuations, morning headaches, poor sleep quality, and daytime sleepiness.

The good news -- with ASV my OA index is now usually 0-2, but my CA index can range from 1-10, and my Hypopnea index has exploded compared to on plain BiPAP and is now the largest component of my AHI values most days. I am having some good days with total AHI around 3, but last night I was over 18 and my average improvement in total AHI is probably only 1-2 events per hour since moving to BiLevel ASV. My current average AHI is around 7.


Here's a graph of one of my best days:



Here's last night:




Now two clips of my "overall" charts covering most of my BiPAP period and the transition to BiPAP ASV around Sept 25th:






The sleep lab, my sleep doctor, and a Best Doctors review all suggest that that my response is atypical. Any ideas??

[chunkyfrog]

Bump.
I wish I could help.
Experts please chime in.

[sawinglogz]

What are you using to record your SpO2?

[Tonk]

What are you using to record your SpO2?

I'm using a CMS50E. I've used it nearly every night since mid January 2104. I temporarily "lost" part of my SpO2 data prior to my previous posting, but reindexed it in SleepyHead and the whole chart is below:
The numbers under 80 are typically due to the device moving on my finger, etc... I am not having desaturations below 80.




My Oxygen levels are generally better than before ASV, but I still have occasions where it drops into the low 80's range. With the ASV I don't have the long non-breathing gaps that I had before it.

[Ogeo]

I am too new to all this to be able to help. I'm still trying to figure out my own charts. I posted some graphs about a week ago and only got one response. I wonder how many on the forums are using ASV's? I've been thinking about trying to figure out who is using a ASV and then message them to see if they will look at my graphs but haven't done that yet. Hope you figure it out.

I just changed my mask to the AirFit P10 and have noticed that my pressure doesn't go near as high during the night as when I have used other masks. I have also noticed that when I'm away from home, my pressure goes up and stays up for most of the night. Not sure why.

[cnaumann]

Are you using the auto backup rate? I have not had good results with it, I have been doing better using a manual backup rate set just below my normal low respiration rate. I do not have enough experience to make specific recommendations.

Zoom in on some of those hypopnea outbreaks so that you can see the flow rates for individual breaths. I don't think you should be getting those spO2 desats, and I am wondering what is going on there.

[Tonk]

I am too new to all this to be able to help. I'm still trying to figure out my own charts. I posted some graphs about a week ago and only got one response. I wonder how many on the forums are using ASV's? I've been thinking about trying to figure out who is using a ASV and then message them to see if they will look at my graphs but haven't done that yet. Hope you figure it out.

I just changed my mask to the AirFit P10 and have noticed that my pressure doesn't go near as high during the night as when I have used other masks. I have also noticed that when I'm away from home, my pressure goes up and stays up for most of the night. Not sure why.

Pulling numbers out of a hat here, but my impression is something like: CPAP 75%, BiPAP 22%, BiPAP ASV 3%. Gotta love being unique

When I (recently) started reading & posting here, I read a lot - many of the questions have already been answered, you just have to find them. When you post, be sure to mention ASV in the Subject line. You can look in the index at the number of reads -- has your post been read?

As to pressures being higher away from home, that doesn't surprise me - I never sleep as well in other beds as in my own. Sleep studies are always a joy that way. On my first sleep study, I only slept an hour or so - not long enough to get a clear answer. The last two studies they were fine with using a zolpidem which helped initiate sleep so that they could evaluate me better. At home I rarely need it - I'm asleep almost as soon as my head hits the pillow - it's just not a restorative sleep.

[Ogeo]

Pulling numbers out of a hat here, but my impression is something like: CPAP 75%, BiPAP 22%, BiPAP ASV 3%. Gotta love being unique
Yes, I love being unique. And on top of being in that 3% I also have to make it more difficult by having pressure ranging from 21 to 25 which adds a whole new perspective to being in the unique club.

When I (recently) started reading & posting here, I read a lot - many of the questions have already been answered, you just have to find them. When you post, be sure to mention ASV in the Subject line. You can look in the index at the number of reads -- has you post been read?
Yes I put the ASV in the title.

