New ASV. Oscar pics.

Link to my thread for my Aircurve 10 ST: viewtopic/t184243/Shallow-Breather-Osca ... shots.html

I have centrals, obstructives, and hypopneas. After a year on the ST machine, I still not getting the rest that I feel I need to get, so I went back to the my sleep doctor and asked if I could "pretty please" be considered for the ASV machine? Here are the titration results:

Total Sleep Time was 288 minutes resulting in a sleep efficiency of 67.6% with Total Recording Time of 426 minutes. 39 awakenings. Sleep latency 14.5 minutes and REM latency was 100 minutes. 2.8% supine. Sleep stages 4.3% N1, 77.3% N2, 5.6% N3, 12.8% REM. 150 arousals, resulting in arousal index of 31.3. 115 stage shifts.

ASV was initiated at EPAP min 3, EPAP max 15 and PS of 5. Snoring was eliminated at all pressures. 21 respiratory events: 0 apneas (0 obs, 0 mixed, 0 central) and 21 hypopneas. Mean O2 was 95% and min sat of 91%. 0% below 90% O2 sat. No Cheyne-Stokes. P10 with pillows and mouth tape.

EPAP PS RATE TST %Sup SupAHI REM RAHI CAI HI AHI ArIDX Nadr O2avg
3/15 5 0 106.5min -- -- 10.5min 5.7 0 2.8 2.8 29.9 91% 95%
3/15 6 0 25.0 min -- -- 0min -- 0 7.2 7.2 52.8 92% 96%
3/15 7 0 61.0 min -- -- 12.5min 0 0 4.9 4.9 19.7 93% 95%
3/15 8 0 57.0 min 14% 0 8min 7.5 0 3.2 3.2 15.8 92% 95%
3/15 9 0 38.5 min -- -- 6min 10 0 7.8 7.8 23.4 935 95%

No abnormal behavior noted. 11 periodic limb movement for a PLM index of 2.3. Heartrate was 71 beats per minute average, range 63-87. No arrhythmias.

Diagnosis: Obstructive Sleep Apnea; Treatment Emergent Central Apnea

Impression:
1. ResMed ASV at EPAP min 3, EPAP max pressure support of 5 to 9, auto-rate was used.
2. At ASV of EPAP min 3, EPAP max 15, PS 5 the apnea-hypopnea and arousal indices normalized, snoring eliminated, O2 maintained above 91%.

Recommendations:
1. ResMed ASV at EPAP min 6 and max 15, pressure support 5-8, and auto-rate. Follow-up in 1 month

*********
So, there it is. I was surprised to see the recommended min jump to 6 when we only tested 3 during the study. I was happy to see 0 obstructives and 0 centrals, but I'm a little concerned that I had so many hypopneas. Is the min of 6 a response to the hypopneas?

Thanks for looking,
SB

Do you think that the ASB will do a good job handling all of those hypopneas?

Yes, a properly configured ASV will kill all apneas and hypopneas.

I suspect you'll need to change those settings once you have the machine. Resmed recommend the PSmax should be 15 or more. But try it out and see what works for you.

Thank you

Good morning. I hope you all slept wonderfully last night.

I'm adding three nights of Oscar pics because I'm curious to know what the experts here on the board see.

As a non-expert, I'm wondering if my top pressure is high enough. It seems to be topping out at 16, but I thought my Rx max should be 15 top + 9 PS max or 24 as the absolute max pressure.

I'm loving that I'm not seeing any centrals, obstructives or even though nasty hypopneas. And I'm dreaming like there's no tomorrow. The best thing about the ASV versus the ST machine is that it doesn't feel like it's forcing you to breathe. The ST always felt like an iron lung. "You will breathe or else." The ASV is more subtle. It let's me breathe in, and then add just a little push to keep me out of hypopnea. It's a gentler experience. I told my wife, ASV is more like a good dance partner. ST was a drill sergeant.

Thanks for the insights in advance. If I need to zoom in on anything, I'm happy to do it.

Have a blessed day!!

Looking good!

