Concerns about new AirCurve 10 ASV

[lostie42]

This is my first time posting, but reading this board has been helpful as I continue to desperately search for solutions to a very complex and perplexing case (more on that another time). 

So, I recently switched from a PRS1 ASV to Resmed AirCurve 10 ASV a few weeks ago because the former wasn't getting the job done. They run noticeably different. One odd thing to me is how on the S1 my 95% EPAP could average as low as 5 or 6 if I allowed it, whereas with AirCurve it pushes right to whatever limit I set it at that night (I have to limit it because the times I haven’t, serious aerophagia has kicked in). I know the assumption would be that I need those higher pressures but that’s very debatable given my history and data from the other machine. 

Not only this, but it climbs towards that max WHILE I am awake, just getting settled. The S1 never did this, it always stayed low if I was breathing normally, and temporarily reacted from a sudden break, only to go back down once breathing normalized. This one just keeps going up and up. Why would it increase pressure when I don’t need it? Seems like shoddy programming or a malfunctioning device, to have pressures climb and climb while nothing in my sleep has actually changed (and it’s not because of ramp). 

Another thing, is it normal for SleepyHead to only show LL, CA, OA, UA, and H for the AirCurve? Does this machine not track RERAs etc.? Why is it so limited when it’s supposed to be top of the line? I am having a hard time getting that and other things to show up on SleepyHead, and the wiki was not helpful in resolving it.

Thanks in advance for any insights and opinions on this!

[Sleeprider]

Easy stuff first, the Aircurve 10 series don't record RERA. We have another member "mymontreal" that has the Resmed ASV and is also affected by aerophagia. He has done some pretty remarkable settings to keep below the threahold where air ingestion causes discomfort, yet let the pressure support resolve his central and mixed apnea issues. Most of his results seem to near perfect with regard to events. In ASVauto mode, you get variable EPAP, but there is no problem with limiting its range as long as you get satisfactory resolution of OA. The pressure support should resolve CA and H events. It would help to know what your settings are, and you can search for the other member's thread and take a look at what he has done.

[trish6hundred]

Hi lostie42,
WELCOME! to the forum.!
I wish you good luck with getting your settings dialed in to meet your needs, you came to the right place for help so hang in there for more answers to your questions.

[storywizard]

Losti42 wrote:is it normal for SleepyHead to only show LL, CA, OA, UA, and H for the AirCurve?

The Aircurve 10 ASV does not track CAs or OAs. It only shows Hypopneas and what Resmed rather euphemistically calls UA (unidentified Apneas) Sleepy head will show whatever you want, however there is no need to keep the OA or CA options on your event graph as the Resmed algorithm does not track them. It is one of the features I was really surprised by when I upgraded from my S9 Adapt...still the machine works like a charm...

Storywizard

[DeepBreathing]

The Resmed CPAP / APAP machines detect central apnea by means of the forced oscillation test which is basically a rapid cycling of pressure when it detects an apnea. The FOT takes a few seconds to get its result. It's important on these machines as you want to increase pressure for an obstructive apnea but not for a central.

The ASV machine doesn't bother testing. It just gets on and adjusts the PS to treat whatever problem is presenting itself, and does this on a breath-by-breath basis. This is one of the reasons it is so successful, and why so many people are getting AHIs consistently below 1.0.

[lostie42]

Thanks for the responses.

I will keep tweaking. The thing is, I have already done lots of tweaking (on both machines) and to no avail, and with mostly low EPAP pressures. Low AHI but restless sleep due to arousals/UARS/RERAs. The flagged events have been mostly hypopneas, very few obstructive, even on low EPAP. But my new sleep doc says that EPAP is ‘far too low’ to give me enough support, and the way to treat the UARS is with good pressures. Wants me to go up to 13-15 EPAP range, according to latest ASV titration (wherein I still had a ton of arousals, which is my actual problem).

On Resmed so far my AHI is still typically low, but with higher average pressures than PRS1 and the same horrible EDS symptoms. I don’t see how limiting the pressure will help me, especially if the machine thinks I need those (which it does when I don’t cap it).

[lostie42]

FYI on some of my numbers so far on Aircurve:  Avg EPAP 6.68  Avg IPAP 8.75   IPAP 95% ~14   and maxing out in the 20's most nights.

[Sleeprider]

Lostie, you have #Sleepyhead, so it's time to post some data. The links in my signature describe how to organize and post the data. One more post an you will be able to post the charts or links. We're not clairvoyant and can only help you based on your settings and your response to them. Chances are, we can get to a better solution pretty quickly.

[lostie42]

It's saying I don't have enough posts, even though I do.

[lostie42]

Pressures have seemed to normalize -- I think I was mistaken about too high of pressures earlier. However, the bottom line issue remains: AHI is good, no leaks, but symptoms are AWFUL. Soul-crippling, functioning-destroying awful. Anyway, here are some screenshots of a few days. Maybe someone can see something I don't...