Trying out ASV, impressions & results

I've posted a few times about my xPAP treatment and my fun with it. viewtopic.php?f=1&t=80104 and viewtopic.php?f=1&t=81132 if you're bored.

Short version: been on xPAP for 2 years, tweaking and adjusting. Numbers have been looking good-ish, only feel 50% better. Tried every CPAP and BiPAP setting and combination there is, far as I know.

The numbers haven't indicated many centrals in terms of what the bipap is reporting, but I've had centrals on sleep studies (and some PLMs, but not enough). My original sleep study was straight hypopneas. It has made me think that maybe ASV would be worth trying, in case it's a breathing regulation issue of some type, as opposed to just basic obstruction stuff.

Finally, I've run out of things to try on the bipap, so I was looking around for an ASV to try. I figure it'll either work, or I'll have enough data then to basically say it's not a sleep apnea issue, but something else. Got the machine this week, and though it's too soon to tell much I thought I'd share some data and also my impressions going from xPAP to ASV, in case it's helpful to others.

First, the data. I may post the first few nights in case it's interesting. I did NOT sleep well last night on it, since it's a bit different. But dang the numbers are perfect - never had an AHI of 0.0 - lowest I ever got on CPAP/BiPAP was like 1.5 or so. Not that it really matters that low, but it's a bit to me in a good way. Check it out:

Summary:



Pressures & Events:



Volumes:



I probably only slept about 4 hours last night, so there's a lot of bouncing around, but I did get some sleep after an hour or two.

Also interesting to me is waveform data, something I don't have from my M series bipap. This is something I wanted to see, because you only know what the machines considers events normally without it. Overall the waveform was pretty normal, which I'm happy about!

This was one of the times when the machine went higher and I'm pretty sure I was sleep, but clean looking:



There seemed to be long periods of this sort of pattern. Seems pretty normal to me, but there's weird pressure drops and volume changes. I'm going to assume it's normal unless somebody says otherwise. Dunno if the ASV was trying to check something or just cycling.. or if I was breathing differently?



I'll take a more careful look at the waveforms when I'm more settled in with the machine.

I've always wanted the pressure set in the 13-17 kind of IPAP range - always where I felt like it needed to be. Where the machine seems to want to go, it's agreeing. I might even bump the EPAP a bit. The first week or so I want to see what it will do while it's more open. Given that there's no events, I'm not even sure I need to touch anything, anyways. I was pretty confident in what pressures I wanted on the ASV, despite not having an ASV titration. I guess it helps that the ResMed is so automatic, you can't really set much.

I was happy to see my breathing rate was steady - something I've not had data on before at home.

My impressions as an experienced CPAP/BiPAP user trying ASV for the very first time:

In a lot of ways, it doesn't feel that much different than a BiPAP to me except when it kicks in. It was less weird than I expected, but with the machine being so free on every breath, it's odd. I think because I'm not having centrals apparently that there's less of the "surprise" increase than might show up for somebody getting it for CSA or ComplexSA. On the other hand, I could totally tell when the machine went from "monitoring" mode into "active" mode after a few minutes. That will definitely take some getting used to, if I stick with it. I tried to just relax and breathe steady, the same way I adjusted to BiPAP (which seems so far to have been a bigger adjustment).

We'll see if I feel any better - given the AHI on my bipap, I don't really expect to, but I don't know what else to try.

Any thoughts or suggestions are welcome

Nice AHI! I hope you found the silver bullet!

Me too! But I'll be wondering WTF it is if it's not sleep apnea, seriously! (Already had a bunch of stuff like thyroid checked)

While 0.0 AHI is not impossible it is a bit rare especially if it happens night after night after night.
The S9 machines have been known to have a little bug in the firmware where it gets "stuck" reporting the same thing over and over. A reboot of the firmware (pull electric plug) usually takes care of it. Just to make sure you might try creating some fake events by holding your breathing a few times for about 30 seconds.

I like to experiment too but my pockets aren't deep enough to experiment with the ASV machines.

So glad to see it's working for you X!

Reading your description was like hearing about my own Adapt ASV experiences. I have also seen 0.0 AHI now for ALMOST 10 days straight. Though on two nights I had a hyponea event that shows up but I can't understand why it was labeled at all. The waveform looks just like any other.

A friend is sending me an older used PR Auto SV (Philips ASV), so am looking forward to how this compares to the S9 Adapt ASV.

Be sure to use your faster moving mask pressure chart when comparing to the flow rate - and then expand the picture to see how the individual breaths look. This will also help you in setting the maximum pressure by knowing if you have any breaths that are struggling (during inhale) and the max pressure is too low.

