ASV Titration Assistance

Dread · Post by **Dread** » Sat Nov 18, 2023 4:56 pm

Hi, my sleep doctor has put me on ASV. The issue now is fragmented sleep. I feel like the pressure is not right, but i don't understand ASV tiltration compared to ST. I was wondering if anyone could assist me with getting better pressure. Here is my OSCAR data from last night.
https://imgur.com/a/effDUdz

Dread · Post by **Dread** » Sun Nov 19, 2023 9:27 am

Im having similar issues. Breathing looks eratic. Wake up middle of the night.

Pugsy · Post by **Pugsy** » Sun Nov 19, 2023 9:41 am

Awake breathing IS erratic when compared to asleep breathing.

If you are waking up several times a night you can expect to see those periods of awake breathing reflected in the flow rate or breathing graphs.

The million dollar question is, of course, why the wake ups and why not sleeping?
You have to fix the sleep problem first and that will reduce the periods of time with erratic awake breathing.

And it may or may not be related to anything apnea related or setting related.

Dread · Post by **Dread** » Sun Nov 19, 2023 12:39 pm

Would it not be something with pressure. Oscar looks like I wake up as I’m kicked out of the sleep.

Pugsy · Post by **Pugsy** » Sun Nov 19, 2023 12:58 pm

Dread wrote: ↑
Sun Nov 19, 2023 12:39 pm
Would it not be something with pressure. Oscar looks like I wake up as I’m kicked out of the sleep.

There is no way to tell from the data available exactly what caused the awakening/arousal because we can have all sorts of reasons for waking. To fix any problem we first have to identify the problem and then we look for potential solutions.

There are spontaneous arousals which mean no known cause.
There are airway related arousals.
There are external factors causing arousals.
There are the normal awakenings after the completion of a REM stage sleep cycle.

Your machine can ONLY maybe deal with the airway related arousals...if ( big IF) that is what is causing the arousals.
Could it be pressure related??? Not impossible I suppose but I have my doubts.

Your machine is pretty much useless when fighting any of the other potential causes for awakening no matter how much we want to find a miracle setting.

We don't sleep soundly all night long without any arousals. None of us do that....heck, just post REM arousals..which are normal...will mess up sleep quality if we don't go right back to sleep for any number of reasons.

Sleep maintenance insomnia....where we wake up often or too soon or whatever.
Sleep onset insomnia...where we have trouble falling asleep at the beginning of the night but it can also rear its ugly head in the middle of the night too.

How many awakenings do you actually remember??? Do you go right back to sleep when they happen or does it take some time with some tossing and turning involved???

Dread · Post by **Dread** » Sun Nov 19, 2023 5:05 pm

I wake up from a Dream, go back to sleep and then don’t have anymore dreams. Takes me like 30 minutes to fall back asleep.

Dread · Post by **Dread** » Sun Nov 19, 2023 8:40 pm

Pugsy wrote: ↑
Sun Nov 19, 2023 12:58 pm

Dread wrote: ↑
Sun Nov 19, 2023 12:39 pm
Would it not be something with pressure. Oscar looks like I wake up as I’m kicked out of the sleep.
There is no way to tell from the data available exactly what caused the awakening/arousal because we can have all sorts of reasons for waking. To fix any problem we first have to identify the problem and then we look for potential solutions.

There are spontaneous arousals which mean no known cause.
There are airway related arousals.
There are external factors causing arousals.
There are the normal awakenings after the completion of a REM stage sleep cycle.

Your machine can ONLY maybe deal with the airway related arousals...if ( big IF) that is what is causing the arousals.
Could it be pressure related??? Not impossible I suppose but I have my doubts.

Your machine is pretty much useless when fighting any of the other potential causes for awakening no matter how much we want to find a miracle setting.

We don't sleep soundly all night long without any arousals. None of us do that....heck, just post REM arousals..which are normal...will mess up sleep quality if we don't go right back to sleep for any number of reasons.

Sleep maintenance insomnia....where we wake up often or too soon or whatever.
Sleep onset insomnia...where we have trouble falling asleep at the beginning of the night but it can also rear its ugly head in the middle of the night too.

How many awakenings do you actually remember??? Do you go right back to sleep when they happen or does it take some time with some tossing and turning involved???

So my Oscar looks normal? I thought there might be something with pressure we are missing.

Pugsy · Post by **Pugsy** » Sun Nov 19, 2023 9:13 pm

Dread wrote: ↑
Sun Nov 19, 2023 8:40 pm
So my Oscar looks normal? I thought there might be something with pressure we are missing.

I am sorry but I don't see where we can put the blame for your awake breathing on something with the pressure.
It's "normal" in the sense that the irregular breathing indicates awake status which we don't want to see much of (we expect to see some) that evidence for not sleeping as soundly as we wished. It is normal to have some evidence of awake breathing on any of these reports.

IMHO you have a sleep problem and not an apnea or machine setting problem.

You are using Auto ASV mode....the pressure can and will vary a LOT in that mode. That's its job. That's what ASV does.
Now for some people the ASV way of doing things can be a bit unsettling and that's just part of what happens when someone is using ASV. It can take some time for the brain to come to understand that this weird machine doing weird things is really helping. Perhaps it's simply the newness of it all with ASV that is messing with your sleep.

How long have you been using this ASV machine?
Perhaps you just need to give it more time for the brain to adjust to this way of doing things and then you can sleep more soundly and faster. I have heard from some people that it took 3 to 6 months.

BTW...don't assume that because you don't remember a dream that you didn't have one.
Not remembering dreams is actually a good thing.
Remembering dreams isn't a good thing. It means we are waking up too much.

Dread · Post by **Dread** » Mon Nov 20, 2023 1:50 am

About a 1 month. The only thing I do notice is ASV pressure sometimes drops alot, but i assume its due algorithm. I do notice some dcent leaks, ill try to fix those and see if it helps.

Dread · Post by **Dread** » Mon Nov 20, 2023 4:25 am

Okay, could it be leaks? This is the damn 4th time I’ve waken up at 2 am. I note the dry mouth or drooling is common between a;l of them.

Pugsy · Post by **Pugsy** » Mon Nov 20, 2023 6:44 am

Yes, leaks, no matter how big or little, can sure disturb out sleep.
Just because the leaks are small and not really impacting therapy itself doesn't mean that they can't/won't disturb our sleep.

Dread · Post by **Dread** » Mon Nov 20, 2023 7:41 pm

Yeah because I’m not sure. My biggest thought was the pressure because the 2 weeks ago I was sleeping through whole nights and now it’s fragmented. I gained a little weight, so makes me wonder

ASV Titration Assistance

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