Lozaman's ASV Therapy Thread

[Lozaman]

Hello all, this is Lozaman. I'm a newbie here and hoping some of you experienced users can help me sort through or understand my issues. I am an otherwise fairly healthy 49 year old married father in SoCal. Two months ago I started to stop breathing (or very shallow breathing) when I would fall asleep, then I'd wake up with a racing heart, over and over, leading to severe sleep deprivation. Thank goodness my doctor put me off work for a while to deal with all of this, as I was a danger on the road. So far I had 2 sleep studies. First night showed no OSA (I never snore) and some CSA's/Hypopneas. CPAP made it worse. Second night they titrated me on an ASV machine, which seemed to work, and I bought the ASV. I'm still in the middle of a million referrals and tests to see if they can determine "why" this is happening, but so far my heart and throat all look good. Waiting on brain scan, neurology and endocrinology referrals. I know this is not a medical advice forum, I just wanted to give you some background.

With the help of this forum and a private consult with Jason from FreeCPAPAdvice I have had a steep learning curve the last few weeks. I am on an AirCurve 10 ASV with AirFit 20 FFM. I use a chin strap and Remzzzs mask liner, and unfortunately I do need a little Ambien to relax me as I still have much anxiety about wearing the mask and falling asleep, but it works for me. I am also reading the "Sound Sleep" book some of you recommended.

I'm not exactly sure what's happening with me, but I do know that at sleep onset, I definitely stop or shallow breathe. Just as I'm falling asleep, in that in-between stage where I am sort of dreaming but not yet asleep, I can feel the ASV pressure support give me a big breath. That wakes me up a little but eventually I get to sleep. These initial events are never recorded as "events" for some reason. The rest of the night my AHI is low, usually 1-2 per hour. However, I still wake up 2-3 times per night for no apparent reason. No events are recorded at the times I wake up either. Maybe I'm just not comfortable enough yet to sleep through the night.

I have posted a screenshot from last night of the only "recorded" event, a hypopnea. I am giving you about a 3 minute sample and hoping someone can help me understand what may have happened here (assuming I did it right and you can see it?). Was I waking up? Was it a mask leak issue? Was it a real hypopnea? Again, despite knowing all the "lingo" now, I am very much a newbie and really don't understand how to read these graphs yet. Any help is much appreciated, about the graph, or about my condition and treatment in general. I would love to get off the machine someday, or maybe train myself to use nasal masks (which didn't work the first time). The FFM is hot and leaves so many marks on my face and other issues (which I know you are all familiar with). Sorry for the long initial post and I look forward to hearing from you.

(Machine settings: Min EPAP 5, Max EPAP 15, PS Min 4.4, PS Max 19. These settings work for me because I don't really need the ASV 99% of the time, just a big breath when I stop breathing occasionally. These settings were recommended by Jason and my sleep doc).

[Pugsy]

I added "ASV" to your subject line so that the people using ASV would hopefully stop by and offer input.

The one hyponea you are asking about...I think it is arousal breathing flagged and of no consequence.
My best guess is the leak caused an arousal and subsequent irregular breathing caused a flag. I don't think you were really asleep.

You may or may not even remember that brief of an awakening.

Waking up for no apparent reason....did you know that it is normal to awaken after each REM cycle? Most of the time we just roll over and go back to sleep and aren't awake long enough to form a memory of the awakening.
Google sleep stage hypnograms and look at the normal cycles we go through each night.

So what you are experiencing could be simply a post REM awakening and you were awake long enough to remember it.
It is also possible that your brain is still coming to grips with the alien stuck on your face blowing air up your nose. This will improve with time as the brain learns that the mask and machine are its new best friend.

Learning to adjust to ASV ..... for some people it just takes longer than others.
How long have you been using it?

It is also possible that mask comfort issues are a factor in the wake ups....leaks definitely can be a factor even if they aren't big leaks.

Have you thought about adding a mask liner? It might help with the hot sweaty feeling stuff...and help with leaks too.

[idlewire]

Two months ago I started to stop breathing (or very shallow breathing) when I would fall asleep, then I'd wake up with a racing heart, over and over, leading to severe sleep deprivation.

