ASV, leakage and flow limit

[garyseven]

Hello,

I am grateful to have found this community. Suffering with dizziness, fatigue and high BP, I was diagnosed with Mild OSA (AHI 6) in home and overnight lab studies last August. I was prescribed CPAP with pressure 10cmH20 a few months later but couldn’t stay compliant. I tried Excite OSA and also lost 25 pound so my snoring stopped, but not sure which helped me there! I was able to cut back on BP meds and I tried a WatchPAT One last month to see if apnea had resolved, but result showed pAHI of 10.6 and . I was titrated for and failed BiPAP (12/8) a couple months ago as well and, in viewing the Oscar and BiPAP titration data, it seemed centrals were presenting themselves. My sleep therapist loaned me a ResMed AirCurve 10 ASV a little over a week ago. I don’t know of any CPAP/BiPAP to ASV conversion and so have been experimenting with the titration for comfort and AHI reduction. Unfortunately, the BiPAP titration was performed before my LVEF results (>45%) became available, so testing on ASV wasn’t an option. 

While I’m better at tolerating the ASV (6+ hours per night), and the machine’s LCD sleep report shows AHI at a seven day average of 0.34 and average daily leaks less than 24, I’m not feeling any better (slightly worse, if anything) and the Oscar report looks peculiar to me with respect to flow limitation and leaks. Also wondering if the ASV can catch OSA’s as well as a CPAP/BiPAP can? Mask is ResMed N30i with pillows (I’m told this is correct for UTN cushion) mask-type setting Any suggestions or input, including suggestions for OSCAR fields to include here, are very much appreciated!  

Gary

   

[SarcasticDave94]

The ASV when properly set up will treat all Apnea. Flow limits not very well though. In fact I'd ignore the FL chart on ASV.

It might be helpful to take screenshots of OSCAR via the F12 button and attach like you have. The formatting is a bit different than what I expect.

OSCAR charts in pretty normal order, Events, Flow Rate, Mask Pressure (standard Pressure OK somewhat interchangeable), Leaks were the ones I paid attention to while on ASV.

[garyseven]

Thanks so much for your reply, SarcasticDave. I'm attaching an updated screenshot of my Oscar data per your suggested layout. Hoping to find out if these leaks seem excessive and/or if the self-titrated ASV pressure settings seem appropriate and ideal given my previous lab-titrated results (CPAP 10cm in late 2023, BIPAP 12/8 last month). Haven't tried Auto ASV much, just regular ASV. 

Thanks!
Gary

   

[SarcasticDave94]

OK thanks, better view of OSCAR here.

ASV mode as you have now equals fixed EPAP. You'll probably be wanting more than 4. In this mode, it has no auto adjusting to EPAP.

ASV Auto mode makes EPAP a range, where it will Auto adjust between Min and Max settings. You might want to try this mode with a small range, maybe 6-10 or so.

Leaks? The experience when I used ASV, you'll get better results minimizing this leak rate. There's a small amount of large leaks. ResMed leak redline is 24 L/Min. Just below that and you'll have probably sleep disturbance from it. Over 24 and the machine will struggle to compensate.