Resmed ASV -- help with first sleepy head report?

[ephraimh]

edited for clarity :Could I get some feedback, please? This is a new machine that I got in January. I've included the data fields that seem relevant to me. Would any other data be relevant? I've also uploaded a summary. I'm using the BrokenGL build.

Up until April 5th the details screen shows no summary available. The AHI jumped from the 0.13 on April 4 to 4.58 on April 5th and has been high for me since then. I have no idea what happened on 4/5. I didn't change any settings, prescription drugs or anything. I shut the machine off a number of times a night when I have to get up to go to the bathroom or sip some water for the dry mouth and that only takes a few minutes at max. For whatever reason, I'm not having to do the first one every night as I used to. A few days a week I'll turn it off in the morning and doze for a little. I do that if I feel "VPAPed out." I'm still tired and it's too early to get up but using it when I'm not sleepy enough just feels so odd. Not sure how to explain that. It's only a couple days week.


I gave the card to my doctor on the 22nd & got it back on the 28th. Do those numbers for that week make sense? I don't understand that at all.
thanks

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[robysue]

Bump

ephraimh,

I see you are using an ASV and you might get some quality feedback if you added "ASV" to your thread title.

I'm not knowledgeable enough about the Resmed VPAP ASV to give much feedback. But on the Daily Detailed data you post, it sure looks like the IPAP pressure graph is very, very busy. That can be caused by a large number of machine-triggered inhalations. In ASV mode, the machine will try to trigger inhalations by increasing the IPAP when the machine is not happy with the way your breathing looks. I don't know how your machine scores "paitent triggered breathing" vs "machine triggered breathing." Perhaps someone with more ASV experience can tell you that.

The colors on your Overview data charts don't agree with the colors on mine. That's probably because I'm using an older SleepyHead on this particular machine. Even so, I can say this:

Prior to April 4, the AHI numbers looked really good. Between April 4 and April 20, the AHI numbers look pretty bad. Between April 22 and April 29, things look excellent as far as the AHI is concerned. And between April 29 and May 4 the AHI numbers look bad again. Usage seems to be about the same regardless of whether the AHI is good, bad, or indifferent, although there seems to be a downward trend in usage starting with April 4. Bedtimes and wake up times could be much more consistent---if you worked on going to bed and waking up at the same time every day, you might sleep better. It also looks like you wake up and turn the machine off and on during the night. You write:

I shut the machine off a number of times a night when I have to get up.

The question is: Why do you need to get up so frequently? Or are you turning the machine off and back on any time you wake up?

At any rate: I have no idea why the AHI would cycle through periods of being really high and then really low. I do know that my own AHI data does have some periodicity apparent, but in my case, we're talking about 4-7 days with an AHI between 0 and 1.5 followed by 4-7 days of an AHI more in the 1.5-3.0 range. With occasional really bad nights that are often correlated to my coming down with an upper respiratory virus OR additional restlessness from the insomnia acting up.

[Julie]

Not all your graphs show leaks or rate, and I wonder if you're mouth breathing and losing air pressure that way - have you ever tried taping or a FF mask?

[robysue]

Not all your graphs show leaks or rate, and I wonder if you're mouth breathing and losing air pressure that way - have you ever tried taping or a FF mask?

Julie,

ephraimh's data does include the relevant leak data. I've taken the time to download his/her images and add a RedLine at the Resmed 24 L/min level.

Here's the overall summary data:



Notice that while the maximum leaks are usually over 24L/min, the 95% leak rate is almost always below the Large Leak line. The median leak rate is always well below the Red Line. If ephraimh is doing mouth breathing, it's not very much mouth breathing OR it's not resulting in large leaks that last very long. That said, there does seem to be a correlation between the worst of the nights in terms of leaks and the worst of the nights in terms of AHI. It would be very useful to see some detailed data from the April 4-April 14 range and compare it to some detailed data in the April 22-29 range

The data from April 5, the one night of detailed data ephriamh has posted, looks like this after you add a Red Line at 24 L/min:



There's clearly some spikes going on in the leak graph that go above the Red Line on this night between 4:30 and 5:00. But we don't see the usual "mesa-shaped" high area in the leak graph that usually indicates some mouth leaking is going on. It looks more like mask shifting, possibly being caused by the wild jumps in IPAP pressure that are also going on around that time.