I'm not exactly sure what's happening with me, but I do know that at sleep onset, I definitely stop or shallow breathe. Just as I'm falling asleep, in that in-between stage where I am sort of dreaming but not yet asleep, I can feel the ASV pressure support give me a big breath. That wakes me up a little but eventually I get to sleep. These initial events are never recorded as "events" for some reason.

Same thing started happening to me almost 4 months ago, so I feel your pain. It would keep me awake for 30-40 hours at a time. This is central sleep-transition apnea, and it occurs in healthy people to a mild extent, as ventilatory needs are reduced in the sleep state. But to the extent you and I experience it, it is not normal. I'm still trying to chase down a cause as well, but you should add a pulmonologist to the list of doctors to see; reduced lung volume can be implicated in central apnea, as well as CO2 dysregulation.

The machine is responding to your drop in ventilation with pressure support. As long as it actually gets you to breathe, it's not going to flag anything when this happens.

[Lozaman]

Thank you Pugsy, for the quick reply, and your analysis. You’re right, the awakening may be normal but then I feel the “alien” mask and awake almost fully for 10-20 min or have to use the restroom. I’ve only been at this about 2 1/2 weeks. I actually do use a liner and it helps. It’s a hot Summer here in the Inland Empire of SoCal and I’m just a normally hot person so the sweating may improve as the weather cools.


Sent from my iPhone using Tapatalk

[Lozaman]

you should add a pulmonologist to the list of doctors to see; reduced lung volume can be implicated in central apnea, as well as CO2 dysregulation.

Idlewire thank you and good luck finding your cause as well. I did see a pulmonologist and he’s going to order a blood gas test. He didn’t even check my lungs other than an x-ray. I’ll ask him about these things next time I see him. It seems like if I could just get past that initial onset apnea I MIGHT not even need the machine, but it’s a catch 22 because I need to get to sleep first.


Sent from my iPhone using Tapatalk

[Lozaman]

I tried to quote idlewire but it came out without quotes. Any advice on how to quote?


Sent from my iPhone using Tapatalk

[Pugsy]

I tried to quote idlewire but it came out without quotes. Any advice on how to quote?


Sent from my iPhone using Tapatalk

You can just click on the quote button upper far right of the post.... like I did for the above and the reply box will open and the quote will be there and then you can reply.

You can also edit out stuff...but sometimes that's a lot of work so I often just do snippets.

Or you can do snippets and use the quote button on the forum editor (4th button from the left).
Click on the button and the quote brackets will appear and then you insert the snippet.

Any advice on how to quote

Or highlight a portion once you have opened a reply box and then hit the quote button on far right
Like this

it came out without quotes

[Lozaman]

Awesome.


Sent from my iPhone using Tapatalk

[Lozaman]

Hello again and thank you for those who posted to my first ever thread. I would like to continue with a couple more screen shots and see what you think. Again, I'm a newbie to wearing a mask an I am trying to learn to discern real events versus the many false ones I seem to be getting. Any help interpreting these two images is greatly appreciated.

#1) In the first one, there are 2 hypopnea's but one is right before a huge leak and one is during the leak. Is this just me waking up and maybe adjusting the mask?

#2) In the second one, the ASV registered 2 hypopnea's again. I can see the flow rate looked slightly different right before each one. Do these look like real events? And how are they related to the fact my mask pressure was so high for 5 minutes prior to that? I'm trying to understand what this means.


Thank you for any guidance. You guys are so great.

[Pugsy]

#1) In the first one, there are 2 hypopnea's but one is right before a huge leak and one is during the leak. Is this just me waking up and maybe adjusting the mask?

That would be my guess...the breathing at 05:40 and up to the flagged event 45 seconds later points to maybe arousal breathing and not asleep breathing...so if this were my report both would be considered SWJ.

The second image and 2 flagged hyponeas....doesn't look like asleep breathing to me well before the flags....again if my report I would be thinking SWJ and shrug my shoulders and move on.

[Lozaman]

Thank you again Pugsy. One clarification please: what does SWJ mean?


Sent from my iPhone using Tapatalk

[Pugsy]

SWJ sleep/wake/junk. Flagged events that aren't real asleep events. Probably awake or arousal related.
The machine can't tell if you are asleep or not. It only measures air flow and our awake breathing is very irregular compared to asleep breathing and the machine will sometimes flag that irregularity as some sort of apnea event.
False positive kind of thing.
You have to be asleep for the flagged events to really matter. Awake stuff doesn't count.