Please help...do I need an ASV?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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palerider
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Re: Please help...do I need an ASV?

Post by palerider » Tue Nov 08, 2022 11:45 pm

BreathFree wrote:
Tue Nov 08, 2022 11:06 pm
palerider wrote:
Tue Nov 08, 2022 9:58 pm
BreathFree wrote:
Tue Nov 08, 2022 8:52 pm
Pugsy wrote:
Tue Nov 08, 2022 7:40 pm
Before I started worrying about those few centrals I would first
1...make sure that those were real asleep centrals and not SWJ sleep/wake/junk .
2...I would turn off EPR (or reduce it) just in case it was a factor in the centrals (assuming real asleep centrals and not SWJ centrals).
I doubt it will change the results but there is a remote chance that turning off EPR will reduce real asleep centrals.
PS 5.0 over 5.0-24.0 (cmH2O)
A PS of 5 is like EPR on steroids.
What pressures should I try... PS 0 IPAP 10 EPAP 10?
Why don't you try what Pugsy suggested? lower your pressure differential between inhalation and exhalation, whether it's called EPR, or PS, it's the same thing, a difference between the inhalation and exhalation pressure. The higher that difference, the more ventilation you have, the more ventilation, the more CO2 is blow off, the more CO2 that's exhaled, the lower your drive to take another breath.

Yes, one can *cause* central apnea with too much added ventilation.

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Re: Please help...do I need an ASV?

Post by Pugsy » Wed Nov 09, 2022 6:17 am

Why not just try cutting PS in half ...for a starter.....or maybe cut it down to 1 and see what happens.

I have a friend who uses bilevel after her doctor gave her a bilevel because her pressure needs are in the upper teens and he wanted to help her out with more pressure relief upon exhale since her starting pressures were above 15 cm.
He was thinking the added PS would be more comfortable for her than EPR at 3 on the regular apap machine was.
She was using PS of 4 (which effectively functions like EPR if EPR could do 4 instead of 3) on the bilevel and having about 15 centrals PER HOUR and we couldn't understand why. Then she mentioned to me that when she was using the apap with EPR at 3 that she didn't really have any centrals to speak of.

So we tried using PS of 3 instead of PS of 4 and low and behold the centrals happening dropped significantly....like down to less than 1 per hour average and some night she didn't have any centrals.

Now we have no way to know for sure if the same would happen for you....and if your centrals are arousal related then it won't but there is a chance that changing PS might make a difference and it's an easy experiment to try.

If the PS (extra ventilation) is the trigger for your centrals...then reducing or turning PS off will help.
The extra ventilation isn't always the cause for everyone's centrals but for some people (like my friend) it can be the cause.
If it is the cause for your centrals....we don't know if a simple reduction in PS will do the trick or if you would need to just eliminate all pressure relief. This is why we try multiple experiments....just in case we get lucky.

And...you still have to figure out if those centrals flagged are real asleep centrals and not arousal/awake flagging.
If you weren't asleep then you have to figure out why not sleeping soundly and work at it from that aspect.

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Re: Please help...do I need an ASV?

Post by BreathFree » Wed Nov 09, 2022 3:04 pm

Pugsy wrote:
Wed Nov 09, 2022 6:17 am
Why not just try cutting PS in half ...for a starter.....or maybe cut it down to 1 and see what happens.

I have a friend who uses bilevel after her doctor gave her a bilevel because her pressure needs are in the upper teens and he wanted to help her out with more pressure relief upon exhale since her starting pressures were above 15 cm.
He was thinking the added PS would be more comfortable for her than EPR at 3 on the regular apap machine was.
She was using PS of 4 (which effectively functions like EPR if EPR could do 4 instead of 3) on the bilevel and having about 15 centrals PER HOUR and we couldn't understand why. Then she mentioned to me that when she was using the apap with EPR at 3 that she didn't really have any centrals to speak of.

So we tried using PS of 3 instead of PS of 4 and low and behold the centrals happening dropped significantly....like down to less than 1 per hour average and some night she didn't have any centrals.

Now we have no way to know for sure if the same would happen for you....and if your centrals are arousal related then it won't but there is a chance that changing PS might make a difference and it's an easy experiment to try.

If the PS (extra ventilation) is the trigger for your centrals...then reducing or turning PS off will help.
The extra ventilation isn't always the cause for everyone's centrals but for some people (like my friend) it can be the cause.
If it is the cause for your centrals....we don't know if a simple reduction in PS will do the trick or if you would need to just eliminate all pressure relief. This is why we try multiple experiments....just in case we get lucky.

