Please help me interpret my data card results. ASV new user

Hello,

I am new on ASV. I am using the new respironics ASV unit after being diagnosed with Central apnea. I am a 30 year old, in shape male with no known health issues.

Can you help me understand how well or poor this is doing for me? I realize my AHI looks pretty decent. You'll notice in the last date(last night) my AHI was it's highest. I was seemed to have a lot of weird breathing while getting to sleep.

Do you see any Cheyne-stokes style breathing?
How does my breathing pattern look?
Are my pressures on average high, medium or low?
Anything else worth noting?
From what you can tell, are the majority OSA or CSA?

I'm new to ASV also.

Your charts show hypopneas but not obstructives or centrals.
I wish my results were as good.

You might modify your subject title to include ASV ...like interpret my ASV data card results.
This gets the attention of the few ASV users here who can help you.

icipher wrote:Do you see any Cheyne-stokes style breathing?

No...if you hand anything that looked like CSR it would be flagged under PB (Periodic Breathing) and it would include centrals and you have neither flagged.

For breath by breath analysis you really need to look at the waveform graphs. That is a separate graph from what is shown in these pages. On the History tab look for the little blue paperclip looking thing just to the left of "Summary"..that's wave form graphs which is a breath by breath picture of your breathing for the night.

I will let the others answer your other questions.

Pugsy wrote:You might modify your subject title to include ASV ...like interpret my ASV data card results.
This gets the attention of the few ASV users here who can help you.

icipher wrote:Do you see any Cheyne-stokes style breathing?

No...if you hand anything that looked like CSR it would be flagged under PB (Periodic Breathing) and it would include centrals and you have neither flagged.

For breath by breath analysis you really need to look at the waveform graphs. That is a separate graph from what is shown in these pages. On the History tab look for the little blue paperclip looking thing just to the left of "Summary"..that's wave form graphs which is a breath by breath picture of your breathing for the night.

I will let the others answer your other questions.

Unfortunately, i don't see anything resembling a little blue paperclip next to the summary icon.

Crap....I forgot you aren't using Basic. Give me a bit to open up Pro (it takes forever) and I will find wave form and point you to it.

On the Overview tab or Therapy data tab down by the date on the right side is the blue paperclip looking thing...click on that for waveform graphs.

Thanks Pugsy, here they are. Also, what is a "timed breath"?

icipher wrote:...

• Do you see any Cheyne-stokes style breathing?
• How does my breathing pattern look?
• Are my pressures on average high, medium or low?
• Anything else worth noting?
• From what you can tell, are the majority OSA or CSA?
• What is a "timed breath"?

...

So many questions! So little time! ..


Do you see any Cheyne-stokes style breathing?

Nope. There is a definite waxing and waning to Cheyne-Stokes Respiration (CSR). There is none of that in the data you posted.


How does my breathing pattern look?

Pretty normal for someone what has central sleep apnea. It's irregular and probably follows your level of sleep. Often when someone has problems with central sleep apnea, they have more problems during deep sleep than during REM sleep. During REM sleep there is more neural activity, which tends to lead to more regular breathing.


Are my pressures on average high, medium or low?

While it might not feel it to you, they are fairly low. Most of the time your PS (pressure support) is only 5.2cm H2O or less. That's the "90% of the time your Pressure Support was" line if your first post. Ditto with EPAP. The 90% number is 8.7 with your minimum EPAP of 8.0. That's not a lot higher than your minimum. Again, that's good.

This means your ASV does not often need to intervene. That's good. Hopefully catching this now and using ASV therapy will help you avoid damage to your body (diabetes, kidney issues, heart issues, etc).


From what you can tell, are the majority OSA or CSA?

Actually, it's hypopneas. You had zero OSA or CSA. And even the hypopneas is very low. Your AHI score is 1.6. Most people would give a right arm to get a number like that.

Caution: This does not indicate how you feel. If you feel well and the AHI number is low, then all is well. If you still feel tired, it's likely there is something else in play that needs to be addressed.


