ASV journey begins

[tmoody]

Quick summary: diagnosed with OSA about ten years ago. Used CPAP until last November, but started to gain weight and have elevated blood pressure about the and a half years ago. My CPAP wasn't a data-capable device, and I never went for a follow-up until last fall. So I have no idea of my AHI for all those years.

The doctor didn't order a new sleep study, but switched me to APAP. The APAP showed typical AHI over 10, often around 15, with a high percentage of centrals. So the doctor ordered a lab study and confirmed the centrals. He prescribed an ASV, after a titration study. I got the machine Tuesday.

The first night was...interesting. I woke up several times, feeling like a hurricane was blowing through my head. I the morning, my voice was raspy, I felt hungover, and the machine showed an AHI of 15.9 for the night.

I've had worse AHI a few times on APAP, but rarely a worse night's sleep. I called the sleep doc but didn't manage to speak to anyone useful (typical). I decided to see what a second night would be like.

Night two...I woke up once to go to the bathroom. I woke up breathing gently, the machine not seeing to push me at all. Went back to sleep and didn't wake up again until morning, for a little over eight hours total. I was again breathing calmly upon awakening. My AHI was 3.5. That's the lowest number I've ever seen, although I know some here would consider it high.

I'm using nose pillows for the first time at home.

So there's my story of my first two nights with ASV, and they couldn't be more different.

[Sir NoddinOff]

Two nights = sample size too small. ASV and 'nose pillows' doesn't tell us much either... please fill out your equipment profile.

Also, get free Sleepyhead and post some graphics. I can't remember if the newest ResMed ASV machine works with Sleepyhead just quite yet. Maybe somebody else can report on that. That's another reason why the equipment profile is important.

First: Here’s the link on where to get free Sleepyhead software:
http://www.sleepfiles.com/SH2/?TestingVersions
If you like Sleepyhead and use it, please try to donate to Mark for his great work… the ‘donate’ link/button is about halfway down this page.
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Here, in order, are the three excellent links that graphically show you how to get the correctly sized Sleepyhead images to show up in your CPAPtalk post:
https://sleep.tnet.com/resources/sleepyhead/shorganize
https://sleep.tnet.com/resources/sleepy ... screenshot
https://sleep.tnet.com/reference/tips/imgur
Don’t worry if you blow it the first time… most of us did!

[tmoody]

Two nights = sample size too small. ASV and 'nose pillows' doesn't tell us much either... please fill out your equipment profile.

Also, get free Sleepyhead and post some graphics. I can't remember if the newest ResMed ASV machine works with Sleepyhead just quite yet. Maybe somebody else can report on that. That's another reason why the equipment profile is important.

First: Here’s the link on where to get free Sleepyhead software:
http://www.sleepfiles.com/SH2/?TestingVersions
If you like Sleepyhead and use it, please try to donate to Mark for his great work… the ‘donate’ link/button is about halfway down this page.

Okay, I've filled out the equipment profile. And I've downloaded Sleepyhead, but no luck yet getting it to run. I'm getting the "Missing MSVCR120.dll" error, and Microsoft won't let me login to get the file, so for the moment I'm stymied. -- And actually, now that I look around, that file isn't missing anyway.

Also, I'd like to be able to review the data for my four months or so on the DreamStation APAP. I gather I need a special beta version of SH for that, which isn't available while Mark is sorting out his unfortunate licensing issues.

Anyway, until I've worked out the technical problems, all I have right now is the AHI number on my PRS1 ASV. After the first night, that number has been 5 or less every night since, once as low as 1.3. As for how I feel...no different. As I mentioned in another thread, I've never had a lot of subjective symptoms to begin with, except after bad nights (AHI>15). My blood pressure has been dropping gradually, as my AHI with the APAP machine started to fall to the 10 range. More relevant to that, no doubt, has been my weight loss, which has also been painfully slow, but it's there.

I have a little bit of nostril irritation from the Swift FX nose pillows, but I still prefer them to the nasal mask I was using for ten years.

