No Answers Yet For Problems With ASV

[BrianinTN]

Also, in Encore Pro 2.5, I have found that graphing Unintentional Leak never gives any data for the graph. You will probably want to switch that to Total Leak, which you can do in the settings. I forget where, exactly, off the top of my head.

I shall look into the setting in Encore Pro 2.5 and get that changed. Thanks for the information.

EDIT: FOR ENCORE 2.4.x ONLY: click on the "Company Settings" tab, and then the "Preferences" sub tab. Then click "Edit" at the bottom, and the 5th set of options are for "Large Leak." You can toggle it between "Unintentional leak" (Encore's guesstimate, since it doesn't know what mask you're using and therefore doesn't know the intentional leak precisely), or "Total leak."

That was nice. Or were you just coating me with fluffy flatter?!

You know us Southerners. We'd never tell...

[Paper_Nanny]

Also, in Encore Pro 2.5, I have found that graphing Unintentional Leak never gives any data for the graph. You will probably want to switch that to Total Leak, which you can do in the settings. I forget where, exactly, off the top of my head.

I shall look into the setting in Encore Pro 2.5 and get that changed. Thanks for the information.

It's not immediately obvious, so I'll save you (and future readers) the trouble of hunting: click on the "Company Settings" tab, and then the "Preferences" sub tab. Then click "Edit" at the bottom, and the 5th set of options are for "Large Leak." You can toggle it between "Unintentional leak"

I believe Brian just saved future readers the trouble of looking for the mask leak setting in Encore Pro 2 v 2.4.12.2

To change the setting in Encore 2.5, go to Company Settings tab, Calculations, Report. There is a choice between "Unintentional Leak" and "Total Leak". Choose "Total Leak", per adipasqu.

[adipasqu]

Is there any reason in particular you are using your machine in BiPAP mode with no back-up rate?{/quote]

Why yes, yes there is. Explanation is in post by Paper_Nanny on Thu Jun 30, 2011 7:49 pm. The posts immediately after and before that also are related to the reasons for running my machine that way.

Thanks for pointing me to the relevant information earlier in the thread. As always, I am not a doctor but I would like to give you some feedback on your data. I noticed in your latest data on your new machine that you have very little pressure variation (EPAP and PS) throughout the evening, which indicates to me your EPAPmin is too high. This is corroborated by your high CAI of 8.1, as too high of a pressure will cause more central events. Hyperventilation is over-breathing (i.e. over-inflating your lungs from too high of a pressure in use), thereby reducing the CO2 concentration in the blood to the point where spontaneous breathing is suppressed, producing central events. One way to counter this is to take more frequent breaths that are smaller in volume (increase ABR and decrease tidal volume in ASV speak), which decreases the amount of air exchanged from the lungs, allowing CO2 concentrations to build for spontaneous breathing. This is where ASV mode should help you by setting a backup rate to subconsciously "train" you to breathe more frequently. I would be curious to see what would happen if you dropped your EPAPmin to 4 cm and put it back in ASV mode (auto) for a few days. I'm willing to bet your ABR will go up, Vt will go down slightly, and your CAI will plummet. Just a thought...

-A

[Paper_Nanny]

Dena, the RRT who did my PFT today, did not know what a MIF or MEF were, so I did not get those.

Kinda like why Muffy said, "Be sure they get 'the thing' ".

You should eventually get a MIF - MEF. As a test of respiratory muscle strength, it is different from PFT and a more sensitive measurement of what needs to be tracked. One can have normal PFT and reduced MIP - MEP (especially MEP). However, don't need those values right now.

Right. That was my understanding, that those values weren't needed right now. Consequently, after posting this on 06 July @ 3:31 pm,

I called the hospital. The RT I spoke with said the Complete Pulmonary Function Test includes: Spirometry, DLCO, Plethysmography, and, if indicated, a breathing treatment with albuterol and a repeat of the Spirometry.

And how about a NIF?? Only if it is ordered separately.

I did not follow up on getting a separate order for the "The Thing." I have that on my list of things to discuss with MSD when I see him next month.

One thing I don't understand is-- MIF- MEF. NIF... NEF?? What is it I am going to be asking for?? I could just take in the picture of "The Thing" posted by NotMuffy and say, "This one. I would like to have this one, bitte sehr, Herr Doktor, Sir!"

Deborah, who keeps posting things, despite having had no time to think yet today.

