Titration study + New machine (ASV) UPDATE w/ doctor

[sleepinow]

BTW - do you have the software necessary to look at your results each day?
It is possible to get a link to the download.
If you are using a Windows machine, then the process can be straightforward - with a Mac, it's apparently a little complicated.

If you need the software, post a separate message requesting help.
Can you adjust your equipment list to indicate which model number you have - 950 or 960. Take out the humidifier tank if you have one, turn the machine upside down and it will be there on a little label.

One last note: did your sleep study mention anything about restless leg symdrome or periodic leg movements.
Both of these can cause partial arousals during the night and you ASV machine will react with a pressure increase under some circumstances that may be waking you up.

Yes I have both sleepyhead and the company program lite version. Thanks I will update the machine information even further

I took the home study test which I believe is crappy but it did detect some of my apneas and I had a diagnosis of sleep apnea from it. I do not think the device was capable of knowing if I had restless leg syndrome

[sawinglogz]

How can I tell if I mouth breathe? Does the data place it under as leaks? I usually do not wake up with a dry mouth but I do notice that I sometimes wake up at night with drool on my pillow

If you're mouth breathing, the air will leak out your mouth unless you're using FFM or hybrid.

If you're leaking, your ASV will start cranking up the pressure to compensate. You'll probably wake up and notice.

So look at your chart for leaks. The first time I tried nasal pillows, I had major leaks whenever I mouth-breathed.

[sleepinow]

I am not sure if my data will show leaks because my EPAP pressure is pretty low 5.5 (I did the pressures myself). How do I read leak data and how can I tell if my leak is significant enough to worsen my therapy?

One thing I do notice however is that sometimes when I wake up I notice that my EPAP pressure is increased. I however do not know if it is because of consecutive apneas, leaks, mouth breathing, or a too low standard EPAP pressure

Can exercising increase my mouth breathing?

I will look at the data tomorrow and/or post it tomorrow on here. Thank you all so much for being helpful in trying to see what my problem is. I really appreciate it

Oh and what should I expect when going from a nasal to a full face mask on a ASV unit. Like would it take over two weeks to get used to? Should the mask fit a little loose like the swift fx? I bought a Quatro Fx or something like it for backup purposes and hope that it will be sufficient if I do have to switch mask types. (But darn, the thought of getting used to a new mask especially one that covers the face is bad)

[sawinglogz]

I am not sure if my data will show leaks because my EPAP pressure is pretty low 5.5 (I did the pressures myself). How do I read leak data and how can I tell if my leak is significant enough to worsen my therapy?

There's a leak chart in Encore Pro when you view the night's details.

One thing I do notice however is that sometimes when I wake up I notice that my EPAP pressure is increased. I however do not know if it is because of consecutive apneas, leaks, mouth breathing, or a too low standard EPAP pressure

I'm not sure what it uses to decide its favorite EPAP, but mine seems to creep up about 1 cmH2O during the night. I can see it on the charts, but I don't see why it's doing it.

If the increased pressure makes it hard to fall asleep, I press the ramp button.

Oh and what should I expect when going from a nasal to a full face mask on a ASV unit. Like would it take over two weeks to get used to? Should the mask fit a little loose like the swift fx? I bought a Quatro Fx or something like it for backup purposes and hope that it will be sufficient if I do have to switch mask types. (But darn, the thought of getting used to a new mask especially one that covers the face is bad)

You might try the Mirage Liberty. It's a hybrid (nasal pillows + mouth cover). That might be an easier transition coming from nasal pillows. Technically it's not rated up to 25 cmH2O, but I never get near that limit.

I switched to the hybrid from the FFM because I didn't like the air leaking around the bridge of my nose, and any pressure on my nose makes my sinuses stop up.

Most of the challenge will be finding positions that don't nudge the mask/headgear to the side & cause a leak. Nasal pillows are so small that that's less of an issue.

