Air Pressure Issue

[Vako]

A standard OSCAR chart will be fine. You may want to present one like that and one swapping in mask pressure in place of pressure.

On the ASV, to have a static EPAP, this will be via ASV mode. Whether this mode or ASV Auto is more useful will probably depend on how many Obstructive based events there are. I found by using ASV for 2 years that EPAP in the ASV tends to treat most of the Obstructive events, while PS takes in the workload of dealing with Centrals.

Do note that flow limits may be present, and it's due to a side effect of ASV CA treatment.

Here's some info
This one is me starting low to see if leak would stop but it failed badly. Same mask also. It's 3 bad I can only post 3 pictures at a time. Have so many I want to show.

[Vako]

This one is much better, I'm sticking with it for now to see what happens, slept all night, woke up at 7am to breathing burning plastic, forgot to turn on my MK2 ?

[Vako]

Look at last Feb to May 2024 I used it 111 times with max Epap and PS settings without issues but can't do it anymore ?

[SarcasticDave94]

OK, you'll need to get off the Ramp or run it with higher pressure when you also edit EPAP Min, and short timing. My experience is Ramp will increase CA, which isn't what you need.

I would begin increasing EPAP, at the least minimum EPAP goes to 5. After about 2 days, you may need to increase EPAP Min again to 6.

In the meantime, EPAP Max might also need to go up.

Follow the Titration guide Sleeprider attached.

You don't need to track or post the flow limits chart. They will almost always show FL events while on ASV.

[Vako]

OK, you'll need to get off the Ramp or run it with higher pressure when you also edit EPAP Min, and short timing. My experience is Ramp will increase CA, which isn't what you need.

I would begin increasing EPAP, at the least minimum EPAP goes to 5. After about 2 days, you may need to increase EPAP Min again to 6.

In the meantime, EPAP Max might also need to go up.

Follow the Titration guide Sleeprider attached.

You don't need to track or post the flow limits chart. They will almost always show FL events while on ASV.

Wait wait. I believe ramp is helping me with it because when the therapy stRts and I'm still awake I'm struggling because the machine wants to force air and stops sending when it wants to at my rhythm which is the way it's supposed to do but nope. By the time I'm "out" I guess my rhythm is on par with the machines.

Epap is 4 9.60 and it worked good I think, so you mean go to Epap min to 6  and try again? If it still find push the max Epap up a little bit more until it forked up then go back to where it was most stable?

Is that what I understood?

[Vako]

First of all, Lefty Lanky has been spewing some really bad advise lately, and you should never use his opinion in lieu of your titration result of EPAP min 9.0, EPAP max 15.0, PS min 3.0 and PS max 15.0 without a qualified evaluation or other data that can identify reasons to make a change.  What are your current settings?  Using a Vauto between 6.0 and 20.0 is an incomplete settings suggestion, but makes sense, however it is an absurd description of ASVauto settings.  Your pressure needs and mask settings will change from a nasal pillows or Bleep, to a full face. A full face mask is very difficult to use with ASV due to the larger mask volume and the flexing caused by the pressure changes inherent in ASV.  Let's start with an accurate understanding of your settings and a better description of your perceived issues.

I posted results, can you also weigh in since @SarcasticDave94 suggested I go by your suggestion?

[SarcasticDave94]

With an ASV, you need to have your breath rate calmed a bit, settled down after lying down, before masking up. If not, the ASV notes the higher breath rate and attempts to pace that for a rolling 3 minute window. That is what you’re facing with regarding the machine forcing air thing.

You do not need to immediately edit EPAP to 6. Try EPAP Min 5 first. Why the increase? Hypopnea AHI at 7.x are in the not treated category. You need more base EPAP pressure.

If you feel you must use Ramp, then this pressure must also go up after the EPAP edit to 5.

And you need not quote every reply. It isn’t necessary on this board. Thanks.

[Vako]

Sorry for quoting it's better for me as it lets me know what the heck I'm talking or replying to but if you don't like it I won't quite you ?. Anyhow, you read the bad chart, did you read the one that was 0.8 something? That has Epap at 4 and 9.60, again should I just go up until it's not comfortable anymore? I have to use ramp, actually I've always used it but it was 5, but now since I get stressed out ( because I have insomnia also ) unrelated to SA, I start overthinking and can not get my breath in sync, again they should make a machine that registers any changes in pattern you make ( at least that's what it was doing when I first started ) or felt like so. 

To recap move just min Epap up? Leave max as is?

On a side note I got a call today from the VA hospital it was my annual "discussion" with the sleep therapist about my compliance, he asked if I was messing with the numbers I said he'll yeah I can't sleep with leaks ( well you can't do that because your sleep test was done to get a specific number set for you blah blah ) I'm in my mind thinking , come make me not to ?. Then he's like which mask are you using that's causing you issues now, I'm like the saMe Airtouch F30 plus 20 others, he's like F what? ( Yes he's clueless ) And then asked  are you using the bleepity mask LOL ( Bleep Eclipse ). He's like well that setting is working fine you are controlling your apnea don't change it well talk in 8 months you are 100% COmpliant but need to sleep more than 4 hours ( I'm like, and you think I lay in bed saying please just 4 hours of sleep? ??) Well just wanted to tell that little funny story.

[SarcasticDave94]

Typical Dr. Quack McDuck stuff there.

So you're supposed to suffer with subpar therapy 8 months until doc gets around to thinking of settings needed an edit? Nope, we don't play that.

On to your settings. This is your therapy. You run the settings your way. We are here to guide.

An option on EPAP to 5 or 6 worth trying. Your ASV does what I'll call fractional settings, AKA it's in steps of 0.2, so whole steps aren't the only the way to go. Maybe try a slight add to EPAP Min. Edit the setting if you choose and at your pace.

Tell the doc I said so.

As for that sub 1 AHI. It's great looking, but how many of that versus the high Hypopnea, etc? I'm not ever going to suggest cranking it all the way to 20, however we're after reasonable stats with comfort and well rested.

[Vako]

No it wasn't the doctor pheww.. I would've lost all hope then. It's just a sleep tech ?

Yeah I will titrate in small increments to try to get back to 0 like it was when I started. But what should be the range difference between Min and max Epap?
If I go to 6 it's just a 3 point difference to max Epap.