[CPAP] Air Curve ASV - Newbie

[randeh]

Your actual results (AHI) look excellent. One thing I am not seeing at all is any sign of CA's, which should be the primary reason they prescribed the ASV unit. That leads me to my original curiosity, which is why did they do that? That's something that perhaps the actual sleep study results will tell us.

The reason I'm doing this little dance is because I think, based on the results I'm seeing, that a lower pressure could certainly be justified, which could alleviate your soreness issues. Your median pressure was 16.1, and your "at or below 95%" was 20.9. Those are pretty high numbers, but they resulted in an AHI of zero. That's almost unheard of in the early days of treatment. So I would not hesitate asking your DME or Doc to drop your pressures 2 points to help with comfort issues. Then monitor the results of course.

Thanks for your insight it is very much appreciated. I will be contacting my new doctor on Monday. My wife was at our primary today and asked for a new referral for me. I will upload a copy of my sleep study when I get my hands on it. Kind Regards, Randy

[vsheline]

I received my Air Curve ASV on Monday for central apnea. This is the first time having any type of device. I have been swallowing a lot of air to the point of waking up in pain. Also my lungs expand quite excessively and have some discomfort. I think my EPAP max is to high so I thought I would lower my Max EPAP from 15 to 14, and PS max from 15 to 14 to start with.
I have tried using a full mask and nasal mask and pretty much have the same results.

My prescription is:
Max IPAP 25
Min EPAP 10
Max EPAP 15
PS Min 4
PS Max 15

Hi Randy,

If you check the set-up manual for your machine (clinician guide, not the user manual) I think you will see these settings are just the default settings.

In my view, ResMed (and your doctor) have messed up by starting a new patient (you) on such an unnecessarily wide range, extending so high.

I think it would have been better to start with a Max PS of 10 or less, and gradually worked higher only if necessary, based on results of therapy. It may have been better to start with a lower range for EPAP, too, especially since you are completely new to CPAP therapy.

In fact, in rare cases, some patients may be seriously harmed by very high pressure, so I think ResMed (and your doctor) should not be defaulting to such high settings at the beginning of therapy.

If you are checking your results (sleep data) daily, you can safely reduce the settings on your machine by setting the Max Pressure Support to only 10 or even 8 or even lower if necessary to reduce excessive (painful) amount of air swallowing (aerophagia).

At least a small amount of air swallowing is normal. After getting the aerophagia under control, you can gradually increase the Max PS if you are still having more than a few hypopneas per hour.

If the Max PS is too low it may fail to fully treat central apneas, turning central apneas into central hypopneas instead of completely eliminating them.

If Max PS is 10 or higher you will probably not see any apneas or hypopneas from central nervous system causes, because a Max PS of 10 or higher will usually be sufficient to allow the machine to completely compensate for a lack of breathing effort. Instead of central apneas or central hypopneas, what you would see in their stead would be times when the machine had raised PS higher than the Min PS setting, in order to do for you some or all of the work of breathing.

If your Max PS is 6 or higher and you're having actual apneas (versus merely hypopneas) these may be obstructive apneas. Staying off your back will usually help avoid obstructive apneas.

The machine is operating in ASVauto therapy mode, so the machine will raise the EPAP pressure automatically when needed, to reduce the likelihood of obstructive events. But unlike an AutoSet, your machine is unable to raise EPAP higher than 15.

You can tell whether an apnea is obstructive by looking at its Flow waveform. If Pressure Support is cycling off and on and is causing large pressure cycling (trying to cause inhalation and exhalation) but no Flow occurs at all, this was an obstructve apnea, even if it did not last long enough (at least 10 seconds) to be officially scored as an apnea.

The sore muscles you feel will probably pass, as your breathing muscles become used to the extra stretching and as they gain strength.

But, if after stopping therapy you find yourself unable to breathe in fully or unable to breathe out fully, it is possible you've had a spontaneous pneumothorax. Spontaneous in this sense merely means "not caused by an accident or by an impact or physical trauma." Pneumothorax means air trapped in the chest cavity, but outside the lungs instead of inside where air is supposed to be. If that happens it could be dangerous and we should stop CPAP therapy and call the doctor right away to find out if we should to go to the hospital.

Take care,
--- Vaughn

[JVinNE]

I received my Air Curve ASV on Monday for central apnea. This is the first time having any type of device. I have been swallowing a lot of air to the point of waking up in pain. Also my lungs expand quite excessively and have some discomfort. I think my EPAP max is to high so I thought I would lower my Max EPAP from 15 to 14, and PS max from 15 to 14 to start with.
I have tried using a full mask and nasal mask and pretty much have the same results.

I also have the stretched out lung feeling sometimes. I've only been on therapy for a little over a week.

My prescription is:
Max IPAP 25
Min EPAP 10
Max EPAP 15
PS Min 4
PS Max 15
Bur Auto

I am waiting for a referral for a new sleep doctor because of all the delays I experienced because of my doctor's staff. It took over three months to have the testing and get the equipment. I do not have a copy of my sleep study yet because the doctor issued the prescription without even meeting with me. In your opinion would lowering the values from 15 to 14 make that big of a difference or should I start off lower.