[Paper_Nanny]

My guess would be that CA are treated under full ASV mode and get logged as hyponeas, whereas untreated they remain CA?

No, because even in BiPAP mode, the CA was not that high and hypopneas were high. See for example graph on 12 July 3:10pm.

Deborah

[Paper_Nanny]

...a trial of low-level CPAP would have been, as is now, a very viable option. Ask your guy that, I'd really like to hear the rationale for clubbing 41 obstructive events to death with an ASV

To set my machine to function like a CPAP, I would set Max Pressure= EPAP Max= EPAP Min with PS= 0? If not, how do I do it? What pressure setting do you think I should go with? I would try it for a few nights or so, to see what happens.

Deborah

[Paper_Nanny]

Thank you for sharing this data.

I'd share my data with you anytime, Mr. Bill! <still haven't found that eyelash batting smiley>

Funny thing is, I still haven't had a chance to look at the data, other than quickly admiring it as I checked that the link worked.

Deborah

edit to add second paragraph

[NotMuffy]

WTF??? I just clicked on the link, which has been removed.

You eat with that #@*!%ing mouth?

NBD, saved file last night.

One thing I don't understand is-- MIF- MEF. NIF... NEF?? What is it I am going to be asking for??

Got the directions from before? Hand 'em that and say "I need this".

Toward that end, when I call the sleep lab, what do I tell them I want? Raw data? Pulse Rate Graphic? *.edf?

NM. The waveform data pretty much answered everything:

• Is there an entity that would be appropriate to use ASV for (chain centrals)?
  
  There isn't.
• Could a reduced circulatory time contribute to Feedback Gain disruption?
  
  Doubt it.
• Did the NPSGs underestimate spontaneous arousals and sleep fragmentation?
  
  Probably.
• Is there anything in the waveform data that can be successfully attacked with an xPAP device?
  
  Probably not. You got 2 OAs there, and they look more like closed-airway centrals to me.
• So what up with them centrals?
  
  They all look like a normal response to something that is abnormal (like an arousal); or should be considered normal (like sleep-onset centrals); or are artifact.
  
  Your sleep continuity could be adversely affected by overly aggressive pressure attack, causing the aforementioned "spontaneous arousals".
  
  Or, your underlying architecture is poor based on the aforementioned drug cocktail, FBM, pain, etc.

[NotMuffy]

...StillAnotherGuest, aka Muffy, aka NotMuffy -- (has)... a sassy demeanor...)

Sassy!?

That does it!

I am totally offended!!

I'm turning all my posts into dots!!

OK, maybe I'll go with commas instead.

[NotMuffy]

...StillAnotherGuest, aka Muffy, aka NotMuffy -- (has)... a sassy demeanor...)

Sassy!?

That does it!

I am totally offended!!

I'm turning all my posts into dots!!

OK, maybe I'll go with commas instead.

Or tildes.

I like tildes.

[JohnBFisher]

...StillAnotherGuest, aka Muffy, aka NotMuffy -- (has)... a sassy demeanor...)

Sassy!?

That does it!

I am totally offended!!

I'm turning all my posts into dots!!

OK, maybe I'll go with commas instead.

Or tildes.

I like tildes.

Which would make it .... tidle-ating!

[ jbf ducks for cover !! ]

[Paper_Nanny]

Wave Form Data from 07-12-2011 has been uploaded. Follow this link...

https://docs.google.com/viewer?a=v&pid= ... w&hl=en_US

And here is the detailed information from last night:



Current Settings on Machine:
Backup BPM= 0/ Off
Pres Max=12
EPAP Max= 12
EPAP Min=8
PS Max= 4
PS Min= 0 (Because I can't get it set to 4. Why is that? I got it set to 4 on the other machine. Why is my new machine refusing to do that??)
Flex= 2

Back to sleeping in My Private Sleep Bubble aka FitLife Total Face Mask

edit to change link to image on detailed data

[Paper_Nanny]

WTF??? I just clicked on the link, which has been removed.

You eat with that #@*!%ing mouth?

No, no. I typed WTF. With my left hand. And I never touch food with that hand. Because that is my WTF typing hand. Unclean. No cussing with this mouth, where my food goes.

