Varying AHI Readings on BiPap Auto SV Advanced

[deltadave]

Yes I have a peak flow meter. My scores are usually around 450. I just checked this morning and I am at 500. As I am asthmatic, my doctor says that's an OK number.

The calculation of normal values for PEFR are based on sex, age and height, but 450-500 LPM is great for pretty much anybody. However, the values must be viewed in context with any medications you might be taking, i.e., wake up, take a couple shots of an inhaler, then measure PEFR could be substantially different from a med-free measurement. Taking any asthma meds?

My thought is that the respiratory events might be circadian in nature (hence, need about a month of detailed reports)(BTW, can you upload the first 3 pages of the detailed report?).

Since wheezing only occurs during during expiration (except in extremis), I don't think the algorithm would do anything differently tho, but a sleep disturbance could be created. Perhaps if you wake at about 4:00 - 5:00 AM, shoot a quick PEFR.

You won't feel great tomorrow, but you will feel better than you did today.

Ya THINK!?

If it weren't for that insightful analysis in that other case, I'd confiscate your dartboard.

[deltadave]

Hey deltadave,
You are using the avatar that SAG suggested for dsm.

I do not see where SAG offered any avatar suggestions for anyone.

However, that would be academic anyway since that poster lacks a sense of humor.

[ozij]

Hey deltadave,
You are using the avatar that SAG suggested for dsm.

I do not see where SAG offered any avatar suggestions for anyone.

However, that would be academic anyway since that poster lacks a sense of humor.

Not sure who you mean by "that poster", but you had me

[JIMCHI]

Used most of the settings last night recommended by Banned. Pres Max 28, EPAP Min 4, EPAP Max 15, PS Min 5, PS Max 15, Backup auto, Flex 0 (I have tended to do worse with Flex at 2).

Results are mixed. Too early to tell if I'm going to have poor symptoms I had yesterday. AHI dropped to 9, but Patient Triggered Breaths dropped to 93% and twice during the night the graph shows it dropped below 25%. Also had an issue when exhaling that it felt like there was little resistance- annoying and kept me from getting to sleep right away. Here's the Encore chart from last night.

[-SWS]

JIMCHI, please tell us how you felt by the end of the day...

I still think experimentally finding an optimal PS-min/EPAP-min combination makes exploratory sense. And toward discerning combinatorial pressure-vs-treatment patterns for the PS-min/EPAP-min pair, I would probably want to explore this 3x3 grid if I were in your situation:

PS min=5; w/EPAP min=4, 6, and then 8
PS min=6; w/EPAP min=4, 6, and then 8
PS min=7; w/EPAP min=4, 6, and then 8

Those nine PS-min/EPAP-min trials would certainly take a while. But that 3x3 grid should also help flush out a useful efficacy pattern of autoSV Advanced algorithmic-vs-manual treatment for both your obstructive and central components. I'd get my doctor in the loop for a proposed home-titration experiment like that...

But that grid attempts to "pattern flush" interplay among these dynamics: 1) central vs obstructive, 2) iatrogenic vs primary, 3) manual vs algorithmic treatment control. And based on what we've seen so far, there may be an optimal "treatment saddle point" waiting for you inside that 3x3 grid.


Good luck whatever approach you decide to take.



P.S. Here's an example of that 3x3 grid simultaneously tracking four different feedback variables:

[JIMCHI]

sws- I'm going to give this a try and will report results. Would you like me to post the results every day or just fill in the whole grid afterwards and then report ?

I felt much better today-- not perfect by any means, but yesterday was a disaster. It was similar to the night I set both the EPAP min and max at 6. I was almost non-functioning the next day- yesterday was probably worse.

Do you have any thoughts about that problem I reported from last night-- that when I exhaled it seemed like there was a little resistance for maybe a second or two and then it just went to a full uninhibited exhale-- disturbing when you are trying to get to sleep and maybe, subconsciously, when you are sleeping. What variable affected that?

[deltadave]

Can we offer predictions for the grid? I need to get ready for the NCAA B-Ball Tourney Brackets.

This will require a few assumptions, including that at least several days are spent on each setting (as noted, this is going to take a while), daytime functioning is based on the the Epworth Sleepiness Scale, and the testing order is run vertical (stay on EPAP 4 for 9 days and vary PS (3 days each setting), then EPAP 6 for 9 days, etc.)

Anyway....

All the AHI will be 9.0 - 10.0.
All the %Triggered will be 90-95%
All the Minute Ventilations will be 7.0 - 8.0.
For daytime functioning, all the EPAP 4.0s will be 14, the 6.0s will be 11, and the 8.0s will be normal (<10).

