Anyone know what a good starting point for a woman using an ASV would be?

[erouting]

Hi All,

I was helped here when I was having trouble with a sleep doc. Ended up buying my own ASV, AHI is now 0.0 and overnight O2 monitoring confirms O2 never falls below 94%. 


My current issue: My room mate was having the same untreated apnea symptoms I used to get. Ran an overnight O2 test and recorded 84% o/2 sat. Can't run a formal sleep test as she has autism and won't go into a sleep lab for any reason, even if not doing so kills her. After my own experience I have roughly the same level of respect for the profession of sleep medicine as you might have for a dog's leavings on your lawn so I can't fault her choice. 

Autism is highly associated with both CSA and OSA. Much higher rate of CSA than in the normal population. She mentioned that she stops breathing at night when she gets tired but is still awake, even before she goes to bed, which is more associated with CSA than OSA and is a problem I have with my CSA. Using a response to treatment approach I put her on an ASV with my settings. It's an older S9 VPAP Adapt. 

She said the pressure was too high so I've lowered the EPAP to 5.4, min pressure to 5.4. Max pressure is at 12. She's taking the mask off after a few hours and complaining of headaches but isn't sure if it's mask tightness or the pressure being too high. Does anyone know what the normal starting settings for women are on ASV therapy or where I could find that information?

Unrelated but also wanted so say thanks, my hospital finally released my raw sleep study results. After some of the advice I got on here I filed a 15 page complaint with the Office of Civil Rights under HIPAA, who found in my favor, compelled the hospital to release my records and then issued an 8 page finding against the hospital for violating HIPAA, so thanks to the board for suggesting that course of action.  

Thank you very much.

[gainerfull]

Is there an option to use the s9 vpap adapt in cpap mode? I'd probably start there at 7cmH20 and review the data in Oscar for efficacy.

ASV is a steep learning curve for someone not already comfortable with cpap.

[erouting]

Thanks for the reply, yes, I can switch it to CPAP mode. 

For me I started with ASV and was completely comfortable doing so but I may have been an outlier. This evening I'll try CPAP and see if that's better tolerated. 

Is 7 the setting I'd use for Max PS or did you mean EPAP or Min PS?

Thanks

[gainerfull]

If you are using CPAP mode it should only allow you to set one pressure.

[erouting]

Yep, just tried changing it on mine, you're correct. Thanks you.

I'll try that tonight. Hopefully she can adjust to that and then graduate to ASV mode. I'm pretty sure she needs it because, again, not breathing while awake but tired isn't an OSA symptom that I've ever heard of, but it is a CSA problem. She's got that so I'm guessing she has CSA like I have.

If anyone does know what the normal starting settings for a woman on an ASV are I'm pretty sure that's where she'll end up eventually. I'd like to know where to find that information. It has to exist somewhere given that resmed make a for her line of pap systems.

[SarcasticDave94]

Generic into for any adult:

ASV default is on ASV Auto EPAP 4-15 PS 3-15, probably a bit much without knowing what you're actually dealing with in events type or counts.

If this is a ResMed AirCurve 10 ASV, there's the CPAP mode of straight pressure, ASV mode with straight EPAP and PS range minimum of a spread of 5, ASV Auto makes EPAP a range as well. As you probably know, IPAP is an at that moment sum of EPAP and PS, and not manually directly adjustable.

If you go to ASV Auto after trying CPAP mode, you may want a slight EPAP Min increase over that low of 4, maybe 5 to 6. And unless you think that high Max settings are necessary, I'd drop those to maybe 10 or 12 on both EPAP and PS.

[erouting]

Thank you. Switching to ASV tonight as CPAP mode did nothing for her. ASV should be fine on lower settings. I had her using my settings with max pressure at 15. All kinds of problems associated with pressure being too high, but, oddly enough, she did wake up rested, just in a lot of pain. Hopefully the lower settings do it. Thanks again.