ASV settings and tips

[jcp519]

Thanks Jay. I feel like I have made significant progress since originally starting CPAP in October of last year. ASV was definitely a big improvement to my therapy and I feel like I'm almost there with getting all of the kinks worked out.

I wish I could be one of the people out there that just throw on their regular old CPAP and sleep great every night.

[jcp519]

So I wanted to post an update.

I've been doing pretty well with the ASV so far and have no issues at all wearing it through the night. I decided to just stick with nasal pillows and mouth taping because I hate the feeling of a FFM while trying to sleep. I feel decent overall, but I still experience some residual sleepiness during the day on occasion. 

I feel like my sleep hygiene is pretty good and I usually get around 8 hours of sleep every night. I'm also dreaming almost every night now, which is something that I haven't done since I was younger.

The biggest complaint I have is that when inhaling and the PS is at min, it feels like there isn't enough push from the machine. I'm hesitant to push my PS min up much because I know that higher PS can induce CA. 

I posted a few charts, but they look pretty good to me. Anyone have any thoughts on my rambling?

           

[stevew168]

So I wanted to post an update.

The biggest complaint I have is that when inhaling and the PS is at min, it feels like there isn't enough push from the machine. I'm hesitant to push my PS min up much because I know that higher PS can induce CA. 

It's good to hear your ASV is working well for you. Increasing PSmin should not impact central apneas, since ASV should completely eliminate CAs if it is set properly.

ASV use is shown to give you the most REM sleep compared to all other sleep apnea machines. I have certainly found this to be true, at least compared to apaps.

[Sleeprider]

PS min gets you the comfort for every breath, but If I was looking to resolve "getting enough push from the machine" that is PS max. You are frequently at your maximum PS, and that is there to stabilize minute vent. I would not hesitate to increase PS max if you tolerate the pressure and get that push you're looking for.

[jcp519]

When the machine is at PS max I'm actually just fine, but it rarely bumps up that high before I'm asleep now. I found that a PS max above 9 gives me pretty bad aerophagia.

Its more an issue when I first put the mask on and the PS is too low. Does it look like I need more PS max though?

[Sleeprider]

Well, PS min and PS max will rise together, so it makes sense to me you may do better at PS 4.0 min and PS 9.0 max.

[jcp519]

So I've tried the new PS settings of 4-9 for a few nights and I've got some questions about it. 

It seems like compared to a PS range of 3-8, my respiratory rate drops more often and I am at max PS more often. I get even more and longer areas of my respiratory rate dropping low and my tidal volume going up where I'm doing long deep breaths. Seems like in response to the low breath rate, my body compensates by increasing my tidal volume. I'm not sure if this is affecting my sleep because on CPAP my respiratory rate remained around 14. It seems to me that a higher PS min makes this more likely to start happening. 

My sleep quality feels about the same, can't tell much of a difference in how I feel.

   

[robbob2112]

bump it if you feel like the setpoint is low.  see how you do.  I get the same feeling and have to check if I turned on the machinre.  like you say, if I bump it very high I get a lot of stomach air.

note - anytime I make any change I give it three days before any other change.  seems like it takes me that long to adjust.  If the change makes me off the charts bad I revert right away.

[stevew168]

I would not be concerned that your respiratory rate goes down and your tidal volume goes up with higher pressure support settings. As long as your minute ventilation stays about the same, it means that you are not needing to breathe as fast, which is good if you are also breathing deeper. 

BTW, I lowered my EPAP to 6-12 and left pressure support at 3.8-15, and for three days since, my AHI has improved to significantly less than 1, and I have much less aerophagia. I should note I'm using a different dental guard as well, which might be helping.

[stevew168]

Well, I set the EPAP back up to 15 vs 12, so much for aerophasia. If I have to fart as loud as my neighbors dogs bark at night, I guess I'm OK.