What is a "timed breath"?

It's essentially a backup breathing rate that indicates you were not breathing regularly. You will note in the detailed waveform data that the blue (breathing) line goes flat a little bit before a timed breath. Essentially, the ASV unit noted that you did not breathe when you should (based on your average over the past several minutes .. it's a moving average) ... and as a result the ASV unit switches from EPAP to IPAP. That is usually enough to help trigger a breath.

You will note that sometimes this also means that your flow rate is not what it should be. To help compensate (and help sustain respiration, which helps break a cycle of under shoot / over shoot), the ASV unit will increase the pressure during inhalation (the read line under the breathing line). This helps assure you get enough air throughout the night, even when your breathing is not regular, or you start to hypo-ventilate (breathe shallowly).


Anything else worth noting?

Nope. You seem to be doing well .. from these graphs.

The key questions are ... How do you feel? Are you adjusting to the therapy? Are you still tired during the following day?


Hope that helps.

John. I can't thank you enough for your detailed reply. I'll have a chat with my sleep doc about the timed breathing and see if he is concerned. Maybe he can tell me if my hypopneas are central or obstructive based.

As long as I get into bed at a decent hour, I actually feel pretty good throughout the day. I would say a little better than before starting ASV. Since i've only been using it for two weeks, we will see if it gets better.

I was on BiPap for about a month before ASV, and my AHI ranged from anywhere between 3 and 7-8 with the occasional 1% PB. The ASV seems to be doing better and actually breathes with me a little better too.

The timed breathing is your ASV system keeping you from having a central. It notices a delay in your breathing and switches to IPAP to give you a nudge.

The graph I look at is patient-triggered breaths %. That gives a pretty good bird's-eye view of your tendency toward central apneas. Looking at your graphs, I see mostly 100% with a few miniscule dips scattered about, and a couple of larger dips.

What's interesting to me is that your larger dips in patient-triggered breaths don't seem to correspond to EPAP/IPAP changes (except on 10/15). That may be typical of true central apnea, whereas mine is pressure-induced central apnea (complex), so I usually see drops in patient-triggered breaths after the ASV kicks up the pressure to ward off a respiratory event.

Overall your centrals look very well controlled. You still have a fair number of residual hypopneas, but that's probably still a massive improvement over your pre-therapy numbers and it might improve over time as you adjust.

As John said, these numbers look good enough that the real question is: how do you feel?

Man this looks pretty good to me. I wish mine was this good. I've been averaging about an AHI of 12.

On the timed breath thing, I'm curious if you'll see it improve. My first few nights my waveform was damn near solid timed breaths. My breaths per minute was around 12. Since then (about 3 weeks) I've seen the timed breaths go way down, patient triggered breaths go way up, and my average pressure support go down steadily. My average breaths per minute have gone up to just over 14. I think it is my brain "learning". I think this ASV is training my brain to have more consistent breathing patterns.

Other than that, I'm just jealous that you manage to snag 10 hours of sleep on a Thursday night. I'd strangle a kitten for that.

sawinglogz wrote:The timed breathing is your ASV system keeping you from having a central. It notices a delay in your breathing and switches to IPAP to give you a nudge.

The graph I look at is patient-triggered breaths %. That gives a pretty good bird's-eye view of your tendency toward central apneas. Looking at your graphs, I see mostly 100% with a few miniscule dips scattered about, and a couple of larger dips.

What's interesting to me is that your larger dips in patient-triggered breaths don't seem to correspond to EPAP/IPAP changes (except on 10/15). That may be typical of true central apnea, whereas mine is pressure-induced central apnea (complex), so I usually see drops in patient-triggered breaths after the ASV kicks up the pressure to ward off a respiratory event.

Overall your centrals look very well controlled. You still have a fair number of residual hypopneas, but that's probably still a massive improvement over your pre-therapy numbers and it might improve over time as you adjust.

As John said, these numbers look good enough that the real question is: how do you feel?

