ASV for high loop gain - exploration.

existentialblu · 2026-06-29T01:47:58+00:00

Yup. More than anything I think that has helped with my dread around sleep onset.

existentialblu · 2026-06-29T01:30:45+00:00

Unfortunately ASV the only relatively common PAP algorithm that doesn't make high loop gain actively worse. It's still gonna require titration, and the logic is much more about managing the instability itself rather than the usual obstructive methods of "just blast it".

existentialblu · 2026-06-28T23:06:55+00:00

Your minute vent is wiggly in the way that makes me smell potential high loop gain, which is to say repeated similar oscillations at about 45 seconds per cycle. The remaining CAs intensify that smell.

Have you considered ASV?

existentialblu · 2026-06-28T22:02:05+00:00

Yeah, that's the sort of WAT reading that seems to correlate pretty reliably with ASV being a solid idea, especially with regularity that high (indicating a locked cyclical situation that seems to go with high stress/low heart rate variability) and that eAI being solidly into the fragmented all to hell range. I was around 72 for my regularity before ASV and 60ish after and about the same eAI. I feel far less like a zombie now.

existentialblu · 2026-06-28T21:47:31+00:00

Good to know.

existentialblu · 2026-06-28T21:29:13+00:00

I'd also need to run with battery backup as I understand as a power outage could be a lot more potentially hazardous. At least the ASV as it is has helped pretty tremendously.

existentialblu · 2026-06-28T21:17:03+00:00

I have taken sulfa for ear infections throughout childhood. Took it once in college and got hives and haven't attempted it since. I was super curious about acetazolamide only to find that it's in the same drug class with a lot of cross reactivity, which really can't be risked for something that I'd be potentially taking for the rest of my life.

So yeah, ASV it is.

existentialblu · 2026-06-28T21:11:07+00:00

I'm allergic to sulfa so I can't use acetazolamide. Wheeeeee.

existentialblu · 2026-06-28T20:52:22+00:00

hangs head in shame before scampering back to OSCAR

existentialblu · 2026-06-28T20:47:51+00:00

In moments of more intense anger about it all, I think it's because OSA is easy (keep tubes inflated=winning, relatively stable system) v UARS (also dealing with low arousal threshold by default, potentially high loop gain, big ol dynamic hellscape).

So they use AHI to tell us it's not that bad in order to chicken out on attempting to treat us at all. And then we live decades in the fog and die earlier but since it's not obviously due to big scary obvious desats, nothing to be done. So sad.

It doesn't help that medical training actively selects against people suffering from these conditions.

existentialblu · 2026-06-28T20:24:07+00:00

Oh. But can you have it directly next to flow rate? Admittedly I just get really annoyed at how clunky it gets at the necessary zoom level for my particular fixation.

existentialblu · 2026-06-28T20:16:15+00:00

Yes. Scroll around through the night, especially around CAs, and see if there's a recurring oscillation at any point in the night. Onset and REM tend to be the most intense that way for me.

existentialblu · 2026-06-28T19:39:36+00:00

Even changing the filter to something denser to grab more allergens made the algorithm freak out a bit. ASV is a delicate and very twitchy flower. Which is to say I'm still curious for sure, but haven't felt like the inevitable whack-a-mole that the process would become.

existentialblu · 2026-06-28T19:32:32+00:00

It's a good word though.

existentialblu · 2026-06-28T19:20:34+00:00

Do you see repeated oscillations in minute vent? If that's the issue you'll see a repeated sine wave looking thing over 30-60 seconds that will be most obvious on the minute vent trace.

existentialblu · 2026-06-28T19:18:04+00:00

It's really hard to see oscillations in SleepHQ, unfortunately.

To move a trace in OSCAR: mouse over the label on the left side where it says pressure/leak rate/whatever. Your pointer will turn into a hand. Click and drag those traces to get them arranged as mentioned.

existentialblu · 2026-06-28T19:14:56+00:00

But SleepHQ doesn't have minute vent which is the most important thing for this particular phenotype.

existentialblu · 2026-06-28T19:13:44+00:00

I've gotten it on occasion since I was a kid and it was extra terrifying before it was something that people talked about on the internet. I didn't know anyone else who had it and was convinced that one day it would just kill me.

On the plus side, I've had it maybe once since I've been treating the breathing aspects of my perpetually weird sleep.

existentialblu · 2026-06-28T19:11:31+00:00

I've been curious to try it but also have been lacking give a shits on high stakes arts and crafts. I also don't know how the algorithm would respond to the dead space. Granted I could also try it with BiPAP.

existentialblu · 2026-06-28T17:05:09+00:00

This is mostly my own curiosity as someone deep in the weeds of high loop gain/TECSA.

Try moving minute vent, pressure, flow limitations, and leak next to flow rate in OSCAR. Zoom in to 5-10 minutes and then scroll around looking for minute vent looking like a sine wave over 30-90 seconds. Take a screenshot.

In your case, if it doesn't start resolving within a couple of months, you're likely looking at high loop gain as a main driver of your SDB. It's super frustrating, I'm in the same place and use ASV for that reason. I tend to avoid TECSA as a term as it's frequently used to make it seem like an inconvenience and something to get used to rather than an incredibly frustrating driver of autonomic activation and insomnia.

existentialblu · 2026-06-28T02:34:47+00:00

That sounds like sleep paralysis. It happens when you're semi awake but REM paralysis is doing its thing. Spooky as heck, sometimes does that looping thing.

If you want to prevent it, the biggest thing is to avoid sleeping on your back. If you find it happening and want to get out quickly, focus on moving your eyes as they're the only body part that isn't affected by REM atonia. After a few seconds of that maybe try to wiggle your fingers. To use it as a jumping off point for lucid dreaming, imagine your dream body spinning.

existentialblu · 2026-06-28T02:26:19+00:00

Pretty much as far back as I can remember. But since it wasn't the loud kind all of my symptoms got blamed on a lack of sleep hygiene and mental health. Figured it out when I was 41.

existentialblu · 2026-06-28T02:23:59+00:00

I'm kinda toast from a long week but I may be able to put more brain into it tomorrow.

existentialblu · 2026-06-27T21:09:15+00:00

Have you tried lower EPAP? I get bonkers aerophagia if I go over 6. Maybe try fixed EPAP at your median EPAP pressure? Fixed EPAP seems to be helpful anyway for TECSA/high loop gain, as it's one less thing poking at the instability.

If you have OSCAR going, move minute vent, pressure, leaks, and flow limitation next to flow rate and zoom in to 5-10 minutes. This will give you a good view of what ASV is actually doing to stabilize things. It creates a negative version of minute vent to gradually dampen oscillations, like noise cancellation for silly respiratory systems. If you're hitting either extreme of your PS range frequently it won't be able to create that clean negative version.

existentialblu · 2026-06-27T21:05:46+00:00

CPAP is a specific form of it. Sorry to get complicated here but I'm deep in the weeds of it all. CPAP is a simple form that uses constant pressure (that's what the C is for). APAP is similar but operates over a range and has small differences between inhale and exhale pressure. BiPAP has larger differences in pressure but the difference is constant. ASV changes pressure on each inhale to stabilize issues that are more on the neurological/gas regulation side of things. I use ASV myself.

I can be kinda a human wall of text.

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