Help with ASV report

[Kody]

Hi Guys, had another thread asking about AHI's, and Pugsy suggested I start a new one and post a Daily report screen shot from my Encore Viewer software.
Would just appreciate some insight into why my AHI"s are still so high. They range average anywhere from 10 to 16. I started my sleep study with AHI of 25, and a low 02 level of 78. Had obstructive apneas and was started on regular CPAP, but the increased pressures brought about centrals. So they diagnosed me with complex sleep apnea and have me on a Respironics BiPAP Auto SV Advanced, and am using a ResMed Mirage Quattro full face mask. They didn't sleep lab test me with the new machine, saying they could tweak it after awhile on it as necessary, so I think the ranges are a guess on their part for now. Thanks for any advice you guys can give me on this.

[ameriken]

Welcome Kody. Good question, I'm dealing with the same thing and your report looks a lot like mine, especially with the low PTB's. I know it's possible to get below 5 consistently, but from what I understand, it may take a while. I've been on 3 months and my AHI varies from 3 or 4 up to 10 to 12. We've got one of the best, if not the best machine out there for centrals and other wierd breathing issues. Maybe together we can figure this thing out.

[ameriken]

Here's a pretty typical night for me:

[JohnBFisher]

... had another thread asking about AHI's, and Pugsy suggested I start a new one and post a Daily report screen shot from my Encore Viewer software. ...

Well, I missed your previous post. Sorry.

... Would just appreciate some insight into why my AHI"s are still so high. They range average anywhere from 10 to 16. I started my sleep study with AHI of 25, and a low 02 level of 78. ...

While your AHIs are still high, almost all of it (99%) is due to hypopneas. That's not too big a deal. It typically does not lead to low O2 levels. I supect the low O2 level was only associated with obstructive and central apneas.

... Had obstructive apneas and was started on regular CPAP, but the increased pressures brought about centrals. So they diagnosed me with complex sleep apnea and have me on a Respironics BiPAP Auto SV Advanced, and am using a ResMed Mirage Quattro full face mask. ...

Well, that and the Resmed ASV units are the gold standard for helping address central sleep apnea (in all its forms).

... They didn't sleep lab test me with the new machine, saying they could tweak it after awhile on it as necessary, so I think the ranges are a guess on their part for now. ...

Ugh! I am certain they had their reasons, but it's definitely not the protocol. The good news is that it appears you are not suffering too much. The apneas are not too bad. The hypopneas could be better. I bet the lower EPAP pressure is too low. However, they should be able to see from the data and then increase your pressure a bit.

... Thanks for any advice you guys can give me on this. ...

Sure ... I'll give it a swing ..

Min EPAP of 6 is VERY low, when the 90% EPAP pressure is 11. I suspect bumping your Min EPAP value to 8 or 9 would help reduce your hypopneas. However, it might also trigger more central apneas ... so don't change it on your own.

Patient Triggered Breathing (PTB) is a classic sign of central apnea problems. But the machine steps in and addresses your problems, so don't worry about it. And it's not as bad as if it had to do that all the time. On my bad nights that seems to be the case for me. It already killed the bearing in one unit (fortunately still under warranty!!).

Lots of Hypopnea and Vibratory Snoring ... A another sign the Min EPAP is too low. But with Complex Sleep Apnea Syndrom (ComplexSAS), bumping the pressure up can be the WRONG thing to do.

Leaks - looks great.

Breathes Per Minute - Looks great (stays in the normal 10-20 range).

Minute Ventilation - Stays fairly steady.

It all looks good. Now for the real question. How do you FEEL? Remember, the machine only records your breathing. There could be a LOT more going on during your sleep that is robbing your of restful sleep. So, how do you feel?



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[pharm30]

mine looks very similar to yours. I seem to have mostly hypopneas..AHI avg for the week is usually around 8.
Kind of funny, my girlfriend thinks I'm obsessed with my "meaningless" data, she just asks how do you feel?
I don't really feel rested per se, but I think my recovery from exercise seems quicker and stamina seems better.

[Kody]

Welcome Kody. Good question, I'm dealing with the same thing and your report looks a lot like mine, especially with the low PTB's. I know it's possible to get below 5 consistently, but from what I understand, it may take a while. I've been on 3 months and my AHI varies from 3 or 4 up to 10 to 12. We've got one of the best, if not the best machine out there for centrals and other wierd breathing issues. Maybe together we can figure this thing out.

