Help! Having Constant Wake-Ups from "REM-related Events"

[rosebladepat]

I'm mostly new to ASV therapy. I've been using a ResMed AirCurve 10 ASV for the past 2 1/2 months with very mixed results. Support from my doctor is hard to come by, so I'm really glad I've found this forum to learn more...

My levels have been very similar throughout and are currently as follows:


Mode - ASVAuto
Min EPAP -  5.80 cmH2O
Max EPAP -  9.60 cmH2O
Min IPAP  -  9.20 cmH2O
Max IPAP  - 27.00 cmH2O
PS Min      - 3.40 cmH2O
PS Max     - 17.40 cmH2O

I'm using a ResMed AirFit N30i and am taping my mouth. This has been much more effective at preventing mouth leakage than the Full Face Masks I was using before. I sleep on my right side or in the Fowler's position (at a 40-degree angle on my back). 

My main issue is that after I exhale and then stop breathing it takes my machine until the third push of air to finally penetrate my nasal passage with air. At that point, I usually wake up to the commotion. This happens over and over (maybe 20 times or more) and especially from 2 am until 7 or 8 am, when I get out of bed. A sleep tech friend of mine mentioned that since sleep is usually lighter between these hours that they are "REM-related Events." The dreams attached to these apnea/hypopnea events are incredibly vivid and memorable, but, unfortunately, they end quickly with my waking up from a brief and shallow sleep.

Any suggestions for what I might do to prevent these constant wake-ups so that I can enter a deeper sleep?

[Gideon]

Can you post your daily charts please. It sounds like your EPAP may be too low.
A full copy of your redacted sleep studies, Diagnostic and Titration and a daily chart from a prior CPAP may also help. The more data you give us the better we will be able to help you.

[rosebladepat]

           
Thank you for the message, Gideon.

I've posted my daily charts from last night. I also posted a daily chart from last month. Hopefully that's the information that helps. I'm new to all of this, so I'm winging it a bit.
I don't currently have my redacted sleep studies, but I've just sent an email to my doctor to request them.

[SarcasticDave94]

With that inhale issue, what you may want a bit more PS in the Min setting.

Let's see what others think, but I'd suggest considering edit to PS to be 4.0 Min, maybe even somewhere higher but might want steps of change. It is sounding like you need a slightly bigger differential between exhale and inhale.

[rosebladepat]

Thanks, SarcasticDave... I'll give that a try. I've turned the Min PS up from 4 to 4.6 for starters...

[rosebladepat]

I should say also that in my Diagnostic sleep study, my doctor found Central Sleep Apnea and Cheynes-Stokes Respiration. After I exhale and stop breathing, my airways shut down, and that's why it's not until the second or third push of air from my ASV that I it finally breaks through and I breathe, and also often wake up. It sounds like, as Gideon mentioned, the EPAP MIn is probably too low. I've bumped the EPAP Min up from 5.8 to 7.

[SarcasticDave94]

Keep us updated.

BTW for a learning minute of what I experienced in ASV therapy:

Assuming you're in ASV Auto, pressure settings are EPAP min/max then PS min/max. These 2 numbers equal IPAP in that instant. Also, all 3 sets are ranges, that all slide about somewhat independent of the others. Exceptions are EPAP min or 4 cmH2O, whichever is lower, is your absolute minimum, opposite end IPAP caps at 25, these being mechanical device limits.

Examples,
EPAP 5 and PS 15 IPAP is 20 also
EPAP 10 plus PS 10 equal IPAP 20
If the need is there for more or less PS, you can shift EPAP numbers to PS and vice versa.

[rosebladepat]

Thank you for the information. It's a continual learning process, especially given that my doctor seems to be untouchable and unavailable...
I appreciate anything I can learn, here!

[Sleeprider]

When posting screenshotst, it helps to have the mask pressure rather than pressure chart. That lets us see the machine response to your flow rate and at what point your respiration recovers. It appears your event rate is low and your machine is mostly responding appropriately. It may take some time observing your posts and charts to come up with a solution to the arousal issues.

[rosebladepat]

I'll be sure to include the mask pressure in my later posts. In the meantime, I'll see if I can find better examples of what I'm talking about in some of my other sleep data. 

Also, I think a chin-tuck has been the reason for much of my sleep disturbances,  either while sleeping on my back at a 40-degree angle (which is how I mostly have been sleeping since I've had my ASV) or sleeping on my side.