ASV settings help please!

[petemsw]

Hi, and thanks in advance for your help. I've been on BiPap for 6 years, and my sleep doc sent me for a sleep lab test last month. We knew I had treatment-induced central apnea but he had to prove it to have it approved by Medicare. The thing is, I don't completely trust his judgment or knowledge on the settings.

It's a ResMed AirCurve 10 ASV, set to AutoAsv. Pressures are:

MinEpap = 4
MaxEpap = 15
PSMin = 3
PSMax = 15

It takes me a couple of hours to fully awaken in the morning, and I begin to feel droopy around 3PM, frequently falling asleep in front of the TV in the evening. This has not improved over the first 3 nights I've been using the ASV machine, although my AHI is by far the lowest it's ever been - on BiPap, it was all over the place, as high as 30 and rarely lower than 7.

I've attached both the standard and advanced OSCAR screenshots. May I please have some comments about the settings? Again, I'm grateful for your help!

[SarcasticDave94]

I'd bump EPAP Min from 4 to 6 and try that a night. Others may add in more suggestions, and we may need 7 later, but for now, let's see how that goes. It's also possible we can trim EPAP Max down a bit, however, it's likely best to do one action at a time.

[petemsw]

I'd bump EPAP Min from 4 to 6 and try that a night. Others may add in more suggestions, and we may need 7 later, but for now, let's see how that goes. It's also possible we can trim EPAP Max down a bit, however, it's likely best to do one action at a time.

One thing I should mention is that high inspiratory pressure with ASV is awakening me once or twice a night, and I’ve been giving up and waking for the day with less sleep than I think I need after repeated waking caused by what feels like a hurricane being pushed down my nose and throat. I never felt this effect in Auto BiPap more with my Philips Respironics DreamStation BiPap, or my older Philips Respironics System One BiPap. Pressure with BiPap was 8/13 with PS of 2/4.

I’ll make this change and will post results tomorrow.

[SarcasticDave94]

I'm afraid we will hit a few speed bumps, but trust me, we'll get you and the ASV to play nice ASAP.

If you've not done so yet, get the free OSCAR tool to view your own sleep data. As for disruptions, as things get optimized, these disruptions should be gone soon too. Certainly post how things went overnight, and do your best to answer "how do you feel?" with a bit of detail. We're fishing for symptoms/complaints that help key in on the therapy and how it's going.

[jaswilliams]

The numbers look great on the ASV just give it time to get used to sleeping with it. Remember not all sleepyness is caused by OSA/CSA it could be medications being used or something else but give the ASV more time 3days is nothing to recover a sleep debt

[petemsw]

Thank you, Dave and Jas!

[SarcasticDave94]

Sorry I didn't pick up on this earlier. I think what you're describing with the overwhelming pressure, it hits you sometimes and startles. At least that's how it hit me. OK you need to act by doing what's called Blow Back. This is a literal blowing back into the mask to send the message to the errant ASV to back off. It will do so for a while, and hopefully let you get some rest.

[petemsw]

Dave: The “BlowBack” trick is handy, but not if the ASV algorithm is bringing inspiratory pressure up so high that it wakes me up multiple times during the night. The machine shouldn’t be awakening us — the whole idea is to stay asleep, right?!

[SarcasticDave94]

Let's see what others say, but there is a possibility some of the events may be disrupting sleep. I'm thinking of Flow Limits and if applicable, hypopneas and obstructive apnea that can be disruptive to restful sleep aren't being addressed as best as they could.

I know the only data I recall was one that stated EPAP Min was on 4. I would consider that as likely too low for any PAP machine. It tends to cause air starvation in most adults, and would likely be too low to prevent some events from being prevented. I consider EPAP to be what creates a stable airway, and starting at 4 it can adjust up, but I think it needs to be optimized some for both comfort and therapy efficiency.

[jaswilliams]

From your graph at arround 4:30 your machine was raising EPAP to try and treat flow limitations I wonder if you were actually awake at that point or you had some form of positional obstruction that the ASV was trying to clear can you post another chart to see if there is a similar pattern if it becomes a problem you could try the ASV mode rather than ASVauto the static ASV mode cannot raise the Epap pressure