I used to do a lot of cussing. Lots and lots of it. But then, several years ago, I got to thinking that maybe it was a bad idea to eat with that mouth. I had a PEG tube put in. That took care of the problem. Cuss with the mouth, "eat" through the PEG tube. Once I quelled the cussing urge, I had the PEG tube taken out. Now it looks like I have two belly buttons. I tell people my PEG tube scar is a second belly button, from when I got born again. Born again into the cuss free me!

Hand 'em that and say "I need this".

Okay. I can do that.

[*]Is there an entity that would be appropriate to use ASV for (chain centrals)?

There isn't.

True or False. This is hypothetical, because I am not having chain centrals.

[*]Is there anything in the waveform data that can be successfully attacked with an xPAP device?

Probably not. You got 2 OAs there, and they look more like closed-airway centrals to me.

Where are they and why do they look more like closed-airway centrals than OAs?

[*]So what up with them centrals?

They all look like a normal response to something that is abnormal (like an arousal); or should be considered normal (like sleep-onset centrals); or are artifact.

Artifact meaning created by the machine and not really part of my wave?

Your sleep continuity could be adversely affected by overly aggressive pressure attack, causing the aforementioned "spontaneous arousals".

So, the machine attacks me with overly aggressive pressure, causing a spontaneous arousal, and my response is to have a central apnea??

Or, your underlying architecture is poor based on the aforementioned drug cocktail, FBM, pain, etc.

Or central auditory processing disorder causing spontaneous arousals?

So, what to do, what to do... That is the question. Given that there is nothing in the waveform data that can be successfully attacked with an xPAP device, should I give up the machine? Or give it up for a week or so to see if there is a subjective sense of lesser quality sleep/ increased daytime sleepiness?

Or try something else with it, to see what happens to the waveform data then?

Wondering and wondering...

Deborah

edit to correct grammar, spelling, and formatting problems.

[Paper_Nanny]

In the previous post, I made reference to my central auditory processing disorder. Though I'd provide some specific information about that. I think it was around 2005 or 2006, after one of MS exacerbations, I ended up with compromised ability to screen out background sounds. Another way to put it would be that my ability to selectively attend to sounds was messed up. All sounds have equal valence. Someone I know who uses hearing aids said it sounds a lot like how the old hearing aids were. The didn't just amplify what he wanted to hear, they amplified everything.

During every day life, I have a huge problem with things like a radio playing in the background when I am having a conversation with someone, paying attention to what someone is saying in an environment with a lot of background noise. For example, when I am at a store, paying attention to what the cashier is saying is very difficult, because I have so much trouble tuning out the background noise. It is one of many things that contributes to my fatigue level.

At night, when I am going to sleep, the central auditory processing problems are a huge issue. So much trouble getting to sleep because I can't stop hearing all the sounds. Husband breathing, dog sighing, wind blowing, neighbors laughing, cars going by, train whistle, etc. etc. I tried ear plugs, but they just dull the noise, not take it completely away. And, with ear plugs in, there is a tremendous amount of noise from... I'm not really sure what all it is. My pulse, my breathing, my body expanding and contracting as it aligns itself to the magnetic poles...

That is how I ended up on Trazadone. The trazadone basically steps in and says, "Stop now!! Silence inside! Quiet. Peace. Sleep.

So why I mentioned Central Auditory Processing Disorder in my previous post is that I wonder if that would account for at least some of the spontaneous arousals. Maybe that part of my brain is still listening, despite the drugs? Or maybe the drugs have started to wear off by then? Or maybe the arousals have nothing to do with auditory processing.

In addition to the Central Auditory Processing Disorder (which is really long to type. I think I am going to abbreviate it as CAPD from now on.) I think I have some level of processing disorder with other senses, too. Obviously sight wouldn't be playing into the game while I'm sleeping, but smell, touch, proprioception, all of those are issues at various times when I am awake. Not as much ast the CAPD, which is always there, to some degree. With the other ones, they come and go and are never as horrible bad as the CAPD, but maybe they distract my brain while i am sleeping.

TMI? SBI. Ta Ta. ... --- ... or maybe ... ~~~ ... would be better?

Deborah

[Paper_Nanny]

BTW, I'd also check with the pharmacist about the modafinil-tizanidine and trazodone-methylphenidate combos.

Called shortly after reading your post. She'll get back to me.

When I went to the pharmacy yesterday, I asked about this, as I had not yet heard back from Holly, my favourite pharmacist and the one I had asked about this. Holly was gone for the day and will not be in today. I will check back with her tomorrow and see if she found anything.