Thanks ameriken, yes your right the reports do look very similar. I'm almost through my second month with this machine and the data has stayed pretty much the same. It's weird that our AHI's fluctuate so much, that was the part I wasn't getting, thinking there would have to be some concrete reason for it to swing so much. Keep at it and let me know how your doing with all this, I'll do the same.

[Kody]

Sure ... I'll give it a swing ..

Min EPAP of 6 is VERY low, when the 90% EPAP pressure is 11. I suspect bumping your Min EPAP value to 8 or 9 would help reduce your hypopneas. However, it might also trigger more central apneas ... so don't change it on your own.

Patient Triggered Breathing (PTB) is a classic sign of central apnea problems. But the machine steps in and addresses your problems, so don't worry about it. And it's not as bad as if it had to do that all the time. On my bad nights that seems to be the case for me. It already killed the bearing in one unit (fortunately still under warranty!!).

Lots of Hypopnea and Vibratory Snoring ... A another sign the Min EPAP is too low. But with Complex Sleep Apnea Syndrom (ComplexSAS), bumping the pressure up can be the WRONG thing to do.

Leaks - looks great.

Breathes Per Minute - Looks great (stays in the normal 10-20 range).

Minute Ventilation - Stays fairly steady.

It all looks good. Now for the real question. How do you FEEL? Remember, the machine only records your breathing. There could be a LOT more going on during your sleep that is robbing your of restful sleep. So, how do you feel?

John, thanks so much for your input. I feel much better about things now, was kind of freaked out about the still high AHI's I was having. However as you point out, I am also thinking it could be the lower EPAP pressure contributing. I will know more in a few weeks when I go back to the Sleep Dept. and see what they have to say, and maybe make a few adjustments. I really appreciate your input thanks again.

[Kody]

mine looks very similar to yours. I seem to have mostly hypopneas..AHI avg for the week is usually around 8.
Kind of funny, my girlfriend thinks I'm obsessed with my "meaningless" data, she just asks how do you feel?
I don't really feel rested per se, but I think my recovery from exercise seems quicker and stamina seems better.

Sounds like were feeling about the same. I do feel MUCH better since using the machine, and the morning headaches are much less than they used to be as well.
I know what you mean about your girlfriend asking you about the "meaningless data" thing. It's just the more we can learn about this the better it should be treating it.
My Wife got tested AFTER me, was diagnosed with Mild Apnea, (AHI's of 10), got her regular CPAP machine, her AHI levels immediatly dropped to 0.5 and stay that way!! It took me about 7 months of sleep studies, waiting for this, waiting for that, and after all this I still have levels higher than we she even started CPAP! lol... Just goes to show you I guess everyone is different with SA and nothing seems to be black and white. Good Luck with your therapy.

[BrianinTN]

Hi Kody. We see this a **LOT** among people with the Respiroics ASVs on this board. Like you, it's almost always a lot of residual hypopneas. (That's a good term to type in the search box above, by the way, if you want to view posts about the same thing.)

In my case, the numbers did improve with two things: (1) months of time, and (2) switching to a nasal pillow mask. I have separate issues with intolerance of positive airway pressure as a modality, but I generally have a low AHI on nights when I can use my ASV.

It would be helpful if you linked more nights of data. However, based on the available data, I'd say that JohnBFisher's advice and analysis would appear to be (as usual) spot on.

[Kody]

Hi Kody. We see this a **LOT** among people with the Respiroics ASVs on this board. Like you, it's almost always a lot of residual hypopneas. (That's a good term to type in the search box above, by the way, if you want to view posts about the same thing.)

In my case, the numbers did improve with two things: (1) months of time, and (2) switching to a nasal pillow mask. I have separate issues with intolerance of positive airway pressure as a modality, but I generally have a low AHI on nights when I can use my ASV.

It would be helpful if you linked more nights of data. However, based on the available data, I'd say that JohnBFisher's advice and analysis would appear to be (as usual) spot on.

Thanks for the info. I did search on those terms and read quite a bit. There seems to be a lot of good opinions and other information that is helpful. It's good to know I'm not alone with the quest to figure out all the finer points of the ASV's and readouts. Speaking of that here is another from the hit parade since you said another would be helpful. Thanks again, you guys are a great help in sorting through all of this.

[ameriken]

When I did my titration on the ASV, the tech told me 'you've got the whole potpourri of breathing issues, as do most people who need the ASV', which is why we're prescribed this type of machine. They're quite amazing machines that tackle some really complex breathing patterns and problems.

