ASV settings and tips

[jcp519]

I had previously made a thread about optimizing my CPAP settings because I had persistent residual central apneas. No matter how hard I tried, I could not get my AHI to be consistently below 5. Some days I would feel great and other days I would still be very tired due to extra CA events.

A few days ago I was able to find an AirCurve 10 ASV with 2100 hours on Facebook marketplace for $500 with lots of accessories. I was planning on trying an EERS with my cpap but for the price, I just could not pass up the opportunity to pick up this machine. I picked it up yesterday, took it completely apart, and cleaned every possible component I could. I believe the previous owner was burning incense when they sleep, but I was able to get 95% of any residual odor out.

I used it last night and it was definitely challenging to try and get to sleep. I had the settings on default for ASVAuto. The worst part of the machine was as I was starting to fall asleep, there would be surge of pressure as my breathing would slow down. This would make me inhale sharply and keep me awake. I was able to get some sleep, but I'm a bit sleepy today due to the fragmented sleep. The good news is, my AHI was 3.38 which is definitely on the lower side for me. Most of the events were hypopneas or UA. 

Would anyone have an recommendations for changes to improve comfort or tips that could optimize the settings?


   

[Jay51]

Congratulations on the new  ASVauto.  With the slight clustering of hypopneas, your could have some positional apnea.  To combat this, use a smaller pillow (lower pillow height), possibly try sleeping on your side instead of your back, and possibly get a soft cervical collar.  Just measure the distance between your chin and sternum in inches and fractions of an inch for the correct size.  Positional apnea can "kink" your airway by tucking your chin or twisting your head and neck and decrease airflow.  A plus is if it works, you can most likely lower your pressure also.  

We may want to try lowering your PS max in the future, too, to make it more comfortable to sleep with.  Max IP of 30 is the highest I have ever seen.  It can be lowered.  Maybe start at max Ipap 20 and can possibly lower it more from there.  Sleeprider and SarcasticDave are pros at the ASVauto.  I have the regular, older S9 Adapt asv (with a sinlge epap setting).  If they see anything more specific, go with their recommendations.  Others here have experience with the ASVauto also.  We can optimze your therapy, it may take a little time though.

You have some large leaks at times also.  Read this to possibly help you here:    Mask Primer

[Sleeprider]

I though I'd pull a recent chart from your CPAP we were working on to compare, and see if we can use anything there to help us with ASV. You have already cut AHI in half. I think we need higher EPAP min to deal with the obstructive issues that have shown up now that centrals are resolved.   I agree with Jay, that the clusters after 04:00 look positional. Let's go with EPAP min 5.0, limit EPAP max to 10.0 and use PS 3.0 to 10.0, and based on your previous CPAP results, I think we will drop EPAP max to 8.0, but you will have to first deal with the positional issues.  It may take a few sessions to fully dial this in. You will find it gets easier fairly quickly.

[SarcasticDave94]

I can't see much to add in, except maybe using an advanced OSCAR chart preset. Flow limits chart isn't necessary in my opinion, as the ASV doesn't bother (can't) much about them.

Leaks can be a hindrance more so with ASV than other machines. Not bad here, but those short areas can get away from you, just be aware.

On the ASV jolt when you're trying to fall asleep: use blowback. Literally blow moderately forceful back through the mask. It signals to the ASV you're not in a Central and to back off.

[jcp519]

Thanks for the input everyone. I'll make the adjustments to all the settings that Sleeprider suggested. As Jay suggested, I'll try wearing the cervical collar again to get rid of the positional problems. 

As far as the leaks, I believe its almost completely due to my mouth opening at night so hopefully the cervical collar will help out. I am also going to try doing some mouth taping to keep that from happening.

[FrankFuss]

I see you were having mostly Clear Airway events with the AutoSet.  I was the same and also tried an ASV machine.  I also had leak issues with the nasal mask, ResMed AirFit N30, and the ASV higher pressures.  I ended up trying a ResMed AirCurve 10 VAuto with the Inhalation Trigger set to Very High, which reduced the Clear Airway events.  With a lower pressure I now have no leaking issues, and I now get an AHI less than 1.

[jcp519]

I actually didn't have too many leak issues with my first night with the ASV. Looking a little closer at the few apneas I had it looks like nearly all of them were related to a smaller leak and then the apnea started. All of them were under 20 seconds and I only had 7 the entire night. 

With some tweaking to the settings, I'm optimistic I can get things dialed in. I think if I get the leaks and positional problems under control I should have pretty few events remaining. 


   

[robbob2112]

I use the ASV with the F30 and previously had large leaks.  So I switched to the F20.  I wish I could get used to any sort of pillows or plugs, but they all seem to pull my nose to my scalp and I breath through my mouth when I hit REM sleep.

Well, just had cataract surgery and I can't wear the F20, but I breath from both nose and mouth. So I am wearing the F&P Evora (they have a large verse a wide like resmed).  So to avoid the leaks I have been putting the mouth tape across the bottom to keep it in place.  Zero leaks and an AHI that bounces between 0.0 and 0.5 typically. 

Just something to keep in mind if you want to go back to it.

[jcp519]

Had a better night last night. I still had quite a bit of trouble falling asleep because I keep anticipating the pressure surge. But I had an AHI below 2 for the first time since starting PAP therapy. I can tell the difference in my sleep quality and that it is much better. I'm a little bit tired because the total length of sleep was low, but I have none of the terrible apnea symptoms that I would usually get.

I resorted to turning on ramp for 20 minutes which did help me fall asleep. I am going to work on not using ramp gradually until I no longer need it.

I seem to have solved most of the positional problems with the cervical collar. Nearly all of the hypopneas happened while I was still awake, with the exception around 6:00 which seemed to be leak related. 

My biggest problem right now is learning how to not fight the machine when it decides to change the PS while I'm still awake. I'm trying to learn how to not focus on my breathing so much and how let the machine just do its thing.


Any more suggestions on things to make the therapy more comfortable or any more settings that could be tweaked?

   

[robbob2112]

Don't chace a number, it is just a general indicator.  What really counts is how you feel in the morning.

One suggestion, be in bed relaxed before you put on the mask and turn the machine on.  If you do something like bring the laundry up from downstairs or anything that makes you exert yourself and you are breathing hard when you start the machine it will start pushing larger breaths than you need/want.  You can blow hard back at it to get it to back off, but I've had very mixed results with that.