Help reading ASV data from Sleepy Head

[DavidT]

Any thoughts on Pat. Trig. Breathing? This is all new to me...I'll try to post some other shots...anyway to fit more into one picture?

[Pugsy]

You might add "ASV" to your topic line to grab the attention of the ASV users.
Yes, you can add as many images as you wish. Just keep adding the url address lines....each one below the previous and the images will all show.
Sorry, I don't use ASV machine so I am no help with Patient triggered breathing.

[DavidT]

Any thoughts on the mask leak..they had me switch and try the Mirage FX

[DavidT]

Pugsy thanks for your help. The only way I figured out how to post images was from reading your past posts on the topic. Thank you.

[Drowsy Dancer]

Any thoughts on Pat. Trig. Breathing? This is all new to me...I'll try to post some other shots...anyway to fit more into one picture?

I believe the left-hand scale is expressed as a percentage. If so, that graph is expressing what percentage of your breathing occurs spontaneously, as opposed to the ventilator kicking in. "Pat.Trig."="patient-triggered."

If your question is asking for a more sophisticated interpretation, I got nuthin'.

[Pugsy]

What percent is the Patient triggered breathing?
Can you go into SleepyHead and "detick" the graphs that are in the way that you don't need at the moment?.
Easy to do so you can fix it so you see the events...pressure...and patient triggered breaths in one image.

Lower right..Event flags...expand that menu and detick those other graphs so you can cut down on the scrolling.

[JohnBFisher]

Any thoughts on Pat. Trig. Breathing? This is all new to me...I'll try to post some other shots...anyway to fit more into one picture?

Greetings! Welcome to the ASV club. Do you know why your sleep doctor put you onto an ASV unit? For example, do you have central sleep apnea, periodic breathing, or complex sleep apnea?

The Patient Triggered Breathing is just what it implies. You were breathing frequently enough that the machine did not start to act as a ventilator and ramp up the inhalation pressure to sustain your respiration. Do you know what your Breaths Per Minute (BPM) setting is? For example, if your BPM setting is 12, then it might just indicate that you did not breathe frequently enough (on your own) to attain 12 breaths per minute. In that case the machine would step in and try to be certain you breathe at least 12 times per minute.

You might be wondering what an ASV is anyway - besides *really* expensive. An Adaptive Servo-Ventilator (ASV) unit is a cross between an automatic BiLevel machine (with an inhalation and exhalation pressure that is different) and a ventilator. When you fail to breathe or stop breathing, it increases the inhalation pressure to force air into your lungs to help you remove CO2 from your blood stream. You see, with various types of breathing problems our bodies set up an undershoot / overshoot cycle that repeats over and over and over. The ASV intervenes and breaks the cycle by sustaining respiration.

What happens is that for some reason you fail to breathe as you should. During this undershoot side of the cycle the CO2 builds up in your blood stream. At a certain point your body kicks in and restarts your respiration. But now you have too much CO2 built up in your blood stream. So, it overdoes it a bit. You hyperventilate a little bit. And it your body blows off more CO2 than it really should. This is the overshoot side of the cycle. And as the name implies you blow off so much CO2 that it actually suppresses normal respiration. Bang! There you are suddenly into the undershoot side of the cycle. This repeats over and over and over ... unless something intervenes and restores normal respiration. And that is what the ASV unit does. Even if you fail to inhale, it switches to inhalation pressure and rapidly increases that pressure until enough air is moved through your lungs to expel some of the CO2. This helps break this cycle.

So, for some reason, the machine felt you were not breathing when you should and it intervened. Your patient triggered breathing fell below 100%.

Hope that helps.

[JohnBFisher]

Any thoughts on the mask leak..they had me switch and try the Mirage FX

Yup. You should call your DME and ask about the mask leak.

Do you have a bed partner? Do you know if your mask was leaking badly when that happened.

Since you are using a full face mask (at Mirage Quattro FX Full Face Mask - is what I assume you meant), you are probably not loosing pressure due to a mouth leak. Instead it is more likely you are loosing pressure because of a leak around the face. When the ASV unit ramps up the pressure, it can cause just about any mask to leak. This can cause these masks to squeak and squawk, not to say anything about the "face fart" sounds. All of which can be very annoying while you are trying to sleep.

