Just started ASV and waking up.

[Sleepless0375]

[attachment=56336][attachment=56336][attachment=56336][attachment=56336]Hi all, my sleep lab just prescribed ASV and I have been really struggling. I tend to wake up 1-3 times a night between 1 am to 5 am. I can't figure out why. My thought was something with pressure as I constantly wake up at no consistent time. I am desperate and was wondering if anyone has any insight.
Below is my OSCAR.

[Jay51]

Welcome to ApneaBoard.  Your pressures with ASV are very similar to the pressures I had when using ASV.  Your waking up a few times during the night may just the nature of the beast with ASV (large pressure swings).  Or maybe not.  

One thing in your summary data stands out IMO.  Your low respiratory rate is 2.8 or something like that.  That is incredibly low.  it was either sleep wake junk CA's when you were either trying to fall asleep or just waking up, or it could have occurred during sleep.  When I used ASV, it kept my respiratory rate much more consistent.  I don't think mine every dropped below 10 at any point.  

Your tidal volume looks good IMO.  Around 600 for median.  Some lows and highs, but not bad IMO.  

You have one period there with a large leak for awhile.  Maybe trying to stop this could possibly help.  Mask Primer   Leaks can be harder to control when pressure is bouncing back and forth between around 10 or so and 20 or so.  

Was your AHI zero on this OSCAR chart?  The only way I can think of to stop the waking up during the night is to lower PS max.  BUT, that needs to be balanced against your OSCAR charts.  If you start getting more events and higher AHI, then you have to decide wheter you want to keep the higher PS and better results or go with a lower PS max and probably less waking up during the night, but more events and higher AHI.  Then there is the possibility in time you can adapt to your current pressures and sleep through the night without waking up.  If you are new, I suggest giving it more time to try to stop waking up during the night before experimenting with lowering PS max.

Also, how do you like your nasal pillow mask?  Do you feel iike you are tolerating the high pressure well with this particular type of mask.  There are many different styles of mask.  Some work better than others for different people.  There are hybrid masks, full face, ones that only fit over the nose, etc.  If you like the pillow stick with them, but be aware that there are many different masks to choose from.

[Sleepless0375]

My AHI was 0.21. The nasal mask is good besides at high pressures, it almost slips off. My first settings were PS 3-8, EPAP 8-10.
I had to up them because I gained a little weight. Right now I’m at EPAP 8-11, PS 5-12. You think I went too high?

[Jay51]

Thank you for posting that info.  Probably the best way to proceed would be to give it a little time, maybe a few weeks to see if you can adapt to things just as they are and stop waking up frequently.  If this doesn't work then you can, 

try lowering the PS max by 1 for a couple of days and look at AHI.  Then if you need to lower PS max again for a couple of days and look at AHI.  If you can lower your PS max a little bit and your AHI still stays low, then this may work.  If this doesn't work then, 

possibly trying a different type of mask my help.  You said this one becomes a bit unsteady with high pressure around 20 or so.  

Please keep posting charts if anything changes and info so we can keep giving suggestions so hopefully you can resolve this problem.

[Sleepless0375]

Are my flow rates RERAs? It seems like my sleep is steady, constant pattern and then I wake up with variable flow rates. Then I fall back asleep.

[Jay51]

Great question.  I can't tell for sure what is happening and why the arousals.  If someone else sees anything here, please post.

[Sleeprider]

Where did these settings come from? You're at EPAP min 9.0, PS min 5.0, PS max 12.0 and can't tell on this graph your EPAP max. Anyway, it's probably too high. If you would like to toss these settings and start over, we can titrate more comfortable and equally effective settings in 2- nights, and I would bet we end up at lower pressure. If you're game to try something, this is it:
ASVauto mode
EPAP min 5.0
EPAP max 10.0
PS min 3.0
PS max 12.0

If you're willing to try it, I promise we can dial you in at more comfortable settings, and you will have minimally higher events if I'm wrong. I think you over-shot the optimum settings. If EPAP is too low, we will see UA events until pressure raises enough to stabilize your airway. PS min is comfort and PS max is to remedy any central events. The machine does a pretty good job at intermediate PS to stabilize minute vent. Since you have altered your original settings I think we just need to see your progression at lower pressures. It would really help to know if you're treating diagnosed central sleep apnea or some other issue.

[SarcasticDave94]

Agreed. That's close enough to ASV titration. PS Min currently seems like it's starting too high and stealing comfort.

[Sleepless0375]

Sounds great, will try.

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Yes, central apneas. On BiPaP ST I had less centrals but still had them. On asv I don’t see them anymore, but I’m getting bad rest.

[Sleepless0375]

My issue now is less centrals and more hyponeas