Good luck!

[Banned]

Anyway....

All the AHI will be 9.0 - 10.0.
All the %Triggered will be 90-95%
All the Minute Ventilations will be 7.0 - 8.0.
For daytime functioning, all the EPAP 4.0s will be 14, the 6.0s will be 11, and the 8.0s will be normal (<10).

Is that using my confiscated dartboard?

[deltadave]

Anyway....

All the AHI will be 9.0 - 10.0.
All the %Triggered will be 90-95%
All the Minute Ventilations will be 7.0 - 8.0.
For daytime functioning, all the EPAP 4.0s will be 14, the 6.0s will be 11, and the 8.0s will be normal (<10).

Is that using my confiscated dartboard?

(That's my LOL Emoticon. Remember, I like BIG).

However, in answer to your question, no, it is not, I do not have "Dartboard Advanced", only the earlier version, "Basic Roulette":

[Hellforge]

Извиняюсь Краткость, сестра таланта !!!

[JIMCHI]

Here's a link to an album with the 4 pages of the Encore Reports plus last night's data.

http://s1235.photobucket.com/albums/ff4 ... 03%202011/

[Pap Goat]

I'm new to the group. My settings should be in my sig.

I'm not saying it would be correct for you. My average AHI in 1 year 5 months is 5.8. I've had nights of 3 and nights of 8 AHI. As long as I feel OK I don't worry about tweaking.

I found this discussion when searching for the proper Min Vent setting. I opted with 3 my average being 6.5. I go in for total knee replacement surgery Monday the 7th and thought it would be best to turn my Apnea Alarm and Min Vent alarm on.

While I have the groups attention 3 seem ok? Then I'll let this get back to its point, the settings I shared in my sig.

[-SWS]

I'm new to the group. My settings should be in my sig.

I'm not saying it would be correct for you. My average AHI in 1 year 5 months is 5.8. I've had nights of 3 and nights of 8 AHI. As long as I feel OK I don't worry about tweaking.

I found this discussion when searching for the proper Min Vent setting. I opted with 3 my average being 6.5. I go in for total knee replacement surgery Monday the 7th and thought it would be best to turn my Apnea Alarm and Min Vent alarm on.

While I have the groups attention 3 seem ok? Then I'll let this get back to its point, the settings I shared in my sig.

Generally, a PS min of 3 is a-okay if it works well. What does your medical team think of your residual AHI and PAP settings? Generally, if a CompSAS patient can't achieve a residual AHI lower that a 5.8 average---while their sleep, oxygenation, and daytime symptoms are very good----then their treatment is successful IMO.

[-SWS]

Here's a link to an album with the 4 pages of the Encore Reports plus last night's data.

http://s1235.photobucket.com/albums/ff4 ... 03%202011/

JIMCHI, sorry I've been running terribly behind. I'll take a look and offer some comments later today. Also, deltadave has some really good comments going worth further discussion. Right now I'm trying to get un-backlogged in real life.

More later!

[Pap Goat]

I'm new to the group. My settings should be in my sig.

I'm not saying it would be correct for you. My average AHI in 1 year 5 months is 5.8. I've had nights of 3 and nights of 8 AHI. As long as I feel OK I don't worry about tweaking.

I found this discussion when searching for the proper Min Vent setting. I opted with 3 my average being 6.5. I go in for total knee replacement surgery Monday the 7th and thought it would be best to turn my Apnea Alarm and Min Vent alarm on.

While I have the groups attention 3 seem ok? Then I'll let this get back to its point, the settings I shared in my sig.

Generally, a PS min of 3 is a-okay if it works well. What does your medical team think of your residual AHI and PAP settings? Generally, if a CompSAS patient can't achieve a residual AHI lower that a 5.8 average---while their sleep, oxygenation, and daytime symptoms are very good----then their treatment is successful IMO.

I had to see my DME last week, my surgeon wouldn't do the knee replacement with out consent from him my apnea was under control. He said everything was fine. I had the other, right one done in Dec. 2009, I had my sleep test in Oct. I mentioned to the surgeons nurse I woke up all the time gasping for air. The surgeon would not do my right knee until I had a sleep test. I had mixed, only had 60 episodes per hour though.

3 seems like a good place to leave it, thanks.

By the way, my user name was suppose to be Papa Goat but for some reason I missed the last "A". And now I don't see how to change it. But Pap works LOL sense were all on some sort of Pap machine ha ha!