Machine or man?

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I can't add much being a newbie except that my S9 is almost silent. I'm not sure if you are hearing machine noise or just worried about ambient noises waking you up but maybe a "sound machine" instead of earplugs would be worth a shot.

I've been sleeping with a sound machine set to white noise for years to knock out ambient noises waking me up.

Thanks waxteeth yes I have had trouble with noise before as I find not getting on with CPAP makes me sleep like I do untreated, and untreated I can wake at the drop of a pin. I often wear earphones in at least one ear to help with noise.

By blown up! I meant the sudden gust of air the asv sends down the pipe when you don't breathe in time. It has stopped me from sleeping with it and I think that was responsible for each of my wakes last night. But I also had similar issue on APAP when that would jump in pressure so there you go

If I could solve these wake ups I think my therapy would be as successful as it was back in January for those brief 3 weeks. Successful to me means waking up feeling refreshed and with energy throughout (most of) the day, like a normal person!

Having some very bad mental sides like awful memory and confusion now, so really want to start the healing process.


EDIT: Yeah looking at the graph, except in one case each time I woke up the mask pressure was 11-12. Now that could be my waking from the physical gush of air or the noise couldn't it.

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Ok last night got about 3.5-4 hours on machine. First started with wisp and had to increase ramp minimum to 5 as at 4 it was hard to breathe. Later found out one nostril was completely closed despite humidifying on F&P before so switched to F10 mask.

Woke a few times. One time tried to get back to sleep but the machine would keep pulsing me with 11-12 gusts nearly every other breath which made it impossible to sleep without damn ramp again. Then woke up very tired and had a machine-less nap for about 40 mins bringing me to 8:10 am.

Now I could:

1. Leave everything alone

2. Reduce max pressure to 11 which was my indicated apap max

3. Reduce ramp time to 20 minutes so ramping twice a night will give me more therapy time at 20 than 30

My sleep doctor asked me not to mess with settings and I haven't so far really, only the ramp minimum and mask type. But I do have to hand machine back in 9 days so have little time to prove to myself if this type of pap therapy is worth buying into.


Very hard at the moment to know if this is any better for me than apap!

Also:

Does the BiPAP autoSV operate like an Auto CPAP or Auto Bi-level device for treating obstructive events?

No – The device does not have an auto-titrating algorithm to alleviate obstructive events. The innovative algorithm was designed to treat complex apnea and periodic breathing. The obstructive component of SDB is treated utilizing a clinician adjustable CPAP or BiPAP pressure level.

From Machine FAQ. Does this mean it is less effective than apap for apnoea events unless it is adjusted to exact pressure needed to treat them like a manual cpap?

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Ok tonight went back for F10 mask and set rise time to 3 instead of biflex 3. Think I might have had best night so far even though I only got 4 hours sleep. Machine has no humidifier as I mentioned so FFM isn't great, but my nose is closing up so wisp is out. AHI seems to be nearly 1 so will try another night with 3 then go down to 2 as others have suggested higher rise time makes it harder for machine to treat?

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Right last night was longest night with machine, had nearly 10 hours on it.

Unfortunately I must have woken up about 7 times! Either ASV is really not suited to me or the settings are not good. It keeps blowing strong gusts of air at me, and I really don't think they're needed. I will take one or two breaths and then the machine will decide it needs to give me a good shove of air for some reason. I am sure that this is waking me up because I certainly don't have any mask leaks.

Can post the data if anyone is interested. Any ideas on how to improve the quality of sleep with the machine or should I just give up on ASV?

[Pugsy]

Can post the data if anyone is interested. Any ideas on how to improve the quality of sleep with the machine or should I just give up on ASV?

Please post a report.

How much is the "burst" of pressure that you are getting that you think is disturbing your sleep? What's the jump?
And why/what is the reason for the machine to think it needs to make that jump?

Did you ever limit IPAP max so that the jump couldn't be so big?
2 weeks is not very long to get adjusted to ASV...it can take months. Since you only have a few days...try something else with the settings or else you won't ever know.