JBF also asked 'how do you feel'. I used to get so tied up in the charts that I would forget to simply guage how I am feeling. Plus, sometimes how we feel doesn't match what we see in the charts. In another thread I once asked why is it I can have an AHI of 10 or 11 and feel great, and then have an AHI of 3 or 4 and feel lousy. As it was explained, the missing part of that equation is how long the apneas may last. An AHI of 3 with 120 second apneas will have a greater affect than an AHI of 10 with 11 second apneas, and the length of the apnea is not scored by the machine. Plus as JBF said, there may also be other factors affecting our sleep that we've got to keep an eye on.

[Mr Bill]

Hi Kody, welcome to the board. If you can get to sleep, I would not worry too much for now. Once you have been getting better sleep for a while, then you might consider fiddling. Most of us have a break in period where it takes a bit of time to convince the sleeping mind that the mask is not just OK but GOOD. I actually have a lower EPAP than you do but mine are mostly central. It took me over 4 months to get to where I could sleep the whole night with the mask on. At the moment, as John suggested, you should ask yourself, how do you feel. If its pretty good then keep on that line for a while. In my experience, the hardest thing is getting asleep and staying asleep. If you are doing that, you may see those AHI'c come down on their own as your body gets used to getting enough breaths resets to expect higher oxygen levels. You may then find yourself with less hyponeas. Good Luck and keep posting.

[Kody]

ameriken what your saying about the length of the AHI's vs the amounts sounds pretty credible I think.
The night before last I had AHI's of 10 and didn't feel all that great. Last night it went up to 14, but I actually feel very good today! What is weird I'm starting to notice is looking at the nightly report the next day, it is showing hypopneas right after I put the mask on BEFORE I go to sleep. I wouldn't think it would be possible to have those while your awake, so maybe the AHI count is not really 100% correct after all as someone else pointed out.

Mr. Bill thanks for the good advice I will keep at it and maybe my breathing will get better with the machine the longer I go. I can get to sleep pretty quick after putting on the mask. The only part so far I'm not thrilled about, is the strap marks and red marks on the bridge of my nose when I wake up. looking in the Mirror, not sure weather I slept on a pillow, or face down on a chain link fence!

[BrianinTN]

Thanks for the info. I did search on those terms and read quite a bit. There seems to be a lot of good opinions and other information that is helpful. It's good to know I'm not alone with the quest to figure out all the finer points of the ASV's and readouts. Speaking of that here is another from the hit parade since you said another would be helpful. Thanks again, you guys are a great help in sorting through all of this.

From both screenshots, you appear to have substantially fewer hypopneas during the parts of the night where the ASV is keeping your EPAP higher. And while a couple obstructive apneas over the course isn't too big of a deal, it's interesting to note that the two you had in your latest report both came at times when the ASV had ratcheted your EPAP down too. I personally don't require a very high EPAP at all, but I believe I am in the minority among ASV users.

Hopefully you'll be able to get some input from your doc soon and he can make some tweaks to your therapy.

[Mr Bill]

ameriken what your saying about the length of the AHI's vs the amounts sounds pretty credible I think.
The night before last I had AHI's of 10 and didn't feel all that great. Last night it went up to 14, but I actually feel very good today! What is weird I'm starting to notice is looking at the nightly report the next day, it is showing hypopneas right after I put the mask on BEFORE I go to sleep. I wouldn't think it would be possible to have those while your awake, so maybe the AHI count is not really 100% correct after all as someone else pointed out.

Mr. Bill thanks for the good advice I will keep at it and maybe my breathing will get better with the machine the longer I go. I can get to sleep pretty quick after putting on the mask. The only part so far I'm not thrilled about, is the strap marks and red marks on the bridge of my nose when I wake up. looking in the Mirror, not sure weather I slept on a pillow, or face down on a chain link fence!

Its typical for most people to experience hyponeas and centrals as our body switches its CO2 sensitivity from waking levels to sleeping levels. Now strap marks, that should not be happening. If you have one of the masks with a soft silicon inner seal, you do not need to have the mask on too tight. In fact it will seal more poorly if its too tight. Strap the mask on while the machine is on and then loosen the mask till that inner seal inflates. Keep loosening till it starts leaking. Then move it around on your face and if you get leaks, tighten the straps just a little. It should feel pretty loose when you are all done. Having it a little looser will keep your sinuses from feeling compressed and you will breath easier and with less anxiety.