Help [trying to understand data]

[Sleeprider]

The reason for using a pressure of 6.0 is based in part on your sleep test which did show a minor obstructive component. Low, fixed PAP pressures generally do not exacerbate central and complex apnea, while resolving obstruction, and sometimes actually improving CA. I think a trial at the lower pressure is a worthwhile effort, however the fact remains you have been prescribed an ineffective therapy device, never intended for the treatment of central apnea and hypopnea. Your goal should remain obtaining ASV, however using low fixed pressure CPAP may be viewed as a bridge to that therapy, and establishes your attempt at therapy compliance.

[TheMacGyver]

Hi everyone.  So, since my last post I took some of Sleepriders advice and went to a lower fixed pressure. That did lower my AHI from 30-40 to 15-20. The problem is that those numbers are not better than my sleep test so I'm not sure im better off trying to use it at all.  Also, with pressures low enough to keep the centrals at bay makes it feel like I want more air. it makes it hard to fall asleep but if I raise pressure above 7-8 central apneas increase.  So, for now I try to wear it a little bit each night to get used to having a mask on and also to see if my numbers are consistent, but usually it lasts less than half the night before I convince myself that I can breathe better without it. This machine just wasn't meant for this.
       I bit the bullet yesterday and bought a lightly used Resmed Aircurve 10 ASV. It is on the way as we speak from vender #2.  before it gets here I want to already have a game plan as far as some sensible starting points for pressures and setup.  I had no problem setting up the Airsense 10 autoset I have but I understand the bi level machines have a few more numbers.  If anyone who has this or similar machines could give me some pointers as to where to start regarding pressure and why. I have very little if any obstructive events even at 7cmH2O so im looking forward to finally being able to do something about my central events. I want to thank everyone again for their help!

[SarcasticDave94]

Hi everyone.  So, since my last post I took some of Sleepriders advice and went to a lower fixed pressure. That did lower my AHI from 30-40 to 15-20. The problem is that those numbers are not better than my sleep test so I'm not sure im better off trying to use it at all.  Also, with pressures low enough to keep the centrals at bay makes it feel like I want more air. it makes it hard to fall asleep but if I raise pressure above 7-8 central apneas increase.  So, for now I try to wear it a little bit each night to get used to having a mask on and also to see if my numbers are consistent, but usually it lasts less than half the night before I convince myself that I can breathe better without it. This machine just wasn't meant for this.
       I bit the bullet yesterday and bought a lightly used Resmed Aircurve 10 ASV. It is on the way as we speak from vender #2.  before it gets here I want to already have a game plan as far as some sensible starting points for pressures and setup.  I had no problem setting up the Airsense 10 autoset I have but I understand the bi level machines have a few more numbers.  If anyone who has this or similar machines could give me some pointers as to where to start regarding pressure and why. I have very little if any obstructive events even at 7cmH2O so im looking forward to finally being able to do something about my central events. I want to thank everyone again for their help!

See my sidebar for my settings. I'm not indicating you ought to duplicate mine BTW.

The AirCurve 10 ASV Auto machine has 3 or 4 pressure settings, depending upon which Mode you're running it in. There are 3 modes: CPAP, ASV, and ASV Auto.

Skipping CPAP...

ASV settings are: EPAP and Pressure Support (PS) Min and Max.

ASV Auto: EPAP Min and Max
And PS Min and Max. This is the mode I'm running mine in.

IPAP Min and Max are controlled by the algorithm and based on EPAP and PS and from the past few breaths I'm thinking.

PS I'm not including comfort settings like heated hose, ramp, humidity.

[TheMacGyver]

Thanks Dave. I’ll look into the epap and ps settings and operation. I figure the rest of the comfort settings will be similar to my airsense

[Sleeprider]

Your problem was never obstructive apnea, so we don't need the pressures Dave is using to prevent OA.  I'm going to recommend that you go by the book in this case, starting with ASVauto mode, and EPAP min of 4.0, EPAP max of 15.0 (I don't think you will ever go above 7.0), PS min 3.0 and PS max 15.0.   We will quickly take a look at the results and make some fine-tuning.  One exception, is if you feel lower pressure left you wanting more, then EPAP min at 5.0 is just fine. Pressure support should avoid that feeling.  Here is the "book". 

[TheMacGyver]

Awesome! Thanks Sleeprider, that titration protocol was exactly what I was looking for. I know if I get some baseline data then with everyone’s help I should be able to get it dialed in. Hopefully I will have the machine by this weekend.

[SarcasticDave94]

Thanks Dave. I’ll look into the epap and ps settings and operation. I figure the rest of the comfort settings will be similar to my airsense

Welcome and that's true on comfort stuff.