I'm finding the most difficult part of using ASV is when I'm awake. The machine is "bossy" about when I should breathe, and if I don't cooperate, it huffs and puffs, and can get uncomfortable. Obviously it's doing what it's supposed to do. So, I've found the best course is to make myself breathe, while awake, according to the rhythm the machine thinks is right, and then fall asleep from there. Since that rhythm isn't my spontaneous waking breathing pattern, it takes a little bit of discipline. On the other hand, it's not a bad way to keep my mind from wandering onto things I have to do the next day. It's a bit like mindfulness meditation, in fact. I lie there and sync my breath with the machine, so that it feels like the machine is doing nothing. Then I drift off.

That's all, until I get SH working.

[tmoody]

I got SleepyHead working!

So, before delving into my current ASV card, I wanted to survey my DreamStation/APAP record for the past several months. Just looking at the statistics, my best month was December, with an average AHI of 12.9. February was more interesting. It started out high, then the AHI dropped abruptly at Feb 9, and only very slowly crept back up. My worst month was January. I can connect some psychological stress to these time frames, but only imperfectly.

Hopefully tomorrow I can look at some ASV data and see what's happening now.

[tmoody]

I'm just going to test my ability to post a SH screenshot. This is a recent, pretty much typical, night on the DreamStation APAP. As I look over my SH data for the whole time I was using the machine, this is the general pattern: lots of hypos, a fair number of centrals, and a smaller number of OAs. It represents a "before" ASV. I'll post an "after" soon.

[icipher]

I'll be curious to see the "after asv" screenshot. Hopefully ASV brings down your periodic breathing a bit.

It took me a couple months to get used to ASV, but I did adapt.

[tmoody]

I'll be curious to see the "after asv" screenshot. Hopefully ASV brings down your periodic breathing a bit.

It took me a couple months to get used to ASV, but I did adapt.

I'll get to it soon. Based on the machine's own readout, the periodic breathing is way lower than what it was. I've just been studying the APAP data, trying to understand what was going on. The variability in AHI was pretty amazing, from a low of 4 to a high of 30. As I mentioned a couple of posts back, on Feb 9 my AHI went from hovering at 16 or so down to about 6, and stayed low (for me) for over a week, then rose again. I try to correlate that with anything else going on in my life. Checking my calendar, I had an echocardiogram on Feb 9. Although the technician isn't supposed to reveal results, he hinted very broadly that I would be pleased with them. I remember leaving the office feeling very relieved, having worried about it for some time. Could that mental change cause a radical drop in AHI? I have no idea; I'd need a lot more data.

Meanwhile, I'm quite comfortable using the ASV, after only a week. I don't have a ton of energy, but there's yet another confounding variable: I started a ketogenic diet a week ago as well, and it's normal to feel a little sluggish for a week or two on that kind of diet.

[Uncle Flapp]

It took me a while to get used to the machine breathing for me. At first the involuntary breaths caused semi arousals and actually created more CAs. Once I got used to it (a few months), I was sleeping like a baby. I've made a few setting tweaks along the way and now my AHI averages under 1. Message being that good things come to those that wait.

Best of luck.

- Flappy

[tmoody]

I've finally got the data from my week of ASV. I'm going to post a screenshot, but I'm not quite sure what to choose. My average AHI for the week is about 4. Looking over the graphs, by far the majority of events are hypos. Centrals are pretty rare, so the ASV is definitely correcting them. On the DreamStation, hypos also dominated, followed by centrals in close second place. Periodic breathing is way down too. Only .88% last night, and usually under 1% for the week; only twice went up to about 2.5%. On the DreamStation, PB was typically 20% or more.

Last night, I woke up at around 4:10 to go to the bathroom. I had some difficulty getting back to sleep. The graph shows some hypos and a few centrals during that time, then another cluster just before waking up. So, I'm choosing a time around 5:00. I don't know if I was awake or asleep by then. Probably asleep, since I think I tend to overestimate the time it takes me to go back to sleep, but I can't be sure. If anyone can suggest a more constructive way to choose a screenshot, please do. I guess I'm mainly interested in seeing if I can make some adjustments to reduce the hypos.

I notice my maximum IPAP (I gather that's inhalation pressure) last night was 20.9. Looking over the week, it was usually less than that--around 17 or so--but did go to 22.6 one night. On the DreamStation, which was set to max at 20, my max pressure seldom exceeded 15. I assume that this difference reflects the ASV kicking in to stop the centrals, is that right?