As to pressures being higher away from home, that doesn't surprise me - I never sleep as well in other beds as in my own. Sleep studies are always a joy that way. On my first sleep study, I only slept an hour or so - not long enough to get a clear answer. The last two studies they were fine with using a zolpidem which helped initiate sleep so that they could evaluate me better. At home I rarely need it - I'm asleep almost as soon as my head hits the pillow - it's just not a restorative sleep.

I actually did okay with the sleep study, the cpap & bipap titration and the AutoSV titration. My 90 year old dad lives about a hour & half drive from me. I go to his place about every week and spend the night, making sure he is doing okay and taking him grocery shopping, etc. His extra bed is about as old as he is. LOL. We added a foam topping which helped but I need to find something else to put my machine on as it is too high, and too noisy. I just don't sleep as good there but was surprised to see such a difference in my pressure while I'm there.

[sawinglogz]

I'm using a CMS50E.

Could you post a zoom in of your best night during the desaturations? Especially 01:45-02:00 and 05:00-05:15? And add your pulse rate to the chart?

At this zoom level I can't tell how long your CAs are or whether it's feasible that you'd desaturate that much during those events. I could also imagine some thrashing causing glitches in the oximetry data.

[wilsonintexas]

I guess I am lucky. I am on ASV, and my AHI is normally 0.0 I consider it a bad night when I get to 0.3 (which for me is 3 events).

I have a RESMED S9. Wen I was looking for which one to get, Pugsy suggested the RESMED over the PR me because it was a little more aggressive in it's algorithm. ( I was having a lot of centrals left over when on BIPAP) .

I am not sure what can be set on each machine, but I think that some fine tuning with some of the parameters shpuld be able ot iprove things. Those are some wicked pressures, I usually max out at 15 or 16, with most of my time around 13.

I hope someone else can chime in soon on this and help you.

[Tonk]

I'm using a CMS50E.

Could you post a zoom in of your best night during the desaturations? Especially 01:45-02:00 and 05:00-05:15? And add your pulse rate to the chart?

At this zoom level I can't tell how long your CAs are or whether it's feasible that you'd desaturate that much during those events. I could also imagine some thrashing causing glitches in the oximetry data.

Here's the 1:45am info:


and here's the 5:00am info:


Use caution in evaluating my pulse info as my "natural" rate is 32-45bpm. I'm being paced over 95% of the time to a base rate of 70 bpm. But that's a different investment in Philips/Medtronics/Respironics <g>


You might want to look at some charts that I posted in an earlier thread when I was still on straight BiPAP that show my historical correlation between apnea and desaturation at viewtopic.php?f=1&t=100494&p=940153#p939849


Thanks for responding to my post!

[Tonk]

An update:

The doctor reviewed my oximetry stats and concluded that while some of my nights were okay, I had some nights with > 8 minutes at under 88% oxygen saturation. He added Oxygen 2L to my current BiPAP ASV therapy.

The first night was wild - AHI 16.2 - though my oxygen sats were improved. But last night (day 2), my AHI was just 0.96 and my oxygen saturation averaged around 95% and nothing was under 90% !

Oh, yeah, NO morning headaches 2 days in a row! I'm cautiously optimistic that we may be on the right road.

[Sleeprider]

I have no expertise to help here, but I'm glad for you that things are improved with the O2. Thought I'd comment that the data you posted for 5:00 AM above looks like classic Cheyne Stokes with desaturation and recoveries leading up to the bigger apnea events. Interesting stuff, but not what one wants to see when checking their own chart. Good luck going forward!

[palerider]

Oh, yeah, NO morning headaches 2 days in a row! I'm cautiously optimistic that we may be on the right road.

neat what getting enough oxygen throughout the night will do for you, eh?

[MountainHigh]

I actually did okay with the sleep study, the cpap & bipap titration and the AutoSV titration. My 90 year old dad lives about a hour & half drive from me. I go to his place about every week and spend the night, making sure he is doing okay and taking him grocery shopping, etc. His extra bed is about as old as he is. LOL. We added a foam topping which helped but I need to find something else to put my machine on as it is too high, and too noisy. I just don't sleep as good there but was surprised to see such a difference in my pressure while I'm there.

Out of curiosity, is there a difference in altitude between your place and your dad's? How about the altitude of your sleep lab?