[sleepinow]

Thanks for your helpful information. I will report my leak data to see if anyone can determine if it can cause a wake up

[JDS74]

It might be helpful if you could post your treatment settings so we could see wht might be causing you to spontaneously wake up. You mentioned the Min EPAP number but the others do matter. Can you get to your providers menu so you can see what the values are?

Here is a list of the paramenters for the AutoSV Advanced machine.
Min EPAP: 5.5 CmH20
Min Pressure Support:
Max EPAP:
Max Pressure Support:
Max Pressure:
Flex Setting:
Backup Rate:
Humidification Mode:
Humidifier Setting:

If your minimum presssure support is high and you experience a central episode, the pressure drops immediately to the min EPAP and swings back and forth. In my case my pressure can swing back and forth between 10 CmH20 and 25 CmH20 as the machine tries to breath for me. I am fortunate that this swing doesn't wake me but some are not so lucky or that well adapted to the ASV machine actions. It apparently takes some quite a long time to get used to the pressure swings. That may be what is going on with you.

[sleepinow]

Okay so I have taken the time to take two nights worth of sleep information randomly chosen in December 26 and January 03. So if anyone can please point out of any probable causes to my lack of sleep during exercise that would be great. I did do some shoveling and running up stairs around the time of these posted days so it should be able to show something. Here goes hoping for the best

December 26, 2013








January 03, 2013








Okay and I have looked at these two nights on encore program and I said that on December 26 my average EPAP was 5.8





So if anyone can help me determine anything abnormal please do so. I can not tell of any big leaks but maybe you can, thanks

[sleepinow]

It might be helpful if you could post your treatment settings so we could see wht might be causing you to spontaneously wake up. You mentioned the Min EPAP number but the others do matter. Can you get to your providers menu so you can see what the values are?

Here is a list of the paramenters for the AutoSV Advanced machine.
Min EPAP: 5.5 CmH20
Min Pressure Support:
Max EPAP:
Max Pressure Support:
Max Pressure:
Flex Setting:
Backup Rate:
Humidification Mode:
Humidifier Setting:

If your minimum presssure support is high and you experience a central episode, the pressure drops immediately to the min EPAP and swings back and forth. In my case my pressure can swing back and forth between 10 CmH20 and 25 CmH20 as the machine tries to breath for me. I am fortunate that this swing doesn't wake me but some are not so lucky or that well adapted to the ASV machine actions. It apparently takes some quite a long time to get used to the pressure swings. That may be what is going on with you.

Thanks for the reply. I have placed those settings in my signature. I do not know what Backup Rate is, but I have a feeling it is BPM which I have on Auto

[JDS74]

You show large leaks at about the same times as the system is in ventilator mode and the pressure peaks. I suspect that is what is waking you up. If that is the case, time will help get used to this new type of device. "regular" CPAP and APAP devices don't have these types of pressure swings that cause this kind of difficulty. It likely will get better.

On December 26th at about 4:00, you have a spike in the leak rate that corresponds with a pressure spike in ventilator mode.

I also suspect that the numbers that SleepyHead shows for EPAP, IPAP, and pressure support are incorrect since you baseline exhale number shown on the graphs are near the 5.5 CmH2O you report.

You entered 5 CmH20 for the max pressure. Is that a typo and the 2 just didn't get entered? Should it have been 25 CmH20 instead?

Check with your sleep doctor or respiratory therapist to see if the min EPAP number should be increased so that max swings that occur are smaller. It kind of looks like the Min EPAP might be something like 6.5 CmH20 or the min pressure support increased to 1 CmH20 from 0 CmH20 as you have noted.

I am not a medical professional and am pretty recently in the ASV game so don't dial wing this stuff youself. Get competent medical advice.

