ASV - Another Interesting Night

A couple thoughts ...

First, have you ever considered trying to NOT hold your breath while you sleep? ... ... Yikes! I can only imagine how you felt without ASV therapy. Unfortunately, I really can understand how you felt.

Do you sometimes find yourself trying to avoid going to sleep? I sure do. I do NOT know what my brain subconsciously recognizes, but prior to a bad night of sleep I find myself trying to avoid sleep. And sure enough when I do, I generally have a horrible night of sleep. I do NOT recognize what my subconscious recognizes. Even if I did I'm not certain what I could do about it.

Second, let me be the first to compliment you on your leak line. With such huge pressure, some leaking is to be expected. Yet, you defy the odds. Way to go!!

One last note. Your AHI value appears to be pretty good considering how you were breathing (or not as the case appears to be!). What's your Min PS. If it's less than 4, you might want to increase it to 4. In my own experience that seems to help reduce the hypopneas. If it's already 4 or higher, you might want to bump it up an extra 0.5cm H2O. That might help.

But now for the question. Considering you had such an "interesting" night, how do you feel this morning / day? Do you feel as if you rested .. in spite of the stats from last night? If so, then your ASV unit is definitely making a difference for you.

John, thank you for your kind and caring comments. They mean a great deal to me.

Answering your last question first. I felt pretty good today. The machine is doing very well for me. Aside from my usual wakes due other non-apnea issues, I slept through all if it. If I am awake when one of these episodes happens, I can really feel the pressure swings and it is quite uncomfortable.

I'll try to not stop breathing at night although, since I will be asleep at the time, I'm not sure how successful I will be.
I do notice that this does happen to me during the day while I am awake and a couple of forced breaths seem to get things started again but the intervals seem to be somewhere between 30 and 60 seconds before I notice. That is what I recorded on the Auto BiPap machine when I was getting centrals at night. Longest one was 105 seconds before I started to breathe again. Didn't wake up for that one either.

Yesterday was lousy since I was able to only get 4 hours of sleep due to a visit from the insomnia bug in the middle of the night.

I struggle with trying to not go to sleep in the late afternoon or early evening no matter how tired I am feeling.
My experience with naps is that the night will be from bad to horrible so I just try to keep on with keeping on.

When I first got this machine last fall, I collected data for a month and then went back to my sleep doctor to work out the parameters I could manipulate. We all know that one night at the sleep center doesn't always (ever?) get you to the optimum pressure settings. My initial settings were Min EPAP 9, Min PS 5. We agreed I wouldn't get into trouble fiddling with Min EPAP in the 9-10 range and Min PS in the 5-10 range. So, where I am now is Min EPAP 10 and Min PS 7.5.
Raising the Min PS above 7.5 led to ever worse numbers and I didn't feel better so I backtracked to 7.5.

I hesitate to consider raising the Min EPAP above 10.0 just because of nights like this one. When they happen, the ventilator mode kicks in for 45 minutes to 90 minutes or so and I worry about hypoventilation if the pressure swing is too small.
My average Tidal Volume hovers around 600 mL and last night it was 730 mL. That seems to me to be an indication of quite good ventilation and air exchange.

Thanks for the comment on the leak line. Except for the two minutes last night, my 'normal' leak rate seems to be at the expected mask leak rate with the unintentional rate hovering around zero. I attribute this to a couple of factors:

1) I use the optional head gear for this mask and it does support the mask from moving when the pressure does its swing from 10 to 25. When I was using the Auto BiPap machine, the head gear was truly optional and I didn't use it after the first month or so. Without the head gear strap, pressures near 25 cm H2O really balloon my cheeks and could easily make for bad leaks.
2) I also use a soft cervical collar to prevent jaw drop as suggested by one of the other members. I had been experimenting with a rolled up towel but the cervical collar is much, much better.

Until those two things, my masks were developing significant leaks at about the 60-90 day time period and I was having to replace them pretty often. The silicone of the Oracle 2 mask stiffens up just a little after a couple of months and won't conform as well when my jaw drops resulting in bad leaks. The cervical collar fixed that completely.

I want to thank you again for all the kind and helpful suggestions you made during the time when I was starting out on this ASV voyage. They made the transition much easier.

One quick note. Believe it or not, in a few months you will NOT notice the high pressure. I honestly no longer notice it. It just takes time to become fully acclimated.

I just reviewed the Tidal Volume data for the month of March.
Mea Culpa but the average is not hovering around 600 mL but is actually 663.1 mL.
I tried to make a correlation between BPM and TV and its all over the place, same thing for %PTB and TV.
Weird.

I was working off my memory of the values for the last few months.

JohnB: I believe it. My perception of the max pressure has diminished in the six months on this machine.
In the beginning, when it kicked in and I was awake, I felt like a balloon being inflated. Now I do still notice and its only a little uncomfortable. OTOH, the pressure swings never wake me up so I must be at least partly used to it by now.

Here is a more normal night for me. Even so, the machine is in ventilator mode for a total of almost one hour while in the interesting night (OP), the time in ventilator mode was almost four hours total.

Notice that the leak line is well controlled.
In spite of the pressure swings, the average leak was equivalent to that of a straight pressure of 10 cmH20.
I copied the leak table from the Fisher-Paykel Oracle 2 User manual and included it in the image.