I think that centrals are more common than many doctors think and this may be the reason you are able to finally bring your AHI down to 0.0.

Pugsy, I have simulated apneas by holding my breath, and it reports OK, so guess it's not locked up.

One thing I have noticed: After 10 days using this machine, my breathing has become more stable and less erratic compared to when I first started. Maybe I'm getting used to it. Even during the day, I think the pacing the machine gives adds a certain breath training that bleeds over into everyday activities. I used to stop breathing quite often during the day - but not as much anymore.

If you get the time, look at your night breath by breath (expand the flow rate) and over time, see if you can adjust the pressures so that you do not miss a single breath all night. I know this sounds amazing, but I see this on my charts now. With the old CPAP and bad centrals, my AHI was always in the 30's or higher, so the treatment IS working.

I hope you continue to post your results.

BTW, I've been using my new ZEO for the last two nights. I'm seeing about an 84 score and trying to improve on the deep sleep. so far I compare to a person about 40 years old, though I am older... if you can believe the statistics they publish. But it IS a great trending tool and I have run some tests and see it is fairly accurate. I don't trust the REM/wake state reports cuz they are so similar in brainwaves, but the deep sleep areas seem good. I notice when my breathing is smooth and stable, just like one of you charts above, this is a deeper level of sleep. The ZEO seems to back this up.

Tom

Finished night 2 with the ASV. AHI is still 0.0 with no events of any type. I'm not sure there's any meaningful difference between 0 events and 2 events per hour, but I guess it's still a trend for now.

Leaks were a bit higher, spent some time in the 25-30 LPM range. Easier to fall asleep this time with it. I'm glad I was used to BiPAP before trying this machine. Going from CPAP or nothing would have been very, very weird.

I felt like I got more hours asleep on it, still not staying asleep the whole time. That makes me not really want to look too much at the waveforms yet, because there's probably a bunch of transition breathing changes in there which aren't due to "sleep quality" as such.

Subjectively, don't feel too different except I felt like I got more sleep than the relatively crappy night last night. # hours sleeping is still a bit low.

Odd question: is there a way to test out the machine without creating "data"? Can I reset the machine? I think sleepyhead/rescan will still have my historical data, yes?

This is interesting to me, since for my current statistical ahi of about 1.6, most of the events are central apneas. Which makes sense, since the cpap is supposed to be dealing with the osa's. I wonder when it becomes a good idea to switch to an asv, anyway? I'm not too worried, an ahi of 1.6 still seems pretty good to me, and I feel okay, so there you go.

I wouldn't worry about centrals with an AHI of 1.6, unless they're very long ones.

My problem is I have low AHI #s, but feel only half-way better. On the ASV, I have even lower #s - we'll see if that changes anything. Your insurance certainly won't pay for an ASV with a low central AHI - and I don't think they should. I'm just trying it out because I'm out of other ideas (and I can afford it).

Xney wrote:I wouldn't worry about centrals with an AHI of 1.6, unless they're very long ones.

My problem is I have low AHI #s, but feel only half-way better. On the ASV, I have even lower #s - we'll see if that changes anything. Your insurance certainly won't pay for an ASV with a low central AHI - and I don't think they should. I'm just trying it out because I'm out of other ideas (and I can afford it).

You can have AHI's of 0.0, but if you're still not getting quality sleep, i.e., more fragmentation than not, you won't feel much better. Something tells me you need to look more at the fragmentation causes and aim for more restorative/deep sleep now that you've got your SDB under control.

Z

Don't go throwing out the baby with the bath water! Though you have a low AHI, it takes TIME to adjust to an ASV. It takes time to adjust to that constant pressure change to address your central apneas. This can lead to very light and disturbed sleep for a few weeks (to several months). But it does get better.

When I fall asleep, I stop breathing for several minutes .. until I am fully asleep and normal respiration resumes. During this time my ASV unit goes NUTS. I end up with very high pressure early on during my sleep. It used to awaken me when the pressure jumps. But no more. I note that the pressure increased, recognize that the ASV is doing its job, and gently drift of asleep - reassured that my ASV unit has my back.

But it took me three or four MONTHS before I reached that point.

Don't give up. Don't throw out the baby with the bath water!

JohnBFisher wrote:When I fall asleep, I stop breathing for several minutes .. until I am fully asleep and normal respiration resumes. During this time my ASV unit goes NUTS. I end up with very high pressure early on during my sleep. It used to awaken me when the pressure jumps. But no more. I note that the pressure increased, recognize that the ASV is doing its job, and gently drift of asleep - reassured that my ASV unit has my back.