[sleepinow]

Sorry about that. I have the changes. My Max pressure support is 5.0 and MAX Pressure is 20.0 not 25.0

I always considered needing a higher pressure. I did one time increase it from 5.0 because it felt as if I was breathing through a small tube at times. I have an appointment on the 16th so I will talk to my polmonoligsit or however you spell it about doing a titration study. Something I should have done a long time ago. Thanks for your support. I really like how the CPAP community is responsive and supportive. The more information I receive the better

[JohnBFisher]

sleepinow, I definitely agree with jds74, it's time for that titration study. You need both the process and the instrumentation measuring your sleep to get your settings correct.

[sawinglogz]

For some reason I'm only seeing 180x100 thumbnails. JDS74, how did you see that much detail?

A few other notes:

Assuming you have the DS960, SleepyHead doesn't work with it, so those charts will be mostly junk, and only the Encore Pro screens will show anything useful.

Also, your pressure support range seems completely off. A PSmin of 0.0 is very unusual, as is such a low PSmax. What the machine wants to do in ventilation mode is crank up the pressure support until you start breathing again. The way you've got yours configured, it can only go up to slightly higher than my MINIMUM pressure support. I don't know what the machine does in that case, but it might very well end up cranking up the EPAP to try to compensate.

I agree with others here: have a titration study so that you can at least get initial settings. And exercise that day, so that they can see you at your worst.

[sleepinow]

Thanks guys and the minimum pressure support gives a boost of pressure on every breath. So basically every breath you take there is a boost of pressure which probably prevents any chance of oncoming central apneas or hypopneas. The max ps usually goes to work when you stop breathing and then the machine triggers an even bigger force of air to try to get you to breathe again. I may be wrong but I have exerimented with certain settings to see their funtionality and what I jave described to you is exactly what they did to me

I can not wait to go see my doctor on the 16th and request to have a sleep study done. You guys have helped me alot thanks!

I have the ds650 but I heard it has problems like the 660 so from now I will stop using the Sleepyhead program

[JDS74]

I think you have the model number incorrect. The SleepyHead charts indicate a 950 not a 650 which in not an ASV machine.
I would continue to use SleepyHead until you get a copy of Encore Pro or Encore Basic so that the averages data display correctly.

It appears that the graphic information is useful and you should take a copy to your pulmonologist when you see him on the 16th and discuss the sudden increases in pressure that may be resulting from a failure to take a breath on time (most likely) or the beginning of a central apnea (less likely).

A titration study will resolve the issue of the need to correct the min EPAP value and / or include a min Pressure Support value in your settings. You can also discuss with him the utility of limiting the pressure rise for a while as you get used to this type of therapy and then, later, increasing the numbers to get to effective treatment. I've got no suggestions on what interim values might be appropriate for you but anything that increases the chances of good compliance, even if not optimal, may help get you past these initial difficulties. Other than that, it's a matter of toughing it out until your body gets used to this very different type of apnea therapy. I'm one of the lucky ones in this regard. JohnB's experience may be more toward the norm in this adjustment period as it took him some period of time to get used to this therapy. He is in a better postion to describe his adjustments.

Please check back in and keep us posted on your progress.
Do hang in there, it can be made to work.

Sawinlogz: I'm not doing anything different from just looking at the graphics. It looks the same to me on my desktop as well as on my iPad. I think your problem must be local to your monitor settings. Wish I had a better explanation of what is interfering with your ability to see his graphics.

[JohnBFisher]

... Other than that, it's a matter of toughing it out until your body gets used to this very different type of apnea therapy. I'm one of the lucky ones in this regard. JohnB's experience may be more toward the norm in this adjustment period as it took him some period of time to get used to this therapy. He is in a better postion to describe his adjustments. ...

At this point I think sleepinow needs to do more than just wait. He's done a yeoman's job of hanging on for dear life. One thing I go back to is that he has so much more problem after exercise than without exercise. Something else (perhaps restless legs or the like) is at play here. And it's not way beyond either waiting or our ability to help. But sleepinow is headed toward what can help.

And, yes!, do keep us updated.