One way I've found to help fight those mask leaks is to use a mask liner. You can purchase a mask liner from any of the following sites:

http://www.remzzzs.com/
http://quietusliners.com/
http://padacheek.com/

I have used both the REMzzzs and the Pad-A-Cheek liners. Both work well. I've not personally used the Quiet-Us-Liners, but others here have.

In all three cases, the mask liner does not fully stop the leak. Sometimes it leaks just as badly, but does not make as much noise. But it does tend to decrease the level of most leaks. One advantage of these is that the mask liners tend to decrease the face oils, dirt and such that tends decrease the life of the silicone mask cushion. Thus, I've found that with the liners the cushion tends to stay a little more pliable a little longer.

Also as a note, Though the REMzzzs recommend using one per night, I find I only need one per week, reusing it for the week. It saves money and (at least for me) is as effective.

Hope this helps.

[Pugsy]

Regarding mask leak. Respironics machines gather Total Leak data for SleepyHead to report.
So vent rate plus excess leak. Respironics doesn't flag a Large Leak (big enough to impact therapy) until somewhere around 85 to 90 L/Min. SleepHead's leak graphs look pretty impressive due to the scale shown. If this were an Encore report the leak line would look much less impressive. I have examples in another thread recently if you want to see them.

Part of your increase in leak, which BTW never reached 40 L/min, is also due to the increased vent rate due to the increase in pressure to 15 cm. Part of it is simply because at the higher pressures the mask will be harder to keep a good seal.

So from a numbers perspective with your leak.....they are well within acceptable guidelines and unlikely to cause a negative impact on therapy since the worst it was happened to be less than half of Large Leak territory.

Now if any leak..even if small..disrupts sleep, that is a different story. We want to limit sleep disturbances as much as possible.

Edit to add one comment. Even when we do see an short spike into Large Leak territory or above it isn't the end of the world. A short lived spike isn't going to make a huge difference in the overall effectiveness of the therapy. We just don't want to spend a prolonged amount of time in Large Leak territory. I often see a brief spike (maybe a couple of minutes to 5 minutes) sometimes pushing Large Leak and sometimes way past Large Leak line. Probably when my nasal pillow pops out from movement in bed. As long as I don't spend much time there..I shrug my shoulders and move on. It is very rare that I spend more than 15 minutes in Large leak territory.
I add this comment so that people don't freak out when they see a couple of spikes (or even a few) beyond ideal. Some people are lucky and have nice perfect straight line leak....others don't but unless massive leak for a prolonged period of time..it isn't the disaster that one might think it is.

[JohnBFisher]

... So from a numbers perspective with your leak.....they are well within acceptable guidelines and unlikely to cause a negative impact on therapy since the worst it was happened to be less than half of Large Leak territory.

Now if any leak..even if small..disrupts sleep, that is a different story. We want to limit sleep disturbances as much as possible. ...

Great post and good points.

[DavidT]

Thank you both for responding.

That explains why the display on my machine says Large Mask Leaks 0%. I was wondering about that.

John,
To answer your questions. My doctor put me on ASV, because during my sleep study (split night) I had one OSA and they introduced CPAP. Once CPAP was started, I had several Central episodes. My sleep lab and primary doctor said I qualified for ASV right away, which is pretty quick compared to other CPAP users I've been reading about. I'm 44, slim and in good physical shape with no high blood pressure or any other underlying health problems that we know of.
My sleep studen was about 2 hours pretreatment and 4 hours on CPAP.

[JohnBFisher]

... My doctor put me on ASV, because during my sleep study (split night) I had one OSA and they introduced CPAP. Once CPAP was started, I had several Central episodes. ...

Which means you have complex sleep apnea. Fortunately your doctor is aware that ASV is the gold standard for treatment of complex sleep apnea. Essentially in the presence of added pressure (1 atmosphere of pressure is pressure, after all), your body senses the added pressure as something that depresses the normal respiratory drive. Regardless of the cause the cycle of undershoot/overshoot occurs. And the ASV is the best therapy to break that cycle (per several studies).

Here's hoping you are able to find good sleep with your ASV unit. I know it's been a godsend for me.