Please help...do I need an ASV?

General Discussion on any topic relating to CPAP and/or Sleep Apnea.
User avatar
palerider
Posts: 31383
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).

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.

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR and come chat on IRC: #cpaptalk on irc.libera.chat

Accounts to put on the foe list: dataq1, clownbell, gearchange, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

User avatar
Pugsy
Posts: 62153
Joined: Thu May 14, 2009 9:31 am
Location: Missouri, USA

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.
Mask: Bleep no headgear mask.. https://bleepsleep.com/
Machine: AirCurve 10 VAuto

I may have to RISE but I refuse to SHINE.

BreathFree
Posts: 13
Joined: Mon Nov 07, 2022 7:37 pm

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.

BreathFree
Posts: 13
Joined: Mon Nov 07, 2022 7:37 pm

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

User avatar
palerider
Posts: 31383
Joined: Wed Dec 16, 2009 5:43 pm
Location: Dallas(ish).

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.

_________________
Mask: Bleep DreamPort CPAP Mask Solution
Additional Comments: S9 VPAP Auto
Get OSCAR and come chat on IRC: #cpaptalk on irc.libera.chat

Accounts to put on the foe list: dataq1, clownbell, gearchange, mper!?, DreamDiver, Geer1, almostadoctor, sleepgeek, ajack, stom, mogy, D.H., They often post misleading, timewasting stuff.

BreathFree
Posts: 13
Joined: Mon Nov 07, 2022 7:37 pm

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

User avatar
Rubicon
Posts: 763
Joined: Sun Feb 20, 2022 6:59 am

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...
All the world's indeed a stage and we are merely players.
Performers and portrayers, each another's audience outside the gilded cage.

User avatar
robysue1
Posts: 551
Joined: Sun Sep 18, 2022 3:39 pm
Location: Buffalo, NY

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.

_________________
Machine: DreamStation BiPAP® Auto Machine
Mask: Swift™ FX Nasal Pillow CPAP Mask with Headgear
Humidifier: DreamStation Heated Humidifier
Additional Comments: Also use a P10 mask
Joined as robysue on 9/18/10. Forgot my password & the email I used was on a machine that has long since died & gone to computer heaven.

Correct number of posts is 7250 as robysue + what I have as robysue1

Profile pic: Frozen Niagara Falls

User avatar
Rubicon
Posts: 763
Joined: Sun Feb 20, 2022 6:59 am

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.
All the world's indeed a stage and we are merely players.
Performers and portrayers, each another's audience outside the gilded cage.

BreathFree
Posts: 13
Joined: Mon Nov 07, 2022 7:37 pm

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!
Attachments
OSCAR screenshot-2022 12 04.jpg
OSCAR screenshot-2022 12 04.jpg (355.72 KiB) Viewed 64 times

User avatar
zonker
Posts: 9801
Joined: Fri Jun 19, 2015 4:36 pm

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!
"the world is full of good people. if you can't find one, be one."-sleepgeek(avatar)

"I'd rather laugh with the sinners than cry with the saints
The sinners are much more fun
You know that only the good die young"-billy joel

BreathFree
Posts: 13
Joined: Mon Nov 07, 2022 7:37 pm

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!
Attachments
OSCAR 2022 12 01 Daily.jpg
OSCAR 2022 12 01 Daily.jpg (676.66 KiB) Viewed 35 times
OSCAR 2022 12 02 Daily.jpg
OSCAR 2022 12 02 Daily.jpg (671.76 KiB) Viewed 35 times
OSCAR 2022 12 03 Daily.jpg
OSCAR 2022 12 03 Daily.jpg (656.08 KiB) Viewed 35 times