I think the fact that "Unknown Apneas" are being scored is because ephraimh is using a Resmed ASV and they just score "Apneas" without distinguishing between whether they are OAs or CAs, and since they're scored as As, SleepyHead lumps them into the "Unknown Apnea" category. That's one of the reasons I hope someone who uses a Resmed ASV stops by to look at this data.

There is a cluster of events between 4:45 and 5:00. From this shot, it's not at all clear what's going on and whether those events are real or just SWJ because of dozing before deciding to turn the machine off and get up. The posted data is also not complete for the night of April 5 since SH says the Wake time is 8:01, but the graphs end a bit after 5:00. It would also be useful to see what the rest of this bad AHI[/b] night looks like.

[Julie]

I really must get one of those things so I can appreciate what's what!

[palerider]

I think the fact that "Unknown Apneas" are being scored is because ephraimh is using a Resmed ASV and they just score "Apneas" without distinguishing between whether they are OAs or CAs, and since they're scored as As, SleepyHead lumps them into the "Unknown Apnea" category.

that is correct. the adapt prevents centrals, (if it's doing it's job properly), so most (all?) scored apneas can be reasonably assumed to be obstructive.

the only way it could determine if an apnea was central or obstructive would be to let it go on long enough to do FOT. however, the adapt responds on a breath by breath basis, so it never waits long enough to score an apnea.

[adipasqu]

ephraimh,

What model ASV do you have? 36037 or 36007? It will say on the back of your blower unit. If you have the 36037, you may want to try it in ASVAuto mode as that will allow EPAP to to increase to treat any obstructive apneas/hypopneas that may not be treated at your current static EPAP pressure.

[robysue]

palerider,

What do you make of the IPAP graph on the Daily Detail that ephraimh provided?

At points it looks like the IPAP drops all the way to the EPAP, but his min PS = 5.0. Any ideas on why that's happening? A SH glitch? An ASV glitch?

[palerider]

palerider,

What do you make of the IPAP graph on the Daily Detail that ephraimh provided?

At points it looks like the IPAP drops all the way to the EPAP, but his min PS = 5.0. Any ideas on why that's happening? A SH glitch? An ASV glitch?

I'd have to see the data itself, (possibly easiest) or multiple shots of the mask pressure, pressure and leak lines.

I see the same thing happening on other adapt data that I have, and on first glance, it looks like they're brief leaks that are dropping the pressure. I see the ipap trace drop, and then a bump in the leak line, even if it's not a BIG bump, since the leak line is a moving average of several (5?) breaths. but, that doesn't make sense, since the pressure line is commanded pressure, and mask pressure is measured pressure... looking at more traces, I don't think it's a glitch, maybe it's a reaction to leaks, or breathing issues, and it's trying to get more of a breath in, or out, of a person.... it shows that it's dropping the ps to zero, or near it, very briefly, on occasion.

it may be an attempt by the machine to normalize breathing, which is what it's really good at with CSR patients, and I see places where it looks like it's reacting to abnormal breathing.. like:



I think that's my current theory, so, not a glitch from either the asv, or sleepyhead.... I think.

[ephraimh]

Here are the full night's graphs of April 5, the night things got weird. My memory is going which is why I didn't notice the first ones I posted did not show the full night. I hope I got these right. My apologies at the outset for whatever I screwed up this time.

The elevated numbers started on 4/5 and have been high ever since except for the week that my doctor had the card. I think sumpin broke on 4/5. What else would account for that other than the machine or card breaking? My doctor examined the machine I got in December and confirmed that it was broken. AHI was about 6 last night.

I loaded SH on 5/4 from the smart card; the card became corrupted. I don't think I locked the card (won't make that mistake again.) I have a new one in there, now, but am getting another, lest I screw the new one up.

It's a 36037

Thank you


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