Can someone look at my ASV data please

[rance22]

I was diagnosed 2 years ago w severe sleep apnea. After 2 years on CPAP I asked for another sleep study as was still feeling tired. The second study was a split study ...1st half sleep efficiency of 93% w CPAP 89%....it says ahi was elevated at 64 and did not improve w cpap...Very high level of centrals was noted.

So tried Bipap....AHI was between 18-21 for 2 weeks.
Bipap s/t for another 2 weeks w AHI between 18-21.

for the last 10 days I have been on a resmed s9 vadapt servo ventilator. The numbers have ranged from 1.0 to 4.4 AHI which is a huge improvement. Mask is F/P full face mask and leaks seem good.

My only issue is I have what I describe as a spacey type feeling...almost like being intoxicated. hard to describe. Could it just be getting used to more 02?

Anyways was hoping my graphs might show more then AHI to see if I am missing something.

Thanks for your time



Getting good AHI numbers but feeling spacey with new servo machine....is there anything unusual in my numbers? thanks

[SGearhart]

Initially it looks like you have a major leak problem. A leak can skew the reporting of data and events. Please list all your equipment in your profile so we can form a better picture.

[ChicagoGranny]

Initially it looks like you have a major leak problem

Are we looking at different images? His leak line looks nearly ideal. 95% is 1.2 l/min.

[robysue]

rance22,

You need someone with ASV experience to look at your data. You might want to rename the title of the thread to Can someone look at my ASV data please. You can do that by editing your original post to the thread.

That said: The IPAP graph looks really, really busy to me. And while the whole point of an ASV is to allow the machine to increase the IPAP pretty drastically on a breath by breath basis, it increases the IPAP drastically only when there's something going on in the breathing for it to respond to. And so the question is: What is the machine responding to when it is increasing the IPAP on so many breaths?

It might also help the appropriate people help you better if you would give a bit of background information: What was your original diagnosis (OSA or CSA or something else) and why were you put on the ASV in the first place?

Initially it looks like you have a major leak problem.

HUH???

The 95% leak rate is 1.2 L/min, which is negligible. Yes, there are a few extremely short lived spikes in the leak graph, but only two of them are over the 24 L/min redline. Leaks are NOT an issue---unless the leaks are waking up or otherwise bothering rance22.

[Pugsy]

The UA flagging may have initially caused SGearhart to think leaks are excessive because usually UAs are associated with big leaks.

In this situation UAs don't mean unknown apneas secondary to excessive leaks and instead it is just SleepyHead having a little problem knowing what category to use.
I have this all the time with my Adapt....Always UAs but ResScan calls them OAs.

To Rance22:
I have no idea what could be causing the spacey sensation but you may need just a little more minimum EPAP...from 5.0 to maybe 6.0. Otherwise the settings appear to be working and I don't see the machine hitting 20 cm IPAP except maybe once so I don't think more IPAP is needed at this point anyway.
How long does this spacey feeling last when you wake up?
Are you sleeping soundly otherwise during the night or are you having a lot of wake ups during the night?

Edit: To Robysue:
He has a history of central apnea with some obstructive thrown in but the centrals were present before beginning cpap therapy...at least I think I have that part of the story correct. He was initially using a S/T bilevel machine with horrible results as it wasn't doing a thing for the centrals.

[rance22]

First off thank you all so much for taking the time to respond. This forum is amazing as I find people without sleep apnea have no idea what we go thru.

Anyways I updated my info. at beginning of post.

Pugsy I would say the sensation last for a few hours upon waking. ..also I wasn't aware epap could be adjusted. i thought the machine does everything automatically?
I will ask to have it adjusted thanks.

I would say I am sleeping thru the night. a few times a night I will wake when the machine revs up but for the most part I sleep thru and I'm having dreams for the first time in ages.

thanks again

[Pugsy]

The Adapt will adjust on it's own but sometimes it still needs that minimum EPAP to be more optimal because it's the EPAP that does the bulk of the work preventing OAs.
Sometimes it just needs a better headstart and it's surprising how things can improve with just a little more EPAP.
I need EPAP 6.6 on my Adapt to get my OAs under control. When I tried EPAP 6.0 my AHI was looking similar to yours.
These machines respond quickly but sometimes still not quick enough so we use a little more EPAP to give them a better head start to jump from.

If you were seeing the max IPAP of 20 being hit often...that's for the centrals...then IPAP might need more room to go to but I don't see it on this report.

I still have no idea what the "spacey" feeling is. It's not a common complaint for post therapy feelings.

[rance22]

Part 2:

What could be the cause of central sleep apnea?
I do not have any heart issues.
I have never done drug or needed opiates for pain relief.

I do take ciprolex (anti depressant) for anxiety ...but I think the source of anxiety was undiagnosed sleep apnea (not ever sleeping). So perhaps with the sleep apnea treated I could get off the medication and see if that is the issue.

I am a shallow breather during the day if that has any bearing on things.

Would a neurologist be a good option to pursue?

Thanks

[rance22]

here is another night

[Pugsy]

I have no idea what might be the original cause of the centrals. Sometimes there is no known cause.
Sometimes there is something that maybe could carry some blame. This is something that a discussion with your doctor would be a better thing to do and yes....neurologist would be my first choice.

The medication may or may not be part of the spacey feeling. Perhaps the dosage needs adjusting now that your apnea issues are a lot better controlled than they were.
I would also want to be off that med just to see how it may have been impacting everything because all those types of meds come with big lists of potential side effects that I wouldn't like.
It is a med that you don't just quit cold turkey without medical supervision....so I am not advising that you do that.
An in depth discussion as to dosage and length of time you have been using it .....etc as well as potential withdrawal side effects...with your doctor needs to be discussed.

I did do a bit of quick research to see if that med was a well known suppressant of the respiratory system and I didn't find anything that was all that alarming in that regard....certainly not nearly along the lines of what opiates or muscle relaxers do. It wouldn't be impossible...but it doesn't appear to be a well known side effect at least from what I found.

[rance22]

Ok thanks so much. My dr did say yesterday to start reducing dosage in half as we both feel the sleep apnea was the cause of the anxious feelings.Like you said there could be no cause for the centrals, just is.

[rance22]

Pugsy
My min epap is now 6
Max epap 10
Min ps 3
Max ps 10
Max ramp 45 min
Start epap 5

Does that look correct?

[Pugsy]

I would change max PS from 10 to 15 and that will open up maximum IPAP a little and the machine won't go there unless it thinks it needs to.

Do you really need ramp at these settings?

[rance22]

Ok thanks. No I don't need ramp I think it was just automatically set by the clinic. I'll just turn it off.

Thanks for your help. Hopefully these little adjustments will make it even better.

[palerider]

To Rance22:
I have no idea what could be causing the spacey sensation but you may need just a little more minimum EPAP...from 5.0 to maybe 6.0.

after looking at the two nights, I'd say 7 for min epap... if it were me. it would likely smooth out the epap line a lot.