Im exhausted. Please, why am I still waking up so much?

[emmylouwho]

I had been experiencing the ASV taking my body for a test drive since switching to nasal pillows in February.  I can't blow back into the machine with nasal pillows like I could with a ffm.  I switched to Auto last night because my AirCurve 10 was set to regular ASV.  I felt a huge improvement with it on Auto.  The pressure increase during sleep transition after having wakened only happened twice that I remember.  I am still exhausted because I keep waking up. I don't know why I keep waking up.  I know my data looks fine but I've gone through some breath to breath this last week trying to find an answer.  I can't keep functioning like this anymore.  I just need to know before I start to look outside of my sleep therapy.  I took some ten minute screenshots in spots where the flow rate narrowed for anyone to please take a look.  I also took a full night shot.  Also I don't know if I changed my therapy's effectiveness by lowering the PS from 15 to 13. I also lowered PS min from 5 to 3. I am not good at reading this stuff yet!  I did notice a couple CAs (?) but I guess that's not a big deal in the overall picture?

[gainerfull]

There's a lot of opportunity to decrease flow limits and to lower your leaks as well. Looks like you're dropping your mouth open at night so you may consider a cervical collar, chin strap, double sided boil & bite mouth piece or mouth tape.

I don't know enough about ASV to recommend any setting changes, though.

[Rich66]

As an ASV user, I prefer my graphs set up as Event Flags, Flow Rate, Pressure (not mask pressure), and Leak Rate. I find those are the 4 most important. Congratulations on the AHI of 0.00 -- I've had plenty of those. And yet I still woke up feeling miserable. What worked for me was to adjust the pressures -- it's a slow going process with a lot of experimentation to see what works and what doesn't.

If it was me, I'd leave the EPAP Min at 3, and set the EPAP Max at 9. I would set the PS Min at 3, and the PS Max at 10. Those are big changes which is not usually a good idea. But the idea is to try and come close to where you get a good nights sleep with few if any apneas. And then dial it in from there, slowly.

Also, I try to eliminate as many leaks as possible -- I use mouth tape. I figure with less leaks I have more accuracy with the graphs. I use the N20 mask and I have found that the air that gets pushed inside me will take a u-turn and come right out my mouth. It really gives me no benefit, it will wake me up, and/or it will give me a sore throat, which wakes me up. Use whatever system works best for you.

My recommendation is as a fellow user of the machine, not as a sleep doctor or some expert.

[emmylouwho]

We really don’t consider flow limits causing arousal with ASV because the limits are pressure supported. My leaks are generally fine and last night aside from that hour (which some of it I was awake) they weren’t an issue. I was waking up about every hour hour to hour and a half the last two nights. Wondering if that’s sleep cycle related? If so, I don’t know exactly what that means.

I’m not aware of dropping my mouth open? It would wake me up if so which it has but I’ve only experienced that at the beginning of using the nasal mask.
The large leak spikes were me adjusting the mask by pulling it away from my face if that’s what you’re thinking is mouth drop.

[emmylouwho]

Thanks, Rich! Glad to hear from a fellow ASV user. It sounds like I am on the right track then. I was scared to move my pressure down to 13 but I can give the 10 a try.  
I’m still not sure if my body is going to like the nasal mask. I wake up with chest discomfort and sometimes aerophagia but it’s a lot better than in the beginning of trying a nasal. 
My wake-up’s don’t seem to be leak related. Usually my nights are better with leaks than last night.  I am open to considering that but I can’t make too many changes at once. I tried tape in the beginning and I couldn’t stand it. The Last 2 nights I woke up every hour to 90 minutes. Before I tried auto, I never went back to sleep after I first woke up from a few hours. So the Auto seems to be the right choice. 
I just tried the N20 last week but it leaks just like F20 for me. The N30 has been good but I am trying the dreamwear nasal cushion next week.  
I’ll remember that set up for screenshots next time. It is what I had done but I thought I read somewhere that someone preferred mask pressure so I swapped it up this time.