Thank you,

Randy

I am also an Aircurve 10, ASV Bilevel user, and my doctor has me on lower pressure than you. I also sometimes wake up with a belly full of air, and some pretty serious airbiscuits (farting) My bf says sometimes I fart in the night, but it doesn't stink; glad I'm not stinking him out.

I also have sleep-onset central Hypopnea, and I've had it off and on for years; since I got a head injury from my exbf. Last night, on the machine, reported in sleepyhead, my AHI was 0.0. My only complaint about the machine is the tummy air. I even like my new full face mask. It's a lot less leaky than the F10 I was using before this one.

This is my report from last night.

Therapy Efficiacy
AHI 0.00
Obstructive Index 0.00
Hypopnea Index 0.00
Clear Airway Index 0.00
Leak Statistics
Average Leak Rate 0.00
90% Leak Rate 0.00
% of time above Leak Rate threshold 0.00%
Pressure Statistics
Average Pressure 8.11
Min Pressure 5.02
Max Pressure 14.94
90% Pressure 11.74

I had a 0.00 AHI on Tuesday night and except for the air swallowing it was the best night sleep I have had in a very long time. As for the farting I am waking my wife and I think the neighbors too. All the best!

Thank you. Yes, the air swallowing is uncomfortable and farty. Congratulations on your 0.0!

Last night, I had one Hypopnea and an unclassified, so I was at 0.21.

[randeh]

  4-10-2015.pdf (Size: 11.64 KB / Downloads: 78)

I received my Air Curve ASV on Monday for central apnea. This is the first time having any type of device. I have been swallowing a lot of air to the point of waking up in pain. Also my lungs expand quite excessively and have some discomfort. I think my EPAP max is to high so I thought I would lower my Max EPAP from 15 to 14, and PS max from 15 to 14 to start with.
I have tried using a full mask and nasal mask and pretty much have the same results.

My prescription is:
Max IPAP 25
Min EPAP 10
Max EPAP 15
PS Min 4
PS Max 15

Hi Randy,

If you check the set-up manual for your machine (clinician guide, not the user manual) I think you will see these settings are just the default settings.

In my view, ResMed (and your doctor) have messed up by starting a new patient (you) on such an unnecessarily wide range, extending so high.

I think it would have been better to start with a Max PS of 10 or less, and gradually worked higher only if necessary, based on results of therapy. It may have been better to start with a lower range for EPAP, too, especially since you are completely new to CPAP therapy.

In fact, in rare cases, some patients may be seriously harmed by very high pressure, so I think ResMed (and your doctor) should not be defaulting to such high settings at the beginning of therapy.

If you are checking your results (sleep data) daily, you can safely reduce the settings on your machine by setting the Max Pressure Support to only 10 or even 8 or even lower if necessary to reduce excessive (painful) amount of air swallowing (aerophagia).

At least a small amount of air swallowing is normal. After getting the aerophagia under control, you can gradually increase the Max PS if you are still having more than a few hypopneas per hour.

If the Max PS is too low it may fail to fully treat central apneas, turning central apneas into central hypopneas instead of completely eliminating them.

If Max PS is 10 or higher you will probably not see any apneas or hypopneas from central nervous system causes, because a Max PS of 10 or higher will usually be sufficient to allow the machine to completely compensate for a lack of breathing effort. Instead of central apneas or central hypopneas, what you would see in their stead would be times when the machine had raised PS higher than the Min PS setting, in order to do for you some or all of the work of breathing.

If your Max PS is 6 or higher and you're having actual apneas (versus merely hypopneas) these may be obstructive apneas. Staying off your back will usually help avoid obstructive apneas.

The machine is operating in ASVauto therapy mode, so the machine will raise the EPAP pressure automatically when needed, to reduce the likelihood of obstructive events. But unlike an AutoSet, your machine is unable to raise EPAP higher than 15.

You can tell whether an apnea is obstructive by looking at its Flow waveform. If Pressure Support is cycling off and on and is causing large pressure cycling (trying to cause inhalation and exhalation) but no Flow occurs at all, this was an obstructve apnea, even if it did not last long enough (at least 10 seconds) to be officially scored as an apnea.

The sore muscles you feel will probably pass, as your breathing muscles become used to the extra stretching and as they gain strength.

But, if after stopping therapy you find yourself unable to breathe in fully or unable to breathe out fully, it is possible you've had a spontaneous pneumothorax. Spontaneous in this sense merely means "not caused by an accident or by an impact or physical trauma." Pneumothorax means air trapped in the chest cavity, but outside the lungs instead of inside where air is supposed to be. If that happens it could be dangerous and we should stop CPAP therapy and call the doctor right away to find out if we should to go to the hospital.

Take care,
--- Vaughn

Hello Vaughn,

Thank you for your informative reply. Since I do not want another night like last night I am going to go ahead and lower my Max PS to 10 and Max EPAP to 13. My only concern is if there are ratios that should be maintained for Min and Max Epap. I was thinking of dropping the Min Epap to 8. Would that be okay or should I leave it at 10?

