Respiratory Rate of 7 on ASV - UARS x 13 years

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
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Rubicon
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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by Rubicon » Mon May 02, 2022 12:00 pm

BTW is your ASV an AirCurve 10 CS PaceWave?

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by Rubicon » Mon May 02, 2022 3:10 pm

Here's another Z-episode to look at:

Image

In the beginning there's normal breathing. If this was sleep. RR is increasing so this might be a REM period. Good a guess as any.

Anyway, there's an arousal as REM is wont to have. Followed by a little disturbance of no great consequence but ASV goes berserk, jacks the pressure out of sight and you're in Z-mode again.

Despite stable breathing during Z-episode, PS is not reduced. I can only offer that perhaps PaceWave has determined that's your new normal and just sits there. You drop your rate to stay physiological, you're happy, it's happy, so there you sit till the next arousal.

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by MRI_Doc » Tue May 03, 2022 11:52 pm

Rubicon wrote:
Mon May 02, 2022 3:10 pm
Here's another Z-episode to look at:

Image

In the beginning there's normal breathing. If this was sleep. RR is increasing so this might be a REM period. Good a guess as any.

Anyway, there's an arousal as REM is wont to have. Followed by a little disturbance of no great consequence but ASV goes berserk, jacks the pressure out of sight and you're in Z-mode again.

Despite stable breathing during Z-episode, PS is not reduced. I can only offer that perhaps PaceWave has determined that's your new normal and just sits there. You drop your rate to stay physiological, you're happy, it's happy, so there you sit till the next arousal.
Rubi,

Thanks so much for having a look and taking the time to download my data. So it DOES make sense that the machine is "driving" this low RR with the high PS and that it's not obviously harmful. Do you have any suggestions for alternative settings? It would seem the shifting in and out of these low RR sessions is not good therapy.

Thanks again!

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by Rubicon » Wed May 04, 2022 3:23 am

MRI_Doc wrote:
Tue May 03, 2022 11:52 pm
Do you have any suggestions for alternative settings? It would seem the shifting in and out of these low RR sessions is not good therapy.
Other than one guy in New Mexico, TTBOMK, nobody advocates using ASV to treat UARS.

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by MRI_Doc » Thu May 05, 2022 8:13 pm

Rubicon wrote:
Wed May 04, 2022 3:23 am
MRI_Doc wrote:
Tue May 03, 2022 11:52 pm
Do you have any suggestions for alternative settings? It would seem the shifting in and out of these low RR sessions is not good therapy.
Other than one guy in New Mexico, TTBOMK, nobody advocates using ASV to treat UARS.
Your knowledge is valid. He's in Savannah, GA now (relocated from NM).

I've been to Stanford x 3 titrations, Mayo Clinic x 2, Mass General with dead space titration / acetazolamide, including CPAP, bi-level (with increasing pressures up to 20/15) and now trying ASV. It seems I have UARS with very high loop gain very resistant to PAP therapy. No leaks and very high adherence. I may consider surgery, but little evidence for any successful UARS treatment other than PAP, so very cautious. I never completely obstruct or desaturate. Normal BMI. It's all hypopneas and RERA's.

But I'm encouraged that high PS can remove all flow limitations, but with that very low RR.

Any thing else to try via PAP?

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by SleepGeek » Thu May 05, 2022 8:30 pm

MRI_Doc wrote:
Thu May 05, 2022 8:13 pm
It seems I have UARS
My 2nd sleep doc told me anyone with sleep apnea has UARS.
Why folks dont like it when you treat em the way they treat you?
If you can be anything why not choose to be kind?
we are here to help.
palerider aka GrumpyHere wrote: What exactly do you think you're adding to this thread?

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by MRI_Doc » Thu May 05, 2022 9:47 pm

SleepGeek wrote:
Thu May 05, 2022 8:30 pm
MRI_Doc wrote:
Thu May 05, 2022 8:13 pm
It seems I have UARS
My 2nd sleep doc told me anyone with sleep apnea has UARS.
There is overlap, for sure. I agree that most people with OSA also have upper airway resistance and some arousals related to incomplete obstruction. But both conditions are usually multifactorial and complex. Fortunately, most people with straightforward obstructive sleep apnea do extremely well on PAP therapy. Those in the mostly UARS category likely have other confounding comorbidities, such as hyper-reactivity to carbon dioxide levels in the blood. Or simply more susceptibility to arousals (i.e. a lower threshold for arousals).

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by Rubicon » Fri May 06, 2022 3:40 am

MRI_Doc wrote:
Thu May 05, 2022 8:13 pm

Your knowledge is valid. He's in Savannah, GA now (relocated from NM).
We've done battle before.

For a while his hustle was "treating expiratory flow limitations". When it was pointed out that the EFLs were probably cardioballistic artifact the "evidence" suddenly disappeared overnight (but not before an astute poster had saved the images and reposted them).

Then the upside-down PSG effort channels in a white paper. OK not a mortal wound but you kinda wonder who's captaining the ship.

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by Rubicon » Fri May 06, 2022 3:42 am

SleepGeek wrote:
Thu May 05, 2022 8:30 pm
My 2nd sleep doc told me anyone with sleep apnea has UARS.
Is he the guy from NM/GA?

