First night worrying, data even more so

[orand]

Wow, 50 events per hour on BiPAP sounds miserable! Glad I’m going to be skipping that phase. 

What was hardest about getting used to ASV?

[Karlin]

My quality of life was poor when I was having so many events. The hardest part of getting used to ASV was the sudden surges of pressure that occur when you stop breathing. I would be drifting off to sleep and then, with great regularity, I would stop breathing. The machine would roar to life and increase the pressure, waking me up. I also had problems with massive leaks. Folks here were very helpful. I had to work with different masks and pressure configurations until I got it right. Now it is working very well.

[SarcasticDave94]

We of the ASV club have a trick when that hard blow from the ASV startles, and it will jolt you so be prepared, OK when it does that I want you to Blow Back. Take this literally, when the ASV blows hard, blow back through your mask, a moderately hard and forceful blow to tell it you're OK and don't need a jolt right now thank you. It will back off.

And yes, near the beginning of this thread I was referring to an ASV then said the ResMed AirCurve 10 is the best. That was still talking about the ASV machine.

Shout out when you get the ASV, as we can jump in and get it set for titration in about 5 minutes. Then you're ready for a good night's sleep. Oh and get your copy of the clinician manual in the CPAP Setup Manual button on the top banner.

[orand]

Thanks, I’m already prepped with my clinician manual for the ASV, and am looking forward to trying out blow-back once I get it.  I’m hoping I won’t have the same adaptation issues as Karlin since his sleep study showed primarily CSA, while mine showed primarily OSA, and I need the ASV due to strong treatment-emergent CSA.

[SarcasticDave94]

OK got it. Again just mentioning, shout out to signal when you get the ASV and we'll talk about pressure setup.

[orand]

My ASV machine arrived today with 1 hour of usage time on it.  What are your thoughts on initial settings?  My newbie default would be to try something like this:

Mode: ASVAuto
Min EPAP: 5
Max EPAP: 15
Min PS: 3
Max PS: 15

But perhaps I should lower Max EPAP and Max PS a bit?  Anything else I should change or be aware of?

[Gideon]

Max EPAP = 8 for now
Let's see how that does. You want a high Max PS as that is what does the work.

[SarcasticDave94]

As an ASV user myself, the EPAP range is about the same as if your therapy is on a VAuto etc. It is your air stent and takes care of all things obstructive IMO. PS with the backup rate is for the CA. My PS would be 3-15 now but new doc wants me to use poorly devised therapy pressures that are not going to work.

You may never hit PS 15, but we don't know that until you try it.

Keep your settings with the EPAP edit bonjour has.

[orand]

Sounds good, going with Max EPAP = 8. Thanks!

[orand]

Here's my data from my first night using the ASV machine.  There were no events whatsoever and an AHI of 0.0, so I removed the events section from the screenshot.
   

I experienced what Dave warned me about, with the ASV machine blowing too hard.  Unfortunately I didn't think to try blow-back when this happened, but now I know and will try it next time.  This is what it looks like in the data:
   

It really slams you hard with a single big jolt, seemingly out of nowhere, causing a single breath to be twice as deep as usual.  In the screenshot above, it's using the max Pressure Support setting of 15.  I'm toying with the idea of adjusting PS down to 10 to avoid experiencing such a big jolt.  It typically occurs right when I'm starting to lose conscious control of my breathing, which is really counterproductive to falling asleep.  I'm aware of the philosophy of keeping max PS high, just in case you need it, so I'm a bit conflicted about this.

My sleep tracker claims I was asleep for 5 out of 8 hours, but it really felt like I was asleep for at most 1 hour.

Mask leaks were pretty much nonexistent, but I experienced quite a few chipmunk cheek / Dizzy Gillespie episodes, and that ended up being the biggest barrier to falling asleep.  I've been trying to keep my tongue tightly sucked to the roof of my mouth, but the seal always breaks suddenly, without warning.  It seems to happen most when there's a larger-than-usual pressure boost.  I've mouth-taped for the past 3 years, and so I've continued doing that with CPAP, but when chipmunk cheeks happens, the additional pressure causes air to leak through the micropore tape.  It's not enough to register as a leak in Oscar, but it's really annoying.  Typically I catch it and resume the tongue-block technique within a quarter of a second or so, but on a few occasions I realized I had been experiencing a continuous minor (taped) mouth leak for quite a while.  I tried re-taping with fresh tape a couple times, and that seemed to help a little bit, but the issue still happened.

I'm guessing the tongue technique is going to be my biggest obstacle to sound sleep.  I'm really trying hard, but I think there's something about the anatomy of my mouth that's making it harder than for the average person.  I'll keep at it, and hopefully I'll master it.

There was also minor aerophagia, but it was tolerable.  I'm guessing that will subside once my body gets used to handling it.  Maybe reducing the PS will help this too.

There was also a weird period between 3:20-3:55 where my respiratory rate doubled from about 7 or 8, up to 14 or 15.  The Pressure Support also dropped to the minimum setting and stayed there throughout.  I reviewed my video recording, and this was during a period where I was completely immobile on my stomach.  There didn't seem to be any obvious trigger for the breathing rate to double or return to normal, so it must have been due to dreaming or deep sleep.  It was during this phase that my SpO2 dropped to its lowest level of 91%.

Any advice, or additional data you'd like to see?