ASV and periodic breathing

HI all,

I have a Philips Respironics System One ASV machine and I am getting a few nights every month with very high metrics for periodic breathing and clear airway. I am relatively young (age 33). I am fearful that when I get older I will have more and more nights like this using the machine. As I understand it, ASV is the best treatment available for mixed apnea (central and obstructive mix), which I was diagnosed with 2 years ago. My question is this: If my AUTOMATIC ASV device is regularly indicating high periodic breathing and clear airway readings am I benefiting at all from treatment? My sleep doctor regularly tells me that this is the best available treatment for my condition and the machine automatically adjusts to my breathing patterns. Attached is my Sleepy head data if anyone would be so kind to offer any insight into the data.

Where are your event flags? Is it a bug in Sleepyhead or did you turn them off?
Below the graphs on the left where you see the "Flags" with a little arrow by it...click on the arrow and expand the menu and make sure all the choices show green/black. If any are red/black click on it to change it to green/black. If they are all green already...we got a problem with Sleepyhead and your machine being incompatible. Hopefully that isn't the case.

Hide the calendar...turn off the pie chart (Preferences/Appearance ...remove check mark for show pie chart)
Review this thread.
viewtopic/t158560/How-to-post-images-for-review.html
Get me a screen shot of the detailed nightly report without zooming in on anything. The one above is useless...sorry.

Go into the clinical menu and write down all the settings you see. I know it shows it on Sleepyhead but sometimes the settings shown in SleepyHead is a bit buggy. Report back as to what you see in the setup menu.
If you don't know how to get to the setup menu area go here and request the manual and it explains how.
https://www.apneaboard.com/adjust-cpap- ... tup-manual

Did you ever have a sleep study done in a lab to attempt to get optimal settings?

If we are to believe the statistics...your machine isn't moving much to try to fix the obstructive stuff..and not doing much to try to fix any central stuff. The bulk of the AHI appears to be hyponeas and while normally we think of them as being obstructive in nature they can sometimes be central in nature when using this type of machine.

Are you comfortable changing the pressures yourself?

No, these results are not acceptable as "as good as it gets"...not without trying something else and having all other options fail.

Do you take any medications of any kind, if so what? Especially anything that might suppress respiration like pain meds of any sort.

Do what Pugsy says and re-post the new graphic.

BTW - the numbers to get from the clinical menu are:
1) Max Pressure
2) Min EPAP
3) Max EPAP
4) Min Pressure Support
5) Max Pressure Support
6) Breath Rate (should be set to Auto)

In addition, the version number of SleepyHead would be helpful. Some time after Vers 9.8.1, some important Respironics ASV reporting functionality disappeared.

That being said, there are some issues in the data:
1) You seem to be set up to have (at least initially) no pressure support so that there is no change in pressure between EPAP and IPAP when the machine starts.
Generally this in not a good thing for a Respironics ASV machine treating complex sleep apnea. Your data suggests that is what is happening. Setting the parameters wide enough and letting the machine work it out doesn't generally end with good treatment. You need to start somewhere near what the requirement are to prevent almost all OSA events, have at least 10 cmH2O pressure difference between the initial Min EPAP and the computed Max IPAP, reduce substantially any VS events (the machine doesn't try to correct these but just reports them, and minimize the reporting of central events by stopping them from starting. Respironics doesn't flag every central event that it detects if it can correct them in less than one or two breath cycles. Those are the "timed breath" flags that just seem to happen out of nowhere. You only see the centrals that last substantially longer and the breathing graphs show a pressure flat line.

2) Initial pressure seems to be 4 cmH2O which is not very effective when you look at the pressure graph. If it was, the pressure wouldn't be continuously increasing as the night continued.

3) Towards the right, the pressure graph seems to be consistent with "periodic breathing" but as Pugsy said, the indicators/flags need to be turned on so that whatever is happening can be seen in context.

4) The OSA number suggests that as mentioned in (2) above, the Min EPAP needs to be increased.

4) This is one time that the Encore waveform printout would be very much more useful because you could look at the breathing patterns, breath by breath, without having to drill down, look at a segment, then zoom out, move to different time frame and repeat. For the rest of the data, SleepyHead is just fine - you can see everything you need to see easily and clearly.

JDS74 wrote: ↑

Sun Jun 17, 2018 8:23 pm

This is one time that the Encore waveform printout would be very much more useful because you could look at the breathing patterns, breath by breath,

Yep. The only thing that I really like about Encore is the wave form graphs. Makes flow rate evaluation soooooo much easier, faster and consistent because the scale is always exactly the same and it's all together in one big picture.
Without knowing all the settings its impossible to know what's going on but I wonder if max EPAP is so low that it along with the PS max being too low is simply not letting the machine do what it might want to do. Can't tell much from the one snippet of the report above.

And with SleepyHead's history of screwing up machine settings I don't want to trust what it might report...hence the request for the settings as seen on the machine itself.