Thanks for your insight. To clarify, the timed breathing episodes are basically would-be centrals?

When you mention the "100%, do you mean that all the events i am having look to be centrals and none appear to be obstructive?

Does it look as the the hypopneas i am having should be anything to be concerned with or do you THINK they are relatively harmless?

I should get an oximeter.

Frankly, your data looks REALLY good. It appears the unit is doing its job and helping you pace your breathing ... just what the doctor ordered.

To give you a comparison, here's why my machine sometimes works overtime to help sustain my respiration:



As you can see, it's about 20 minutes of just not breathing well. I sometimes awaken after these events and have a horrible time getting back to sleep. DUH! .. But I no longer awaken in an absolute panic. THAT is an extremely unpleasant way to awaken.

There are several of us that have nights more like mine above than like your data. I'm not saying don't share it with your doctor. But even the timed breathing your doctor will probably just say something like "Good! The unit is doing what it is supposed to do! Keep using it. It's making a difference!". How do I know that's the sort of thing a doctor will say? Because that's what my doctor has said. As long as the unit is doing its job and helping to sustain respiration AND we feel well, then it's good.

Hope that helps.

JohnB

This AutoSV machine is just amazing.

Even with continuous large leaks, it managed to detect and treat a variety of events and keep you breathing.
As posted earlier, I had a night where it was breathing for me continuously for about 80 minutes, the next night only 40 minutes, and now its back to 5 - 10% machine triggered breaths.

Even though my AHI is higher than on my auto BiPap 750, I feel better because I don't have to go through the nonsense of not breathing for 30 to 60 seconds at a time or long series of CSA breathing.

Even though I've only had it for 18 days, I'm going to wait another two weeks before scheduling an appointment with my sleep doc to see if anything needs to be tuned a little.

BTW, Kudos to CPAP.COM. Their price was exactly equal to the Medicare reimbursement price which also has a substantial co-pay which I don't have to pay.

icipher wrote:Thanks for your insight. To clarify, the timed breathing episodes are basically would-be centrals?

How's this for an equivocal answer: "maybe". The machine is deciding that it has been too long since your last breath and giving you a nudge (switching to inhale pressure). If the machine's guess was right, then yes, it averted a central apnea. But sometimes it's just you and the machine not being in sync.

I've encountered this in two situations: after an active dream (breathing rate spikes during dream, then drops after the dream is over) and when waking up in the middle of the night (when I take slower, deeper breaths).

The PR is pretty good at ignoring gradual changes (apparently the ResMed ASV is much pickier about keeping you on a fixed breathing rate), but anything sudden enough makes it think you're skipping a breath. If you find that happening to you, here's the trick: it seems to be based on the pause in between breaths. If you exhale slowly and keep the pause between exhale and inhale short, it won't try to make you breathe when you don't want to. So I just do that for a few breaths, and usually drift off shortly thereafter.

When you mention the "100%, do you mean that all the events i am having look to be centrals and none appear to be obstructive?

No, I mean that the patient triggered breath percentage graph is 100% nearly all of the time, with a few dips.

Does it look as the the hypopneas i am having should be anything to be concerned with or do you THINK they are relatively harmless?

It entirely depends on you. My diagnosis was modera OHA comprised entirely of hypopneas, and I definitely feel worse when I have more than one or two hypopneas in a night, but I suspect the feeling isn't due to the hypopneas themselves, but rather due to whatever sleep disturbance caused the hypopneas. (Certainly one or two hypopneas shouldn't disrupt sleep that much by themselves.)

So again it comes down to the question of your original diagnosis and how you feel. I don't see anything obviously wrong. What was your original AHI number & what was the breakdown between hypopnea, obstructive apnea, and central apnea?

Also, as John often points out, it can take months to fully adjust to ASV, so you might see the hypopneas recede over time as your sleep continues to improve.

I should get an oximeter.

I always recommend Kevin at Cooper Medical Supplies because of his fantastic customer support.