Just tried ASV and I hate it. Help?

[Broomstick]

ResMed AirCurve 10. Just got it yesterday.

EPAP: 5
Min PS: 0
Max PS: 20

None of this matters because I can't get past the ramp.

More. I wan't More air. Feeling like I'm using a regular CPAP set to 5. Can only adjust the EPAP.

If I was to disregard the ramp, I'd have to fight with the backup rate pressure attacking me every few seconds. I can go for a long time without taking a breath.

Does a regular BIPAP not have a backup rate to contend with? If so, maybe I should be on that.

I don't know why this doctor insisted on ASV when he said the CPAP (with MY chosen settings) was treating both my OSA and CSA. I just needed something let me breathe out and provide me pressure support. 

Am I missing something? My will to continue any of this is fading fast.

[sheepless]

you might raise min epap, but more importantly I think min ps has to be higher to breathe easier (ps helps inspiration; epap is expiratory). why can't you adjust ps? do you have the asv or the vauto? ps is certainly adjustable in asv (I've never used vauto so my knowledge of it is practically nil). my understanding is, among other differences, asv in auto mode enables a min and max for epap while vauto allows an adjustable but fixed epap. I can't imagine ps is not adjustable in both machines. if there's an asvauto mode, try that to see if there are more setting options.

also, asv takes a few times to get past it nudging us to breathe regularly. after a few nights, the machine and I synced up and fighting the automatic backup pressure was no longer noticeable.

[Gideon]

Set your min PS to 3 or 4.  That will put your IPAP on 8 or 9 initially.  Try that and see.  

don't forget the blow back trick.  Almost every ASV user has had some initial issues with ASV.

Please post all of your settings.
Min EPAP
Max EPAP
Min PS (0)
Max PS (20)
Max IPAP

[Broomstick]

Set your min PS to 3 or 4.  That will put your IPAP on 8 or 9 initially.  Try that and see.  

don't forget the blow back trick.  Almost every ASV user has had some initial issues with ASV.

Please post all of your settings.
Min EPAP
Max EPAP
Min PS (0)
Max PS (20)
Max IPAP

1. Those other settings are only available in ASV auto mode. I'm just in regular ASV mode. 

=====



2. Now (with PS min raised to 5) I have more incoming air . Good. But it's delivering the backup rate. I thought the ramp was supposed to hold it off. 

3. You don't get to choose the Min IPAP. I had to manually raise the pressure of the previous CPAP in order for it to be effective. Relying on the machine to automatically rise to the proper pressure didn't work. I don't have much confidence that this machine will be any smarter, but we will see. I don't trust a machine to determine what I need.

[sheepless]

min ipap is set by setting min epap + min ps. so min epap 5 + min ps 5 = min ipap 10

again, give it a week. most asv users, including me, adapt to the machine (or the machine adapts to us, or both) backup pressure. it's how the machine resolves ca and it turns out to be better than not breathing! after that first getting used to it period, breathing is much more natural feeling than apap for me.

also, as bonjour mentioned, when the machine feels like it's taking off on you, forcibly exhale (blow back) to reset it to lower pressure.

[SarcasticDave94]

FWIW both bonjour and sheepless have on-target comments. Agree also with the implied ASV special learning curve.

I’ve been on injured reserve break for a while, so if you don’t mind, explain why you’re not using ASV AUTO mode. Thanks. I only request that because ASV AUTO is far better than ASV mode, at least for me that is.

[ajack]

He would have been titrated on needing epap5. From previous charts he had no OA/H at 8 epr3. I don't know what epap OA/H come in. So 5 may be set to vent the mask and he didn't need more?

It;s a learning curve, the only thing is when the machine is building up too much pressure, while you are awake. If you blow/exhale hard, it resets the machine. You will get use to breathing steady, so as not to upset it.
If you were to go auto, I would have
min epap 4
max epap 10
min ps 3
max ps 15

[Broomstick]

After a few minutes I am struggling to breathe while still awake. Same would happen with CPAP ocasionally. Always would happen when waking up.

I feel like I really have to dig deep to get a good breath and breathing is labored. Trying to identify exactly what is happening.

Perhaps I'm breathing in too fast. I wonder if I'm creating like a vacuum where I'm sucking faster than the machine can push out. What can I say. That's how I breathe.

Then I need to yawn (some of this is in my mind. I start feeling that I have to yawn when I'm about to put the mask on for the first time.

All I know is after a few minutes it is hard to breathe. I pull the mask off and it is a huge relief.

Another problem might be the mask pushing my jaw back. It's often hard to breathe with just the mask on with no hose.

I'm often pulling the hose off to take a deep breath. (gotta blow out all that air first). And a lot of the time, I have to lift the mask off in order to get a good yawn in.

One deep breath and I'm good to go again. I can put the mask right back on until my breathing gets out of sync again.

[mesenteria]

If you are struggling to get enough air while you're attempting to drift off, you have ramp enabled?  Y/N?  If you do, we advise against its use.  Most of us don't use ramp.

Or, your initial pressure might be too low.  Maybe a whopping whole half a cm of pressure might help, especially if your settings are lower than about 9.  As you get into higher performance from your machine, that half a cm would not amount to a hill of beans, and you'd not notice.  Go up a whole cm if there's room.

I'm assuming the mask is suitable, comfortable, and that there are no major leaks....?

You have very reasonable advice already, and I hope it works for you.

[Broomstick]

If you are struggling to get enough air while you're attempting to drift off, you have ramp enabled?  Y/N?  If you do, we advise against its use.  Most of us don't use ramp.

Or, your initial pressure might be too low.  Maybe a whopping whole half a cm of pressure might help, especially if your settings are lower than about 9.  As you get into higher performance from your machine, that half a cm would not amount to a hill of beans, and you'd not notice.  Go up a whole cm if there's room.

I'm assuming the mask is suitable, comfortable, and that there are no major leaks....?

You have very reasonable advice already, and I hope it works for you.

I'd remove the ramp if it wasn't for the backup rate. Getting blasted at such a high pressure while not ready was brutal. 

One thing I did was I got rid of that default 20cm Max PS. Thats insanity.

I want to say that the backup rate while awake is something I'll NEVER get used to BUT...

There was a point in the titration (did not sleep) where I was very comfortable. I was pretty much just laying there and letting the machine breathe for me. That's what I want. 

That mild nudge is exactly what I want while awake but would do nothing to help an actual central. So I NEEED the ramp I think. 

Then it changed (ramp expired?) where it began hitting me at a higher pressure and too often. The mask would push against my face every 5 seconds. That was just annoying. What happened to me with this machine was brutal. My lungs actually hurted from the air being forcefully pushed on me while not inhaling. 

My plan is to call the doctor and find out what the machine at the lab was doing when I was breathing comfortably.