Help with ASV problem?

[Midge 82]

Hi. I'm new to the forum and would love some idea or suggestions. I've been using an ASV for two years and my treatment has been successful until recently. 

I've been using the Resmed Aircurve 10 for about 2 years after being diagnosed with (primarily) Central Sleep apnea, with obstructive and Cheynes Stoke breathing also. I was having pretty severe symptoms of waking up with chest pain and gasping for breath and 02 dropping into the 70s. My AHI was 60-plus during REM and awakening with chest pain. 

My treatment went very well until recently, with enormous improvement, and I was having less than one AHI.

For a reason I can't figure out, I've started having intermittent episodes of extreme shortness of breath during sleep, awakening gasping and with chest pain. On average it happens two nights a week and it's fine for the other five nights. I've brought the machine in to Lincare to be checked out and they say it is fine. I've changed the mask and tubing. Some nights it's fine and works well and then some nights I'd swear I'm not getting air at all, but when I hold it to my face, air is clearly coming out. It feels like I have to breathe really hard to get the air in. 

I've gone back to the place where I had the sleep study and they look at the computer recording of my results and say that it doesn't look like anything is wrong. But I am waking up gasping and with chest pain for some reason, right?  They moved the EPAP from 5 to 6, and the pressure range is still 3 to 15. 

I had a really bad episode last night. The Myair report from resmed showed only 0.1 events per hour and my mask seal was supposedly perfect. But I woke up feeling terrible and literally gasping again. 

I've thought about getting another sleep study but since it only happens around 25% of the time, it seems like a crapshoot that anything would show up at all. 

I've thought about switching to another type of mask and I'm open to suggestions... but the dreamwear was good for so long; I'm not sure what could have changed. I have had a lot of trouble sleeping when I've used a full-face mask. 

I'd love to hear any suggestions. Many thanks in advance,
Midge.

[Sleeprider]

Welcome to the forum. There is a lot we can do to help you solve this puzzle, but first, you need to download the free #Sleepyhead program which will give us a detailed view of exactly what's going on. Also, your machine has an ASVauto mode that can automatically adjust EPAP pressure. It's kind of ridiculous to have someone using fixed mode when you are aware they are having a problem that Auto ASV can resolve better.

From your post, you are in ASV mode with EPAP 6.0 and PS 3-15. With #Sleepyhead we can determine if anything is abnormal with your respiration,and how the machine is applying pressure. You are not having events, so the most likely culprit is not the EPAP pressure, bit the PS range. I think you can safely switch to ASV Auto Mode with EPAP min at 4.0 and EPAP max at 8.0, PSMin 2.0 and PS max 12.0. Without seeing data, we are guessing, bit these settings may lower the maximum pressure you experience, while providing a range of pressure support that is effective for most users. Once we see the data we can home i on the problem and better settings, possibly limiting maximum PS further. If we go too low, it will show up as hypopnea or periodic breathing, but we want to achieve comfort. Do you feel like you might be ingesting air, (aerophagia)?

[Sleeprider]

Midge, just a quick preview of what you can look forward to with Sleepyhead.  This chart from another member shows the events, respiration flow, mask pressure, machine pressure, leaks, snores, and respiration rate.  Much more is available, along with the event breakdown, respiratory statistics and machine settings.  Any portion of the chart can be zoomed in to where individual breaths can be analyzed.  

The first image shows fixed ASV mode, and the second shows ASV Auto. See the difference? As you can see, there is a lot of detail. If we can compare comfortable nights to the ones that are stressful to you, we will probably pick up the difference.

[Midge 82]

Sleeprider, Thanks so much for your response. I was able to download the sleepyhead software and able to see some results, but I have not been able to figure out how to upload it and post it here. I really don't understand the instructions at all, but I'd love to post it if you or someone can help me to understand how. Many thanks.

[Midge 82]

In response to your previous question, I have only felt like I'm swallowing air on occasion if I try to sleep on my side. This forces me to sleep on my back most of the time, even though I'd rather not. But I don't think that swallowing air is the primary problem at all. Last night I slept almost entirely on my back and woke up several times feeling like I was suffocating (not getting enough air, as opposed to too much).

P.S. How would I change it to ASV auto mode? Many thanks?

[SarcasticDave94]

First, welcome to the Apnea Board. To access clinical mode, get the setup manual for your ASV. To access clinical: It involves pushing and holding both home and the knob in for about 5 seconds. Then push Settings. See the word Therapy? Just below that is MODE. Highlight and click mode. Select and click ASV auto. Push the home button and select exit clinical mode. Done with changing Mode.

But I forgot, the mode change to Auto means you need another EPAP number as well. You can do that as well before exiting clinical.

Standby I'm editing this in a min...

Sleeprider wants this: "EPAP min at 4.0 and EPAP max at 8.0, PSMin 2.0 and PS max 12.0."

Assuming you're at clinical menu start and you must do the mode change to ASV Auto; click on Settings, below MODE is EPAP Min and Max. Select EPAP Min change the value to 4.0 click to lock it in. Repeat for EPAP Max but use the number 8.0, Min PS equals 2.0, Max PS equals 12.0. Finally hit home. Select & click exit Clinical menu. Viola, you're done.

[Sleeprider]

Attaching images to your posts is easy.  I wrote this tutorial, but need to go back and use some Sleepyhead charts instead of my sailboat.  http://www.apneaboard.com/wiki/index.php...pnea_Board   Not sure what I was thinking. Be sure to use the Reply button rather than the quick reply edit box so you have access to post attachments.

Dave described how to access settings, and here is a link to a tutorial with pictures. https://www.apneaboard.com/resmed-airsen...setup-info. Once you are in Settings, you will see Mode, EPAP Min, EPAP Max, PS Min and PS Max. When you setup ASV Auto mode, your settings in ASV mode won't be changed, and you can return to those at a future time by just switching back to ASV mode.

[SarcasticDave94]

Just to confirm what Sleeprider says, mode change doesn't erase settings, but switching from ASV Auto to ASV will remove to 2 place EPAP range with a single setting. Reverting back to ASV Auto gives you the EPAP range again.

FWIW I've never ran my ASV machine in any other mode than ASV Auto. Personally, I think you'll like the results.

Best to your success, and if there's any other ASV questions, I'll help to the best of my experience, knowledge, and whatever else may be of assistance.

Happy Tuesday!