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by Rubicon » Fri May 06, 2022 3:51 am

MRI_Doc wrote:
Thu May 05, 2022 8:13 pm
But I'm encouraged that high PS can remove all flow limitations, but with that very low RR.
OK but you were doing fine prior to the arousal. There was no FL. Your post-arousal breaths told ASV that the sky was falling OMIGOD CRANK IT UP CAUSE WE"RE ALL GONNA DIE!!

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by Rubicon » Fri May 06, 2022 4:32 am

MRI_Doc wrote:
Thu May 05, 2022 8:13 pm
But I'm encouraged that high PS can remove all flow limitations...
Yeahbut a FL without an arousal is a non-entity.
MRI_Doc wrote:
Thu May 05, 2022 8:13 pm
Any thing else to try via PAP?
As unorthodox as your approach is (including exploiting a weakness in the ASV algorithm) other than the results looking weird every now and then I didn't see anything that's really dangerous (as long as your MV stays WNL you probably won't wake up dead in the AM).

Lemme go back and browse breath by breath looking for arousals and FLs (this'll might take a bit @5000 breaths/night x # of nights).

For instance, in this image, it looks like you have the aforementioned CB contamination (see expiratory limb and then how they seem to also appear in some inspirations):

Image

IMO those breaths are not flow-limited, they are distorted by CB, but the ASV is chasing them with pressure increases.

4980 breaths to go, and we can put one night in the books.

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by Rubicon » Fri May 06, 2022 4:25 pm

So this is a bad feature of ASV (but with a happy ending):

Image

In the first box there is a disturbance, an arousal from sleep. The breaths are larger than usual as stage changes from sleep to wake (probably-- doing the best we can w/o PSG!).

Anyway, this is seen in the larger tidal volumes (maybe even larger since VT is a 5 breath average). So the body's response would be a compensatory post-arousal central apnea to get things back to normal.

Welllllll, here comes ASV and it's going to just save the day and starts sending in breaths. However, those breaths don't actually go anywhere (as seen in reduced flowrate and tidal volume), so normal breathing (OK rate of 7. Relatively normal) resumes on schedule.

Extra credit: How do we know (or strongly suspect) that's a machine intervention?

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by MRI_Doc » Thu May 12, 2022 12:30 pm

The higher rate and regularity?

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by GearChange » Sat May 21, 2022 1:32 am

MRI_Doc wrote:
Sat Apr 23, 2022 8:12 pm


2. What ASV settings has the most effect on hyperventilation and centrals ? Is it Max PS or Max pressure or EP? I'm thinking Max PS is likely the most impactful. Again, an extensive literature search yielded nothing. But I'm sure this is respiratory therapy 101.
Hello,
Your machine registers an AHI of 0.0 with absolutely no event recording, not one that your Resmed Aircurve algorithm has been programmed to recognize as an apnea event, anyway.
Your chart however shows some curious patterns, specifically your MV and Tidal Volume but I am not sure about what you mean by "centrals" because I don't see any CA events in your chart (when Clear Airway is indicated but no flow is registered), so please explain what you see as a "central".
Resmed literature specifies that their ASV algorithm monitors your breath rate and other characteristics for the preceding 90 seconds and then calculates an optimum Minute Ventilation (MV) and continues to maintain a stable MV by adjusting its parameters to maintain an MV target throughout the session, however your chart MV does not look too stable and I suspect it is because your BR changes pretty drastically at times. Also your Tidal volume is pretty much in the target range, considering your relatively low BR. It may be a good idea to wear a SpO2 monitor overnight and then import the results to OSCAR in order to see what effect this irregular BR has on your SpO2.

In regards to optimum ASV setting, it is best to set the machine to cover the entire range of pressures . This way the algorithm monitor each breath and adjusts its parameters appropriately, having a wide range to operate in. To limit Max settings is best described as installing a governor on the engine of a performance car to limit its speed.
Resmed Aircurve 10 ASV also has another setting called "ASV Auto" which allows you to set one more parameter than the "ASV" setting does. "ASV Auto" mode is intended for people with complex apnea where a good percentage of apnea events are of Obstructive nature while the rest are "Central" (A cessation of Phrenic Nerve activity that results in cessation of involuntary breathing...indicated by Clear Airway and no flow in excess of 10 seconds).

Also check my post out when you have a chance. I go through very long periods with total cessation while my ASV (a Respironics model) keeps ventilation without arousals whatsoever.
viewtopic/t184386/Central-ApneaIs-It-No ... l?start=15

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Re: Respiratory Rate of 7 on ASV - UARS x 13 years

Post by palerider » Sat May 21, 2022 4:54 pm

MRI_Doc wrote:
Thu May 12, 2022 12:30 pm
The higher rate and regularity?
Be cautious, "gearchange" thinks that they know *WAY* more than they actually do,and has some ridiculous biases, CAREFULLY verify, (perhaps twice) anything that is said from that account. (things like not being able to recognize a central on a Resmed ASV)

Rubicon is a professional in the respiratory field and *absolutely" knows what he's talking about. Trust him.

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