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Thanks Pugsy. You'll have to bear with all the graphs I'm afraid as SH will crash if I change anything, also not got a card reader for this PC for Encore (should have one later today).

I am not sure why the machine is jumping pressure. You can see where I wake just before I put the ramp on again, often there is a pressure spike. Not touched any settings but can do if you spot anything that might help! Settings are:

Max pressure: 25 EPAP Min: 7 EPAP Max 10 PS min 1 PS Max 10 BMP Auto

For some reason there is a long leak event near start of night but I always woke with mask on? It also says Biflex 3 but has been at Rise 3 for last two nights.

[Pugsy]

Disregard the BiFlex/rise time thing. That's a SleepyHead bug.
Also I am wondering what is going on with Max IPAP numbers...the graph clearly shows a little higher than the 9.8.

You aren't getting the pressure spikes that I was expecting to see. Your spikes aren't really very big in the grand scheme of things. Now I know that they seem big to you but I see spikes from 9 IPAP to 22 IPAP in maybe 20 seconds.

Looks like maybe IPAP is increasing because of hyponea...that's a big maybe since not many hyponeas getting flagged but maybe there's more that were close to earning a flag causing the increase. It's extremely difficult to try to second guess the machine from what we are seeing or are able to see using this software. It (the data the machine gathers) just wasn't designed to be micro analyzed.

You know some people are just super sensitive to any pressure change. I sleep right through all the big changes in pressure but that doesn't mean everyone else does. I also was lucky in that I adapted quickly to ASV way of doing things but then I experiment a lot and adapting is fairly easy for me. I know it isn't always so easy for others.

I was thinking if the changes were BIG like I see...then maybe limit the IPAP max just to see if that helped your sleep quality any but your pressure spikes aren't nearly as big as I expected BUT maybe they are enough to mess with your sleep so I don't see the harm in at least lowering the ceiling...say to 12...it rarely goes above it anyway and never hits 15 (at least on this report).

There's actually a couple of things I might try if it were me but you don't have the time needed to evaluate them....increasing minimum PS to 3 would be one of them. Just a comfort thing. I have never used the PR S1 ASV (on my list of things to try when I can find one cheap enough) though. This is where a real in lab titration study to evaluate pressure and potential arousals would come in handy. Dial a wingin at home with ASV and all the intricate possibilities is a bit difficult when sleep quality is an issue. We don't have anyway to correlate which caused what.

See what I mean about my pressure changes here.

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I tried changing PS to 3 briefly last night. It was brief because I found that the mask was pulsing a bit on my face with each breath, similar to how EPR can do it. Mask is a good fit but when I breathe out it shifts out on face slightly and then comes back in on inhale. Just seems a bit annoying so turned it off! Might mess with ipap tonight, need to look at my results when I come out of sleep daze.

EDIT: How about the next move I try and disable ASV by equalling PS and see if I can sleep through bipap therapy only? Not sure if I should do that now or wait until the very last few days. Doubt my sleep doctor appreciates me messing with settings but might as well make the most of what I have eh.

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Looks like I spoke too soon. Reviewing the data, it is probably the best night I had yet. Had nearly 4-5 hours without a single wake (I think) and then woke about 3 times later on. I also had another morning of 40 odd minutes without machine as I was feeling so tired. Woke up feeling groggy though still, but not as bad energy throughout the day as previously.

One thing though is I seem to be getting a fair few HAs and even a few centrals. My EPAP max is set only to 10 (I suggested this as doctor asked what my 95% was on S9) is the low EPAP having an impact there, or does that only reduce OSA itself? I must admit to still being confused as to how EPAP and IPAP play their roles


EDIT: Looking at the chart in detail, my EPAP goes nowhere near max anyway. Each wake is usually because of pressure spike and it is the brown of an IPAP (although two browns for IPAP? confusing) like one here woke me after sudden increase to 12.5. I'm putting rise time down to 2 from 3 tonight to see if that helps the machine deal with my HAs anyway.