At this level of zooming we can't really answer your question about arousals. However, overall looks like decent sleep breathing for most of the night. (It is worth noting, however, that the job of an ASV is to insure a good wave form in folks who have problems with central sleep apnea.)
In essence I take a couple of big gulps of air, followed by a "collapse" of the flow rate. I have these events happening a lot in my sleep, making me believe that if I am able to iron these out, my sleep quality will improve massively.
This sounds like it could be a
spontaneous arousal rather than a respiratory related one. And the "collapse" of flow rate could just be a normal transition back to sleep. We'd need to see a zoomed in shot of what you are talking about. The relevant graphs are the flow graph, the flow limitation graph, and possibly the snore & pressure graphs. If we could see that for say about 30-60 seconds before the suspected arousal and about 30 seconds after the breathing returns to normal, that would go a long way in helping us try to figure out whether the arousals might be respiratory related or not.
Now, don't get me wrong: Too many spontaneous arousals can destroy sleep, just like too many respiratory related arousals can. But fixing spontaneous arousals is a more difficult task than fixing respiratory-related ones: Respiratory-related arousals ought to become rare if the pressure is right.
The DISE/sleep endoscopy the ENT performed a while back showed a multi-level collapse of the upper airway, confirming my suspicion of having to focus on UARS.
That's a reasonable suspicion.
Since the machine hardly ever flags any hypopnea's and apnea's, but rather big FL's of 50% and higher,I am quite keen on understanding the following:
- Are these arousals?
If so, can swollen turbinates contribute? (I have a chronic dripping nose during the day, mucho tissues needed)
Should I solely focus on gradually increase Ipap, with perhaps a minor range between Ipap min and Ipap max?
Would it be better to go for a bipap, as opposed to an ASV
We need to see what's happening on a breath-by-breath basis.
The swollen turbinates might (or might not) be contributing to the flow limitations. The nasal congestion, if it is a problem at night, could definitely be triggering some arousals, but throwing more pressure at your nose may or may not fix anything. The question is whether your flow limitations respond in any way to increased pressure.
As for BiPAP vs. ASV: Why were you put on the ASV in the first place? What are all of your actual settings? And how were your settings determined? Because it looks to me like the way your ASV is set up, you are essentially mimicking a straight CPAP running at about 11-11.2cm for the Pressure setting with an EPR =3. That's what the extremely tight PS range is forcing your ASV to do: Your IPAP must stay between 11cm and 11.2cm and your EPAP must stay between 8 and 8.2cm.
You might find increasing the the max IPAP setting and also increase max PS setting to something like 4 or 5. Those changes will give your machine more freedom to increase pressure in response to flow limitations and sort of mimic the way a Resmed VAuto or a PR BiPAP works. Right now, it can't really increase the pressure to respond to those flow limitations at all. (Note: For folks using an ASV for central sleep apnea, the max PS is often really super high---like above 10. When the machine is responding to central apneas, that huge max PS setting allows the machine to increase IPAP drastically in an effort to trigger some inhalations.)
I think given that UARS is on the table for discussion, you really need to let us see some zoomed in data. You might want to post your data at the freebie version of SleepHQ and provide us with a link to a typical night. That way we can zoom in on areas that are of interest to help tease out what might be going on in your sleep.
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.
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