Did I STOP Breathing "AGAIN"

[Cowboy Casey]

So this morning I woke with a slight headache and didn't really think anything about it... Sat down, drank a cup of joe and went and got my card and downloaded data... At first, I thought the data was just"off or wrong" and went on with my day.. The more I thought about it maybe it was correct... I know these ASV's are really close to a ventilator, but I didn't think it was able to do this and I stayed asleep to boot... The machine never picked up anything except a VS, but the pressure pulse went crazzy.... The last screenshot shows my triggered breaths and it went to 0, like not 1 breath for over an hour....

My basis picked me up as going into light sleep at exactly the minute that all this took place, 02:04 and stayed going from light to REM with an interruption (basically it didn't know what was happening)

What is everyone's thought's? Is this something I should be showing to a doctor or asking about?

Screenshot 2014-08-16 21.02.12 by cowboycasey

Screenshot 2014-08-16 21.02.31 by cowboycasey

Screenshot 2014-08-16 21.02.52 by cowboycasey

Screenshot 2014-08-16 21.03.30 by cowboycasey

Screenshot 2014-08-16 21.22.47 by cowboycasey

Screenshot 2014-08-16 21.33.01 by cowboycasey

[JDS74]

Yes, you should mention it to your doctor.
And, no its probably nothing to be worried about.

This happens to me from time to time. The first time I had a more than two hour sequence like yours, I showed it to my doctor. The response was,"That's really interesting. Could I have a copy of the report."

My "worst" night had my PTB% at 52% for the night and, like you, I slept straight through it all.

Welcome to the strange world of ASV.

[archangle]

I was going to say glitch, but maybe that's how ASV works. Note that your minute vent went way down, but didn't quit, and that it varies a little like it's actually recording something.

Maybe you did go into "central mode" for a long time and the machine kept you breathing at a lower rate.

You might want to change the title on this thread to start with "ASV" and stir up one of our ASV Angels to comment.

[JDS74]

Looking in more detail at your screen shots, it seems as if you max iPap is set to less that 17.
When you were in this mode, the machine is switching between 6 cm H2O and 17 cm H2O.
That does not seem to be enough to properly ventilate you. That could account for the headache when you woke up.

How did the max iPap get set so low?

[Cowboy Casey]

JDS74, I have my EPAP set to min 6, max 10 and my pressure support set to min 0 and max set to 6... here is where it gets interesting.. when this happened, my PS went to 11.1 max on its own... Below is what the machine registered for the night

I have my IPAP set to max 20 but it will never get there, 16.9 IPAP is the highest it has ever been, and by the settings, it should have never been able to get to that but it did...

The reason I have my EPAP so low is a have really bad Aerophagia when the constant pressure gets above 7... I am not sure exactly why the pressure support does not do the same thing but it does not, I was almost at 17 PS and woke up with no Aerophagia....


First Last Days AHI FL Machine Pr. Rel. Mode Pressure Settings
8/14/2014 8/15/2014 1 3.10 0.25 PRS1 Bi-Flex x2 ASV EPAP 6.0 PS 0.2 - 11.1 IPAP 16.9

[JDS74]

It can't get higher because your max PS is 6 and your max EPAP is 10.
Are you doing this on your own?
How did you get these setting numbers?
Normally, the settings allow the max pressure to get to 25 cm H2O.

[Cowboy Casey]

Normally, My pressure stays low, my 95% is almost always around 7 EPAP and my AHI average is about 2... Here is a screenshot from last night...

I wonder what would happen if i maxed out my pressure support because PS really does not bother me at all, you would think going from 6 pressure to 17 in 1 breath would wake a person up... I don't know what would happen if it went from 6 or 10 EPAP to 25

Screenshot 2014-08-17 11.07.10 by cowboycasey

[JDS74]

Do you have access to Encore?
It shows better graphs in the wave form graphs. You may be able to get a better idea of what is going on.

However, your numbers look great! No centrals! Everything else handled quite nicely.

[JDS74]

Do you have access to Encore?
It shows better graphs in the wave form graphs. You may be able to get a better idea of what is going on.

However, your numbers look great! No centrals! Everything else handled quite nicely.

[palerider]

So this morning I woke with a slight headache and didn't really think anything about it... Sat down, drank a cup of joe and went and got my card and downloaded data... At first, I thought the data was just"off or wrong" and went on with my day..

it *looks* to me like maybe a bit of cruft blocked the flow sensor for a couple hours, since it wasn't registering any flow at all, and it should have, as you see with your other traces where the machine is doing the breathing for you.

filters clean?

the machine, not sensing flow, would kick into 'breath for you' mode, which it did, based on the high mask pressure swings, but if the flow sensor were registering, then your flow line would show breathing.

just a wild guess though.

[archangle]

So this morning I woke with a slight headache and didn't really think anything about it... Sat down, drank a cup of joe and went and got my card and downloaded data... At first, I thought the data was just"off or wrong" and went on with my day..

it *looks* to me like maybe a bit of cruft blocked the flow sensor for a couple hours, since it wasn't registering any flow at all, and it should have, as you see with your other traces where the machine is doing the breathing for you.

filters clean?

the machine, not sensing flow, would kick into 'breath for you' mode, which it did, based on the high mask pressure swings, but if the flow sensor were registering, then your flow line would show breathing.

just a wild guess though.

If you look at the last graph, it's still showing a low, but "real looking" minute vent and tidal volume. It may be a real central apnea type event, somewhat treated by the ASV, although it still had a low airflow rate.

It might be some sort of SleepyHead glitch, but the other graphs make it look like the machine was reacting to something, which makes me think it's either real or some sort of glitch with the S9 machine itself.

[palerider]

If you look at the last graph, it's still showing a low, but "real looking" minute vent and tidal volume. It may be a real central apnea type event, somewhat treated by the ASV, although it still had a low airflow rate.

It might be some sort of SleepyHead glitch, but the other graphs make it look like the machine was reacting to something, which makes me think it's either real or some sort of glitch with the S9 machine itself.

I think there's a little showing up on the flow graph too, but it's hard to see since he insists on using flickr for his graphs, (ugh).. at least, I haven't gotten it to cough up a full res image.

It's not impossible for something to temporarily block the flow meter. but, like I said, guessing.

[Cowboy Casey]

LOL, I know you hate flickr, but its easy for me... here is a better pic, but still the PITA site...

I started out thinking the same as you palerider, but it seems that it was registering everything correctly but you all know that crazzy things happen when dealing with machines and data....

Just checked the filters, both were spotless and the old white filter looked exactly like the new 1... Went ahead and changed it out anyways, never know..

Screenshot 2014-08-16 21.33.01 by cowboycasey, on Flickr

[palerider]

LOL, I know you hate flickr, but its easy for me... here is a better pic, but still the PITA site...

I started out thinking the same as you palerider, but it seems that it was registering everything correctly but you all know that crazzy things happen when dealing with machines and data....

I just hate it because it leads to crappy pictures, it's great for sharing your photos, not so great for detailed graphs. ever tried imgur?

as to the machine registering correctly, that's very little air for a very long time based on the flow and MV.

however, if the flow sensor did get blocked partially, then you'd end up with that situation, the machine would sense a loss of breathing, ramp up to max effort, show the pressure pulses you're getting on the mask pressure chart, show very low flow, very low MV, very low TV, ... *shrug* I dunno. maybe you died and are just haunting us now

[Cowboy Casey]

LOL, hmmmmm well I feel the same so maybe not dead yet... We will see what a doctor says whenever I can get an appointment with the VA, I have to call and see if I can get 1 in 10 months... They still have not paid for my machine and its almost 3 months... Go figure....