Sample ResScan Report for VPAP Adapt SV

[JohnBFisher]

Folks, I thought you might be interested in some sample graphs from an early report I put together from my ResMed ASV data. I've since increased the EEP value from 5 to 8. I was snoring too much with 5. So, with 8 it seems to reduce the snoring and I sleep better.

During this graph, my maximum pressure was 21.2. With the EEP increase it would be over 24.

The following is one time period when I slept fairly well:



Note that it seems to be cyclic in nature. In fact, the following highlight helps illustrate that:



As you can see, there appear to be three cycles of the yellow pattern and two of the blue pattern. Sure appears to follow the sleep stages:



Remember this was shortly after starting with my ASV unit. So, I was doing a LOT of dreaming at that time.

As you might imagine with those strong pressure swings, I tend to see a lot of leaking. As a matter of fact:



Since that time I have taken some drastic measures to reduce the leak rate. In fact, some nights it feels as if the mask is fused to my face:





For those of you who are not Science Fiction fans, this is the picture from Doctor Who, where the mask is fused to the skin of the person unlucky enough to have come into the realm of the Doctor. He is dead, and wanders around wondering "Are you my mummy?"

So, as you might imagine with all that swinging, I also see swings in my tidal volume:



But as I've noted, the ASV unit definitely makes a huge difference. I sent from a very high AI value with my Respironics BiPAP Auto (M Series) unit to none. Nada! Zero. Zilch. It's WONDERFUL !! Even the AHI vlaue is less than 5 every night.

[qjosea]

Hi Jon, I have the same machine as you. If I post my charts can you help me decipher them.

[Muffy]

Sorry, I must have been mistaken.

Muffy

[dsm]

John,

My reaction to the leak data is - 'get that under control' - it skews results and data significantly on the machine.
It really is leak intolerant.

nicely presented info.

DSM

[Banned]

Am I misreading or is John's EEP set at 5? Oops, I missed the increase to 8cm.

Banned

[Banned]

Even the AHI vlaue is less than 5 every night.

John,

This device is easily capable of AHI 0 every night.
Consider a trial EEP 9cm.
What are your Min/Max PS, again?

Banned

[JohnBFisher]

Hi Jon, I have the same machine as you. If I post my charts can you help me decipher them.

Took me a couple days to figure out just how to say this.

First, I am happy to help you see what you can see in your charts ... with one caveat. I am (and do not pretend to be) a medical professional. Instead, what I will help you do is what I try to do ... understand the data well enough to have a discussion with my doctor about it. This is especially true for anyone who needs an ASV unit!

Second, understand that how you FEEL is just as important as the numbers ... and as I mentioned ... without the full sleep study, much of this is JUST speculation. Speculation based on an attempt to understand the data and what happens during sleep. However, it does not replace the sleep study.

Third, I will ask a ton of questions. I *love* the "socratic" method of teaching. You learn more by answering questions than if I just provide an answer. I might lead you toward some possible conclusions ... but you must decide what is important for you. You must take the data and use it with your doctor and health care team.

So, if you don't mind those caveats, sure. Post your results in a different post and I will be happy to start the exchange.

[JohnBFisher]

Sorry, I must have been mistaken. ... Muffy

Muffy, I'm sorry. I think I missed your first version of your post. Can I help clarify something? I always value your input!

And as I just mentioned, remember this is my best attempt to interpret my own experience with this ASV unit. I used older data just as an example. I thought others might be interested in how you can use the graphs to better understand what's happening during sleep.

BUT, I willingly admit that I learn as much as possible from others such as you. So, if I can help clarify, ask away! I, for one, want to learn as much as possible.

[JohnBFisher]

... My reaction to the leak data is - 'get that under control' - it skews results and data significantly on the machine.
It really is leak intolerant. ...

Exactly. That's how I learned that it was a problem for me throughout the night. I've since cinched down my mask. I tend to get very good or excellent leak results. I'll try to download more recent data and then upload the graphs.

[JohnBFisher]

... This device is easily capable of AHI 0 every night. ... Consider a trial EEP 9cm. ... What are your Min/Max PS, again? ...

Yeah. It's normally less than 5 every night. Frankly, it's normally around 2 or less. I just tend to take the Scotty approach. If I say 4 hours and command whittles it down to 30 minutes, but it only really takes 10 minutes, it works well for everyone!

Banned, I may try upping the EEP to 9. At this point I am trying to stabilize the leak rate. I'm a real believer is "slow but certain". I've modified my mask so I now get good or greater for the leak rate. I still occassionally snore. But during the BiPAP titration, the sleep lab noted I snore all the way upto 16cm H2O. I just don't want any apneas. and minimal hypopneas.

The Min/Max PS are left at default values. Again, I wanted to minimize the changes I made all at once.

As DSM noted, this unit is VERY intolerant of leaks. When it leaks badly I tend to awaken with headaches and such. But I tend to feel great if the leaks are minimal.

Thanks for the suggestions. I will keep it in mind and update everyone.

[Slinky]

...

Remember this was shortly after starting with my ASV unit. So, I was doing a LOT of dreaming at that time. ...

JohnB, how was this graph made? That's not an ASV/ResScan graph, is it? Or is it not a graph of your sleep but rather a generic you found to use?

[DreamOn]

Thanks for sharing your graphs, John. I learn so much from your posts. Well-presented information and very interesting!!!

[JohnBFisher]

... Remember this was shortly after starting with my ASV unit. So, I was doing a LOT of dreaming at that time. ...

