Difficulty Adapting To ASV Device

[lgins]

I have tried using the device on Friday, Saturday, Sunday and Monday night.
 
I find myself having a problem falling asleep with the device. Only one time did I manage to fall asleep with the device, I woke up after one and half hours, gasping for air, I looked at the display and the pressure on inhalation was over 21!
 
When I am trying to fall asleep the pressure support frequently kicks in and is maxed out at the programmed setting; I find myself trying to fall asleep with bursts of inhalation pressures around 21 while I am still awake. (I did last night try the ramp setting for the first time however, the inhalation pressures were too low especially as I was about to fall asleep)
 
The device has been programmed with the following settings: (Resmed Aircurve 10 CS PaceWave)
 
AutoSV
Ramp OFF
Epap min 6
Epap max 13
Ps min 4
Ps max 15
 
I have clocked a total of over 6 hours on the machine, with an average session of 1  hour 30 minutes.
 
I would appreciate your thoughts and any advice you have on the issue.

[srlevine1]

I have tried using the device on Friday, Saturday, Sunday and Monday night.
 
I find myself having a problem falling asleep with the device. Only one time did I manage to fall asleep with the device, I woke up after one and half hours, gasping for air, I looked at the display and the pressure on inhalation was over 21!
 
When I am trying to fall asleep the pressure support frequently kicks in and is maxed out at the programmed setting; I find myself trying to fall asleep with bursts of inhalation pressures around 21 while I am still awake. (I did last night try the ramp setting for the first time however, the inhalation pressures were too low especially as I was about to fall asleep)
 
The device has been programmed with the following settings: (Resmed Aircurve 10 CS PaceWave)
 
AutoSV
Ramp OFF
Epap min 6
Epap max 13
Ps min 4
Ps max 15
 
I have clocked a total of over 6 hours on the machine, with an average session of 1  hour 30 minutes.
 
I would appreciate your thoughts and any advice you have on the issue.

It would be extremely useful to have a look at your #Sleepyhead or ResScan detail report for further examination and suggestions. We know, from your description, what the device settings are, but we haven't a clue about your reactions to changes in conditions.

[SarcasticDave94]

I'd be interested to see what the charted results are as well.

Welcome to Apnea Board, Igins.

Dave B

[ajack]

a couple of months will make all the difference. In a couple of weeks you'll be waking up thinking the machine is broken because you can't feel any pressure. Only to find a gush of air when you break the seal..... Othertimes thinking you took off the mask because you can't feel it on your face.

only one rule, keep the mask on, don't ever take the mask off laying down. Sit up first, so you won't go back to sleep without it. when you wake up and can't get back to sleep, get up and read till you are tired again.

when you feel the machine ramp up as you are going to sleep, give a forceful exhale, it will reset it a lot.

adjust the mask till the leaks are sorted, youtube has good stuff too.

[DeepBreathing]

G'day lgins. Welcome to Apnea Board.

I second the advice above regarding posting some #SleepyHead charts. Ajack's advice is also sound.

However, it does sound like the machine is detecting central apneas or hypopneas while you're in the wake -> sleep phase. During this phase our breathing is often a bit erratic, with long pauses and shallow breathing which can confuse the algorithm. When you mask up, concentrate on breathing slowly and very evenly. The machine will attempt to match your rhythm and so long as you keep it up, the machine will not increase pressure substantially. It's quite soothing to breathe in concert with the machine, and you should be able to drop off fairly quickly. If the machine does suddenly increase the pressure, just blow back hard and it will back off.

If you find you can't sustain this rhythmic breathing, you might need some assistance in the short term, such as zolpidem (Stilnox) or other sleeping pill. You might also find you will do better with a lower maximum IPAP - you can achieve this either by adjusting IPAP Max or by reducing both EPAP max and PS max. Once you've become more accustomed to the machine, you can then increase the pressure in stages back to the prescribed settings.

Ajack is right - once you get accustomed to it, you will wake up wondering if the machine is actually running, as your body adapts so well to the pressure. The Pacewave algorithm is quite remarkably effective, with many members of this board achieving excellent results. Good luck!

[Sleeprider]

I have an idea. Overall, your settings are pretty good, but many users of ASV find they do better with a low minimum pressure support. Clearly it would be much more helpful if we could see your charts, but the one change I will suggest is changing PS min from 4.0 to 2.0. This may reduce your incidence of centrals and encourage more spontaneous breathing. Most people find maximum PS between 8 and 12 is sufficient to overcome central apnea, however, I would really feel more comfortable seeing your results before going there. I'm confident that the change in minimum PS will help.

I want to emphasize, changing the minimum PS does not affect your therapy in any way, but is a comfort improvement. Changing your maximum PS can affect both comfort and efficacy if you go too low, however you are currently at the maximum limit for pressure support, and could easily drop back to 12 which is effective for most people out there. Most of all, you need to resolve to use this great machine and put in the hours. 1-1/2 hours average isn't going to produce benefits. Let's find out how to make you comfortable, so you can benefit from this amazing technology.

[Spy Car]

lgins, first welcome to the forum!

I'm a pretty new ASV user (with the same machine, I believe, with a different model name). I also had initial difficulties with high inhalation pressures shooting up (especially just as I was about to transition to sleep).

The good folks here can offer suggestions to make your therapy much more comfortable. However, to advise you best it really is necessary to see what is going on in your Sleepyhead charts. The learning curve of importing data and posting it here is quite worth the effort.

I went from some struggles with the machine to a pretty good partnership and am enjoying my best sleep in years decades.

Best,

Bill

[trish6hundred]

Hi lgins,
WELCOME! to the forum.!
Good luck with CPAP therapy and getting it fine-tuned to meet your needs.

[lgins]

Hi

Thanks for the words of encouragement, valuable insights and great tips, I appreciate it!
Had a word with my sleep equipment provider and she adjusted the pressure of Ps Max from 15 down to 9 and left the rest of the settings unchanged.
Again last night I was unable to fall asleep, but the machine felt a lot more comfortable and natural. I was able to withstand its pressures for two and a half hours.

When I clock in some more sleep will try post some sleepyhead data.

[srlevine1]

 The process is an incremental one. Some of the lucky ones get it sooner, others get it later. The trick is to keep moving forward. Best of luck.