But it took me three or four MONTHS before I reached that point.

I'm looking forward to getting fully acclimated to the pressure changes with ASV. Sleep fragmentation certainly is a big issue that does not nescessarily show up in the data, especially the AHI Index.

Yes, for those of us with centrals, it can be a minefield when falling asleep. Before the ASV, I would see the same pattern every night. I start out by falling asleep after about 10 minutes. Then my breaths start to get shallower and shallower until they stop. My breathing stops for between 30-95 seconds in succession. After each central apnea the breathing gets heavy for 2-3 breaths and then dies off again. (Cheyne-Stokes respiration) This goes on for about 10 minutes and then I slide into normal, stable sleep and breathing UNTIL I wake up again and this pattern may start over.

Without a machine, I used to dread going to sleep. With the CPAP it was sometimes even worse. With the ASV, I pass through the minefield with no apnea events at all. Sleep is good.

For those of us who need it, I think ASV will become more popular in the years ahead. John, I've been talking with a guy who owns a Trilogy 100. That appears to be the Cadillac of ventilation and can simulate most any type of breathing machine. He uses a standard mask, as we all do, and has many bells and whistles to play with. The downside is they cost $8K and are rarely seen used. I don't need one, but I know you have mentioned you may be looking to one later down the road. If I could find one to borrow, I would grab the opportunity just to see what it can do....

Tom

Xney, I know you have heard some of Dr. Krakow's opinions about flow limitations & titration, and those effects on patient fatigue. Have you considered doing a sleep test under his supervision? Do you feel that you are able to do just as well on your own, with the ASV? I guess the question comes down to "how smart" that fancy ASV really is?

On the one hand, a more precise human titration in a lab (as Krakow once recommended) might be short lived, as it provides just one snapshot of the potential sleep variation and bodily fluctuations over days & months. On the other hand, an advantage might be obtaining a benchmark for optimal treatment results - such as learning that good daytime energy level is possible with the right sleep conditions. That result seems elusive for some of us.

I suspect that physical fatigue issues (as opposed to sleepiness) are biochemical, and actually have a time constant of weeks - or at least days. In that case it would take a lot more patience to identify auto-titration results.

Third night, getting more used to it. AHI is still 0, if that matters. Breathing looks pretty good, there's some transition (I think) breathing between sleep stages or moving around. Maybe some other little weird breathing but it is mostly smooth. Had work cut off my sleep abruptly so not sure how sleep quality really was.

lostsheep wrote:Xney, I know you have heard some of Dr. Krakow's opinions about flow limitations & titration, and those effects on patient fatigue. Have you considered doing a sleep test under his supervision? Do you feel that you are able to do just as well on your own, with the ASV? I guess the question comes down to "how smart" that fancy ASV really is?

On the one hand, a more precise human titration in a lab (as Krakow once recommended) might be short lived, as it provides just one snapshot of the potential sleep variation and bodily fluctuations over days & months. On the other hand, an advantage might be obtaining a benchmark for optimal treatment results - such as learning that good daytime energy level is possible with the right sleep conditions. That result seems elusive for some of us.

I suspect that physical fatigue issues (as opposed to sleepiness) are biochemical, and actually have a time constant of weeks - or at least days. In that case it would take a lot more patience to identify auto-titration results.

I'd consider anything right now, is kind of how I feel. I'm not sure if it's flow limitation type stuff. My bipap doesn't have flow data so I've never seen it before the ASV.

It's possible the remaining tiredness is purely something else, of course.

Xney wrote:I wouldn't worry about centrals with an AHI of 1.6, unless they're very long ones.

My problem is I have low AHI #s, but feel only half-way better. On the ASV, I have even lower #s - we'll see if that changes anything. Your insurance certainly won't pay for an ASV with a low central AHI - and I don't think they should. I'm just trying it out because I'm out of other ideas (and I can afford it).

The centrals that I have don't look long in the data *smile*. I'm tuned into listening to what my wife says about my breathing...she's the one that got me to go in for a sleep study in the first place. She hasn't heard anything more than me stopping breathing before I got the CPAP, and now she's pretty happy without my snoring not keeping her awake, and steady breathing *smile*. She hasn't mentioned anything exotic about my breathing, other than stopping. So I'm hoping that it isn't an issue. I've been stressed out lately due to work stuff, which has a negative effect on my sleep quality. I'm retiring in about a month, so that should change and have less effect on my sleep. I'm hoping for better quality sleep then.