JohnB, how was this graph made? That's not an ASV/ResScan graph, is it? Or is it not a graph of your sleep but rather a generic you found to use?

Just a generic I found on the web (using a Google Images search), with all the generic falacies that I've seen some of the sleep techs here comment about. The old diagram shows minimal REM at the start of sleep and more as the night progresses. Those of us with sleep problems often show more REM sleep early.

[Muffy]

Sorry, I must have been mistaken. ... Muffy

Muffy, I'm sorry. I think I missed your first version of your post. Can I help clarify something? I always value your input!

Well, I was going to post

The following is one time period when I slept fairly well:

Do you have a recent graph, because that is awful! ASV should attack the CompSAS cycle, break it and then stabilize, as in this example



where ASV results are broken down into "acceptable" and "not".

Sure appears to follow the sleep stages:

While SDB tends to stabilize during REM in CompSAS, those reduced IPAPmax areas still don't look all that stable. If your sleep architecture is normal, REM onset is too delayed (it sure occur at about 90 minutes), and if you were on the machine for more than a few days, then the likelihood that that is REM rebound (because those are long periods) is small. They look more like stable NREM, but then the question remains, where the heck are your REM periods.

But as I've noted, the ASV unit definitely makes a huge difference.

Can you be more specific? Are the numbers better or are you feeling better?

And if you're feeling better, is it because you're sleeping (vs not, because comfort and compliance is improved) or sleeping better (SBD events and therefore arousals are reduced).

but once Moe and Larry slid in on their trineo de mierda and started their arbitrary dial wingin' routine again, I suddenly remembered that the ASV expalnation would reveal a key component of The Big Secret, that "missing link" that can only be given to those that know "The Secret Handshake" (RG, -SWS and Bev)(certainly not Muffy, because, as you can see, Muffy has no hands to shake).

Muffy

PS - Schematic for "The Secret Handshake" sent.

[JohnBFisher]

... Well, I was going to post ...

Thanks for posting! I find it informative. And trust me, hands or no, I tend to learn a LOT from your posts.

... Do you have a recent graph, because that is awful! ASV should attack the CompSAS cycle, break it and then stabilize ...

I will try to download the data from my machine. My sleep is improving and lengthening. The leak rates are better. My REM sleep appears to be more normal than in the past.

... While SDB tends to stabilize during REM in CompSAS, those reduced IPAPmax areas still don't look all that stable. ...

Perspective. It's all in the perspective. If you know that I started with ASV only about five days before and this was my first night with more than two or three hours of sleep on the unit, you would think that instability you see was WONDERFUL. At least it was wonderful in comparison to the few previous days.

... If your sleep architecture is normal, REM onset is too delayed (it sure occur at about 90 minutes), and if you were on the machine for more than a few days, then the likelihood that that is REM rebound (because those are long periods) is small. ...

REM rebound was almost certainly still occurring then. The very first time I went onto CPAP therapy and as I went onto ASV therapy I reached a point that I was so starved for good sleep (and especially REM sleep) that I would end up with hypagogic dreams. I would dream when I blinked!

... They look more like stable NREM, but then the question remains, where the heck are your REM periods. ...

It could be NREM. But as I've noted, without the full sleep study, it's just speculation on my part. My sleep doctor did note that my N3 and REM stages were particularly quiet. Hence that was why I speculated that was deep sleep and/or REM sleep. But without all those other leads it's just a guess. However, I do defer to your experience with these!

... Can you be more specific? Are the numbers better or are you feeling better? ...

Both. My AHI numbers continue to fall (mostly ... obviously stress tends to bump up the numbers). And my sleep is both deeper, longer and richer. Deeper - I feel more rested than I have in a long time. Longer ... well I slept about eight hours last night (interrupted by a family member) and seven hours uninterrupted the night prior. I do not remember the last time I slept without interruption for more than five hours.

... And if you're feeling better, is it because you're sleeping (vs not, because comfort and compliance is improved) or sleeping better (SBD events and therefore arousals are reduced). ...

There are several factors:

• Leaks are reduced. That helps with the ResMed ASV. I note there is a STRONG correlation between many leaks and waking feeling miserable.
• Sleep duration is improved. Here's an example of where even for someone who's used xPAP for about 20 years, it can time time to acclimate to a new unit.
• AHI continues to improve. The number has continued to drop. Apnea events have been eliminated. Hypopnea events has been reduced. Average Pressure has dropped over the past four weeks. I assume the machine had to intervene less, thus the pressure remained in the EEP to EEP + Min PS range more frequently.

(Of course as I noted, stress will bounce the numbers up again, but that's normal).

... but once Moe and Larry slid in on their trineo de mierda and started their arbitrary dial wingin' routine again ...

My sleep got so bad, I am really reluctant to make a lot of changes ... and definitely not without checking and rechecking for change.

So far I've upped EEP. That helped reduce the snoring. I still snore some, but my throat is no longer sore when I awaken. And it did not adversely impact any of my other numbers.

... I suddenly remembered that the ASV expalnation would reveal a key component ... can only be given to those that know "The Secret Handshake" (RG, -SWS and Bev)(certainly not Muffy, because, as you can see, Muffy has no hands to shake). ...

Ya know ... for someone without arms or hands to type, you do a great job!

Thanks again. I do enjoy getting your insight and that from -SWS and others. It helps me think this through as I prepare for a follow up with my sleep specialist. I think sleep is better under control. Now I think I need to focus on the neurological stuff that appears to have progressed, leading to these sleep issues.

I'll upload the most recent few days and see what the data shows.