And...you still have to figure out if those centrals flagged are real asleep centrals and not arousal/awake flagging.
If you weren't asleep then you have to figure out why not sleeping soundly and work at it from that aspect.
Thanks to you and others for the clear and logical guidance, I'll set up PS 2 over 8-25 tonight.

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Re: Please help...do I need an ASV?

Post by BreathFree » Wed Nov 09, 2022 3:07 pm

BreathFree wrote:
Wed Nov 09, 2022 3:04 pm
Pugsy wrote:
Wed Nov 09, 2022 6:17 am
Why not just try cutting PS in half ...for a starter.....or maybe cut it down to 1 and see what happens.

I have a friend who uses bilevel after her doctor gave her a bilevel because her pressure needs are in the upper teens and he wanted to help her out with more pressure relief upon exhale since her starting pressures were above 15 cm.
He was thinking the added PS would be more comfortable for her than EPR at 3 on the regular apap machine was.
She was using PS of 4 (which effectively functions like EPR if EPR could do 4 instead of 3) on the bilevel and having about 15 centrals PER HOUR and we couldn't understand why. Then she mentioned to me that when she was using the apap with EPR at 3 that she didn't really have any centrals to speak of.

So we tried using PS of 3 instead of PS of 4 and low and behold the centrals happening dropped significantly....like down to less than 1 per hour average and some night she didn't have any centrals.

Now we have no way to know for sure if the same would happen for you....and if your centrals are arousal related then it won't but there is a chance that changing PS might make a difference and it's an easy experiment to try.

If the PS (extra ventilation) is the trigger for your centrals...then reducing or turning PS off will help.
The extra ventilation isn't always the cause for everyone's centrals but for some people (like my friend) it can be the cause.
If it is the cause for your centrals....we don't know if a simple reduction in PS will do the trick or if you would need to just eliminate all pressure relief. This is why we try multiple experiments....just in case we get lucky.

And...you still have to figure out if those centrals flagged are real asleep centrals and not arousal/awake flagging.
If you weren't asleep then you have to figure out why not sleeping soundly and work at it from that aspect.
Thanks to you and others for the clear and logical guidance, I'll set up PS 2 over 8-25 tonight. BTW...The BiPap came from Apria with PS set at 4

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palerider
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Re: Please help...do I need an ASV?

Post by palerider » Wed Nov 09, 2022 4:38 pm

BreathFree wrote:
Wed Nov 09, 2022 3:07 pm
Thanks to you and others for the clear and logical guidance, I'll set up PS 2 over 8-25 tonight. BTW...The BiPap came from Apria with PS set at 4
I wouldn't put much stock in anything Crapria does.

They likely *guessed* at a PS of four because there's generally no point in having a bilevel with a PS of three, since a plain Autoset will do that.

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Re: Please help...do I need an ASV?

Post by BreathFree » Mon Nov 21, 2022 7:53 pm

Update:
Your sage Pressure Support and Oximeter (02 Ring) suggestions are in place. I'm also spraying magnesium oil on my legs to calm Periodic Limb Movement. Once there is sufficient data, it will be posted seeking your further thoughts.
Should I send my co-pay to Justin?
Rob

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Re: Please help...do I need an ASV?

Post by Rubicon » Tue Nov 22, 2022 6:24 am

BreathFree wrote:
Tue Nov 08, 2022 8:28 pm

ASV Study of 9/1/2022, near perfect nights sleep.
Am I looking at the right page?

Your sleep efficiency was 52%!!

This requires a metaphor >TWA...
Freeze this moment a little bit longer.
Make each sensation a little bit stronger.
Experience slips away.

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Re: Please help...do I need an ASV?

Post by robysue1 » Tue Nov 22, 2022 7:21 am

Rubicon wrote:
Tue Nov 22, 2022 6:24 am
BreathFree wrote:
Tue Nov 08, 2022 8:28 pm

ASV Study of 9/1/2022, near perfect nights sleep.
Am I looking at the right page?

Your sleep efficiency was 52%!!

This requires a metaphor >TWA...
BreatheFree has the links to the two studies mixed up, but you can't tell that until you get to page 3 or 4.

This batch, with sleep efficiency of 52% and an arousal index of 29.1 is from a plain CPAP titration, with the pressure titrated from 4cm to 9cm:
https://imgur.com/eH1y6qN
https://imgur.com/upaRXt9
https://imgur.com/WLuTTSz
https://imgur.com/0hANcz8
https://imgur.com/b1Hrph3
This study shows 2 CAs, 6 OAs, and 2 Hs for the whole night.


This batch, with sleep efficiency of 80.7% an arousal index of 5.4 is from an ASV titration, with the pressures reported as EEV/minPS/maxPS and going from 4/3/15 to 5/3/15:
https://imgur.com/DL2gNza
https://imgur.com/NGetYW1
https://imgur.com/nnUSlL4,
https://imgur.com/7sL0gKS
https://imgur.com/vmEk1xR
Notably, there are 0 CAs, 2 OAs, and 1 H for the whole night.