I propped myself up last night and the aerophagia was much less. I have attached a report from last night. Thanks again.

  4-10-2015.pdf (Size: 11.64 KB / Downloads: 78)
Kind Regards,

Randy

[randeh]

Hi randeh,
WELCOME! to the forum.!
Hang in there for help with your reports and much success to you as you continue and fine tune your CPAP therapy

Thank you, I am learning!

Kind Regards,

Randy

[JVinNE]

"I propped myself up last night and the aerophagia was much less. I have attached a report from last night. Thanks again." That's what I need to try. I have a new (big) wedge pillow and I ought to cover it with a clean sheet, and use it.

[Sleeprider]

I think you can further reduce EPAP. Your median and 95th percentile are both 10.X which suggests you might tolerate a lower EPAP pressure. Any reduction in EPAP will result in similar reductions in IPAP pressure with the same pressure support settings. You need to keep minimum EPAP within 4.0 cm of the minimum EPAP in order to utilize the range of PS that is set. So, at your current settings, I would have suggested min EPAP=10, min PS=4.0 then the minimum IPAP should have been 14.0.

Similarly, if you reduce min EPAP to 9, then with min PS at 4.0 the minimum IPAP should be 13.0.

Here are your settings from the last report:

Therapy Mode: ASVauto
Ramp Enable: RAMP_ON
Ramp Time: 20.0 Minutes
Essentials: ON
Max EPAP: 15.0 cmH2O
Min EPAP: 10.0 cmH2O
Max PS: 15.0 cmH2O
Min PS: 4.0 cmH2O

You really need to start using Sleepyhead software since there the current reports are very much summary information and we can't correlate events with pressure and other factors. To give you an ideal of the difference in detail, I'll post an image of a recent night on my BiPAP. I was adjusting to a higher pressure support so AHI is kind of high, but what I want you to see is how much more useful information is in this report and how we can associate events with other things that are going on in terms of pressure, snores, flow limits, etc.:

[randeh]

I think you can further reduce EPAP. Your median and 95th percentile are both 10.X which suggests you might tolerate a lower EPAP pressure. Any reduction in EPAP will result in similar reductions in IPAP pressure with the same pressure support settings. You need to keep minimum EPAP within 4.0 cm of the minimum EPAP in order to utilize the range of PS that is set. So, at your current settings, I would have suggested min EPAP=10, min PS=4.0 then the minimum IPAP should have been 14.0.

Similarly, if you reduce min EPAP to 9, then with min PS at 4.0 the minimum IPAP should be 13.0.

Here are your settings from the last report:

Therapy Mode: ASVauto
Ramp Enable: RAMP_ON
Ramp Time: 20.0 Minutes
Essentials: ON
Max EPAP: 15.0 cmH2O
Min EPAP: 10.0 cmH2O
Max PS: 15.0 cmH2O
Min PS: 4.0 cmH2O

You really need to start using Sleepyhead software since there the current reports are very much summary information and we can't correlate events with pressure and other factors. To give you an ideal of the difference in detail, I'll post an image of a recent night on my BiPAP. I was adjusting to a higher pressure support so AHI is kind of high, but what I want you to see is how much more useful information is in this report and how we can associate events with other things that are going on in terms of pressure, snores, flow limits, etc.:

Hello Sleeprider,

Can you clarify the following: "You need to keep minimum EPAP within 4.0 cm of the minimum EPAP in order to utilize the range of PS that is set." Should that be minimum EPAP within 4.0 cm of the Maximum EPAP?

Below are my newest settings although I did not change the minimum EPAP. So with my Maximum EPAP at 12 I would set my Minimum EPAP to 8, Correct?

Therapy Mode: ASVauto
Ramp Enable: RAMP_ON
Ramp Time: 5.0 Minutes
Essentials: ON
Max EPAP: 12.0 cmH2O
Min EPAP: 10.0 cmH2O
Max PS: 10.0 cmH2O
Min PS: 4.0 cmH2O

I tested the above settings and it was so much better and when I purposely stop breathing the machine kicked right in and delivered a blast of air. I reduced the Ramp_on time since these settings are very comfortable and I usually fall asleep quickly. I will try the Sleepyhead software on another computer because with this one the graphs go black. Thank you for your help!

Kind Regards,

Randy

[DeepBreathing]

Can you clarify the following: "You need to keep minimum EPAP within 4.0 cm of the minimum EPAP in order to utilize the range of PS that is set." Should that be minimum EPAP within 4.0 cm of the Maximum EPAP?

I think Sleeprider meant to say keep minimum IPAP within 4 cm of minimum EPAP. This just follows from the equation IPAP = EPAP + PS If your minimum PS is 4 and minimum EPAP is 10, then minimum IPAP should be 4 + 10 = 14.

[randeh]

"I propped myself up last night and the aerophagia was much less. I have attached a report from last night. Thanks again." That's what I need to try. I have a new (big) wedge pillow and I ought to cover it with a clean sheet, and use it.

I am hoping with the adjustment I am making I will be able to do away with propping up. My upper back is so sore maybe a wedge pillow would be better. If you do try it, please let me know how it works out for you.

Kind Regard,

Randy