Your EPAP (inhale pressure) is fixed at 6.0, while pressure support can vary between 5 and 10. This will give an inhale pressure (IPAP) of 11 - 16. (IPAP = EPAP + PS). So the max IPAP of 16 is correct. Whether it's high enough is a question answered by another question - are you having many apneas and hypopneas? Quite clearly you're not, so yes, the pressure is high enough.

Then there is the most important question - how do you feel? Seems you're feeling pretty good, so all is well. Yes, the ASV is a fantastic machine - pure magic.

Respirator99 wrote: ↑

Fri May 26, 2023 8:30 pm

Then there is the most important question - how do you feel?

Pertinent question.

This kinda caught my eye:

Total Sleep Time was 288 minutes resulting in a sleep efficiency of 67.6% with Total Recording Time of 426 minutes. 39 awakenings. Sleep latency 14.5 minutes and REM latency was 100 minutes. 2.8% supine. Sleep stages 4.3% N1, 77.3% N2, 5.6% N3, 12.8% REM. 150 arousals, resulting in arousal index of 31.3. 115 stage shifts.

TWA.

Respirator99 wrote: ↑

Fri May 26, 2023 8:30 pm

...the ASV is a fantastic machine - pure magic.

I call it The Big Lie, but potato, potahto.

Rubicon wrote: ↑

Sat May 27, 2023 3:28 am

TWA.

Begging your pardon, it's actually Hiroshima sleep.

Respirator99 wrote: ↑

Fri May 26, 2023 8:30 pm

Looking good!

Your EPAP (inhale pressure) is fixed at 6.0, while pressure support can vary between 5 and 10. This will give an inhale pressure (IPAP) of 11 - 16. (IPAP = EPAP + PS). So the max IPAP of 16 is correct. Whether it's high enough is a question answered by another question - are you having many apneas and hypopneas? Quite clearly you're not, so yes, the pressure is high enough.

Then there is the most important question - how do you feel? Seems you're feeling pretty good, so all is well. Yes, the ASV is a fantastic machine - pure magic.

Thank you

Rubicon wrote: ↑

Sat May 27, 2023 3:38 am

Rubicon wrote: ↑

Sat May 27, 2023 3:28 am

TWA.

Begging your pardon, it's actually Hiroshima sleep.

TWA? Today was awful? This was amazing?

I think I was told before that I have Hiroshima sleep here on the boards. As in train wreck? In my defense, nobody could’ve slept in that place. The study was done in a second floor motel room. A parking lot was literally outside the window. Kids running in the hallway. Music. Ugh.

But, yeah I’m feeling a lot better…I think. I’ll give it some time. But it’s not like I can’t have it.

ShallowBreather wrote: ↑

Sat May 27, 2023 4:55 pm

In my defense, nobody could’ve slept in that place. The study was done in a second floor motel room. A parking lot was literally outside the window. Kids running in the hallway. Music. Ugh.

All 4 of them?

The guy at the desk wasn't Georgie Santayana, was it.

ShallowBreather wrote: ↑

Sat May 27, 2023 4:55 pm

But it’s not like I can’t have it.

"It?"

You mean "Hiroshima Sleep"?

I’ll give it some time.

OK.

Meanwhile, I shall ponder parameters other than The Number:

Rubicon wrote: ↑

Sun May 28, 2023 3:00 am

ShallowBreather wrote: ↑

Sat May 27, 2023 4:55 pm

But it’s not like I can’t have it.

"It?"

You mean "Hiroshima Sleep

No, I mean the machine.

I’m don’t know much about this sleep stuff. But I know that I stop breathing when I’m asleep. And the ST machine was terrible. It had a good Number, but I didn’t feel as good in the morning.

The Number? I’m do check it, I’ll admit, but I’m more enjoying the dreams I get from the ASV. I didn’t get many with the ST.

ShallowBreather wrote: ↑

Sun May 28, 2023 4:11 pm

... I’m more enjoying the dreams I get from the ASV. I didn’t get many with the ST.

Dream recall is generally not a good thing, as it's often (usually?) a sign that REM is fragmented and you're going REM > Wake.