So BreatheFree's subjective feeling that the night on ASV was "a near perfect night" has some grounding in the data.
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Re: Please help...do I need an ASV?

Post by Rubicon » Tue Nov 22, 2022 7:36 am

robysue1 wrote:
Tue Nov 22, 2022 7:21 am
This batch, with sleep efficiency of 80.7% an arousal index of 5.4 is from an ASV titration

So BreatheFree's subjective feeling that the night on ASV was "a near perfect night" has some grounding in the data.
Got it.

Sleep efficiency is still an area that deserves attention IMO.

As noted, ASV will generate waveforms such that you can't have events even if you have them, so you have to look for Servo Attacks to get a better handle on what's happening.
Freeze this moment a little bit longer.
Make each sensation a little bit stronger.
Experience slips away.

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Re: Please help...do I need an ASV?

Post by BreathFree » Sun Dec 04, 2022 9:57 am

Thanks to all!

AHI down to 2.37 from 7-8.

Lowered Pressure Support to 3 over 8 - 25.

Increased Trigger to Very High on November 20.

Applying Magnesium oil to my legs.

Results attached.

Any thoughts on fine tuning from here?

Life is good!
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Re: Please help...do I need an ASV?

Post by zonker » Sun Dec 04, 2022 2:49 pm

BreathFree wrote:
Sun Dec 04, 2022 9:57 am
Thanks to all!

AHI down to 2.37 from 7-8.
Image
Any thoughts on fine tuning from here?

Life is good!
post some charts for the forum to see instead of the info you posted.

continued good luck!
people say i'm self absorbed.
but that's enough about them.
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Re: Please help...do I need an ASV?

Post by BreathFree » Sun Dec 04, 2022 4:08 pm

"post some charts for the forum to see instead of the info you posted."

Please see attached, hope they work.
Any and all thoughts welcome!
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OSCAR 2022 12 03 Daily.jpg
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Re: Please help...do I need an ASV?

Post by zonker » Sat Dec 10, 2022 6:42 pm

BreathFree wrote:
Sun Dec 04, 2022 4:08 pm
"post some charts for the forum to see instead of the info you posted."

Please see attached, hope they work.
Any and all thoughts welcome!
good job getting them posted! but try to get them to look more like this-

Image

makes your charts easier to see.

you'd asked me privately what ahi i've achieved. the chart i posted has an ahi of .90 which is pretty much where i stand. oscar shows me that my average for the year is .73.

bear in mind that each of us is different. my ahi isn't necessarily the same as pugsy or palerider or robysue1 or rubicon. or anybody. we have different body types. different weights. different gender. and a slew of other things that make us not at all the same.

but each of the folk i mentioned, plus all those on the forum, either have optimized their therapy or are in process of doing so. each of us is striving to get the lowest ahi we can. but that is NOT the same number.

when someone starts out, it's natural to assume that you want an ahi of zero. *I* certainly did! :D but that is NOT the goal to shoot for. why? because it sets up an unrealistic expectation. and it's something than can be frustrating to the most of us.

let's see what others will say when they see your charts.

good luck!
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Re: Please help...do I need an ASV?

Post by BreathFree » Sun Dec 11, 2022 7:40 pm

Zonker,

Thanks for your wise and thoughtful reply.

It's down to AHI 1.62 last night. It was 0.0 for the first 2 hours 47 minutes. Will any of the other settings be as useful in dropping AHI as setting Trigger to very high was in virtually eliminating CA's? Any suggestions as to what to tweak next?

Of note, two wakeups with small amount of urine passage. No water intake for three hours before sleep. What's waking me up?

Rob

https://imgur.com/a/2TE35UI

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Re: Please help...do I need an ASV?

Post by Jlfinkels » Sun Dec 11, 2022 7:50 pm

BreathFree wrote:
Sun Dec 11, 2022 7:40 pm
It's down to AHI 1.62 last night. It was 0.0 for the first 2 hours 47 minutes. Will any of the other settings be as useful in dropping AHI as Trigger was in virtually eliminating CA's? Any suggestions as to what to tweak next?

Of note, two wakeups with small amount of urine passage. No water intake for three hours before sleep. What's waking me up?
Prostate issues? Welcome to middle age!

Other than the wake-ups, how did you sleep?

I am not qualified to divine truth from the OSCAR graphs, but can offer some advice. As I was told when I started: don’t chase numbers, chase quality sleep. You are making really good progress. Be sure to revel in the improvements.
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