ASV user request for analysis

[Labromaniac]

Greetings. Brand new member here but 8 year user of ASV and usually the F&P Oracle mouth mask with nose plugs but recently the new Evora FULL hybrid mask which I reallyl like.

My request is for help on a phenomenon that has been happening to me increasingly both before and after the mask change. I have mild complex SA. I am awakened several times a night finding that the ASV is pounding me with high pressure and at a respiratory rate that his higher than I like while lying there awake. It keeps going regardless of my breathing and will not stop until I lean over and press the off button to restart the machine where everything calms down and I can get back to sleep. Last night it was especially bad and you can see how many times I had to hit the button. Very frustrating and I don't know what to do about it. AHIs are almost always close to zero and leaks especially with this mask are negligible.

You may notice that ramp is on, but usually I don't use it. I was just experimenting briefly.

I have never seen it as dramatic as this picture from last night, but the increasing pressure waking me up is common.

My first thought is that the upper pressures are set way too high for my needs and wake me up. But why they are going up in the first place is a mystery to me.

By the way I also wear an upside down soft cervical collar to prevent my jaw from open on those rare times I go onto my back. Has always worked great for this and always improved my AHI score.

Any thoughts on where to start? Thanks for your expertise!

[DaveL]

I'm trying to like the new F&P Evora Full that I bought about 10 days ago.

My first issue was adjusting the mask to fit. I found a way.
(Put the mask on with straps where I think they should be. I don't hook up the mask to the machine. Then on the bed in the way I like to sleep. Take a breath. Plug the open end of the hose. And blow OUT through my nose. Leaks are obvious. Top of mask? I lengthen the straps so the mask cushion can fill with air and seal better. When there's no leak at the top, I repeat with the bottom two straps.) (Doing so lets the mask cushion fill and seal)

Regarding your jaw opening....I use a Knightsbridge Dual Band cap. It's very well made. I put it on over my mask. Advantage for me? It holds the mask headgear in place. It really works.

I've posted lots of comments in the Knightsbridge review on this site. I have to be careful when I put it on. This last 5 days so it's worked really well for me.

I hope this suggestion helps.

I don't have the skill to answer your other questions...but I thought I would comment about the mask.

Others here have wonderful experience and I'm sure they will help.

[Labromaniac]

Interesting device. Thanks for pointing it out. Gotta solve this waking problem - driving me nuts.

[DaveL]

Welcome to the forum!

I'm really disappointed in my ability to read OSCAR. that's my fault. No one elses. Gideon has helped me a lot, as others have.

The Knightsbridge Dual Band is the best made chin strap I've used. And it works better for me than my cervical collar. It's really inexpensive in the US. Cost me a lot to buy here in Canada. Hint: it's worth the cost! I'm just a sometimes happy customer. I've had the best results and the worst results because i didn't put in on right.

I bought an iWatch. And an app. It gives me a sleep report now that's helpful. And it tells me roughly what my blood oxygen level is. Before this watch, I was ok if I woke up in the morning. But hoping isn't solving problems.

I know you're going to get incredible help resolving your problem. I care; that's why I responded.

edit: I wake up with change in pressure. Maybe you do too. So I *think* you need to optimize your settings with expert help.

[sawinglogz]

On my DreamStation, pressing the ramp button once was enough to make it reset its breathing rate. (The previous model required pressing it every breath for about a minute; stopping and starting on that model had an ear-splitting beep!)

So long as stop start doesn’t bother you, that seems like a decent short-term solution.

You might try lowering your max PS and see how that goes for you. It won’t help with breathing rate, but you might find that it lets you stay asleep and doesn’t increase CAs much. Try a little at a time to find the right balance.

If nothing works, look into EERS, which is great if ASV keeps waking you up no matter what you try.

I think we inherently change breathing rates after a vivid dream, and that temporarily gets us out of sync with the ASV’s idea of what our breath rate should be.

[Labromaniac]

Thanks sawinglogs, that is all interesting. Not sure what EERS is, can you explain?

As for changing PS, I have never tried changing my settings. PS is the difference between EP and IP? Looks like I need to go to the wiki.

Any comments you have would be helpful. Cheers.

[Rich66]

Your machine is set at the Resmed default settings for EPAP. The default settings for PS is Min 3, Max 15. I would definitely turned down the PS Max. My opinion, turn off ramp, raise PS Min to 3, turn down PS Max to 12, and see how that works for you. Give it a couple of nights for you to adjust to the new pressures. My doctors had me at too high a pressure and I was not getting proper sleep. I finally just retarded the pressures and then things started getting better. It's a slow process. More adjustments will be needed.

[Labromaniac]

Thanks so much for those thoughts. If I understand correctly, PS is the difference between the EP and the IP. Since I don't seem to be having any obstructive events (my AHI is almost always below 0.5), is the purpose of the PS and variable IP then to knock me out of any central events that the machine thinks I am having?

If this understanding is correct, then is it correct that the setting on my machine allows high pressures to be used that may be entirely unnecessary and thus are waking me up? Is the idea that much lower pressures may be sufficient to knock me out of central events as well as preventing any obstructive events? Is this why you have recommended lowering PS? And maybe max IP should be lowered as well...

Thank you for helping me understand. I am new to considering changing any settings and I have just continued using whatever the sleep doctor set on the machine. My Dx is complex SA and I have used ASV for 8 years.

[Rich66]

The most important goal is "how do you feel".  I have had plenty of AHI 0.00 nights, and still felt miserable the next day..  The EPAP pressures are adjustable, the IPAP pressures are not DIRECTLY adjustable -- the Pressure Support pressures are adjustable, and that is what adjusts the IPAP pressures.  Adding the PS figures to the EPAP figures is what gives you the IPAP pressures.  So if your EPAP MIN is 6, and your PS MIN is 3, then your IPAP MIN is 9.  And the max figures work the same way.
So, using the above example -- if you change the EPAP MIN to 7.6, and you do not change the PS MIN, then your IPAP MIN will become 10.6.  In this example, if you like the IPAP MIN at 9.0 and want to keep it 9.0, then when you turn up the EPAP MIN to 7.6, you need to turn down the PS MIN to 1.4.
Remember, inhaling and exhaling are two different entities.  Don't think of it as "breathing", consider inhaling separate from exhaling.  As for inhaling, do you have mouth leaks, dry mouth, headaches, and/or burps -- then your pressure is too high.  Are you having to pull air into your lungs -- then your pressure is too low.

Next subject -- using example of EPAP MIN 4.0, EPAP MAX 7.0, PS MIN 3.0, PS MAX 12.0. -- if your ACTUAL EPAP pressure is 5.4 (as seen on OSCAR), then your IPAP ACTUAL will be in range from 8.4 to 17,4.   Your ACTUAL EPAP pressure is the leader, IPAP is the follower of EPAP.  So, you have to figure out what you want to accomplish, and make adjustments as needed.
I hope this helped, and is not too confusing, especially when in brain fog mode.

Also, I am way away from what my Doctor prescribed, and the sleep doctor knows it.  She also knows I'm doing better on the pressures I'm using.  Forget the DME, and Doctors are not always right.  Do what feels good for you.

Keep in mind, anything less than 5.0 is considered "treated".  I don't mind if I have a few hypopneas or centrals, the most important thing is "can I function as an adult until bedtime tonight".

[Labromaniac]

This was so wonderfully educational and supportive! I have already learned a ton from you. Thank you so much for the time you spent. So, if my complaint is that I am being awakened at night when my machine decides to start pumping hard as you have hinted i need to try turning down the IP max which I would do by lowering the PS. Do I have this right, and if so, I will go ahead and give it a try!