Looking for guidance on new Aircurve10 ASV

[mymontreal]

After being diagnosed with severe Obstructive sleep apnea 6 or 7 years ago, I spent the last few months with an Aircurve10 Auto CPAP machine - ran into a lot of problems with central apnea events (even at very low pressures), to the extent where I had to consider the possibility that I had been wrongly diagnosed originally and really had central apnea challenges...

With the Airsense 10 APAP - my initial pressure range was 6 - 10 and with that, I had no OA, a couple of H and quite a lot of CA. Tried different pressure ranges - my most recent pressure range was 5.0 - 6.4 - and even with this I had almost zero OA, handful of H and about same # of CA (varied from night to night, but did not seem to correlate with pressure range...)

With my new AirCurve10 ASV machine, I have set it to ASVAuto mode, but am struggling to understand the concept of "Pressure Support" and how it relates to other settings...

Last night was the first night on the Aircurve10 ASV and I tried the following initial settings, to see what kind of night I would have:

EPAP MIN = 6.0
EPAP MAX = 9.0
PS MIN = 0.0
PS MAX = 10.0

If I look at the numbers this morning, the AHI results seem very good, though I had a very restless/painful night - biggest problems I had last night were (1) big problems with aerophagia and (2) I seemed to wake up every single time the air pressure rapidly increased.... I'm guessing this was the Pressure Support kicking in ?

Aerophagia/Acid reflux has always been a big problem for me at higher pressures, so I'm hoping that I will eventually be able to get away with lower pressures/ps... ?

I'm used to understanding my Sleepyhead data with my Airsense10 APAP machine, but don't really understand the pressure graphs and exactly what was happening with PS, on my ASV data from last night... ?

Would welcome any feedback from the group - here is last night's data - please let me know if you need me to zoom in on any particular area:

[url=]ASV[/url]


Regards
Mike

[Sleeprider]

Haha! Nailed it! Reduce PSmax to 9 and I think the rest is all about adaptation. Welcome to ASVauto.

[richb]

Hi mymontreal.  My machine is set for a minimum of 6 and max of 8.  I can see that your machine is working really hard.  I hope you get used to the pressures.

Rich

[Sleeprider]

Rich, what is your PS range?

[storywizard]

After being diagnosed with severe Obstructive sleep apnea 6 or 7 years ago, I spent the last few months with an Aircurve10 Auto CPAP machine - ran into a lot of problems with central apnea events (even at very low pressures), to the extent where I had to consider the possibility that I had been wrongly diagnosed originally and really had central apnea challenges...

With the Airsense 10 APAP - my initial pressure range was 6 - 10 and with that, I had no OA, a couple of H and quite a lot of CA. Tried different pressure ranges - my most recent pressure range was 5.0 - 6.4 - and even with this I had almost zero OA, handful of H and about same # of CA (varied from night to night, but did not seem to correlate with pressure range...)

With my new AirCurve10 ASV machine, I have set it to ASVAuto mode, but am struggling to understand the concept of "Pressure Support" and how it relates to other settings...

Last night was the first night on the Aircurve10 ASV and I tried the following initial settings, to see what kind of night I would have:

EPAP MIN = 6.0
EPAP MAX = 9.0
PS MIN = 0.0
PS MAX = 10.0

If I look at the numbers this morning, the AHI results seem very good, though I had a very restless/painful night - biggest problems I had last night were (1) big problems with aerophagia and (2) I seemed to wake up every single time the air pressure rapidly increased.... I'm guessing this was the Pressure Support kicking in ?

Aerophagia/Acid reflux has always been a big problem for me at higher pressures, so I'm hoping that I will eventually be able to get away with lower pressures/ps... ?

I'm used to understanding my Sleepyhead data with my Airsense10 APAP machine, but don't really understand the pressure graphs and exactly what was happening with PS, on my ASV data from last night... ?

Would welcome any feedback from the group - here is last night's data - please let me know if you need me to zoom in on any particular area:

[url=]ASV[/url]


Regards
Mike

Hi Mike...
That is a lot of Pressure Support going on there...I know when I have the PS to high I feel like I am going to blow up...:-)
As an ASV user and from the last two years having the ASV experience I would say cut the PS down to Min 2 Max 8 And see if you get some relief from the big pressure changes. EPAP may be OK, leave it for now and see what happens with a slightly lower Pressure Support.
As usual this is only my opinion from my experience, others will have other suggestions...

Storywizard

[mymontreal]

Thanks everyone - good feedback so far - I am looking forward to making a couple of Pressure Support adjustments tonight, see if I can get a better night...

I'm guessing all that "Up & Down RED" on the graph is the machine working hard to support my breathing... ?

That's a bit scary to me... I expected to see the machine having to intervene a few times, but not continuously like that... I wonder what that says about my Central Apnea/Periodic Breathing problems, considering that I had no CA or PB events, during any of my overnight sleep studies...

YIKES...

[storywizard]

Thanks everyone - good feedback so far - I am looking forward to making a couple of Pressure Support adjustments tonight, see if I can get a better night...

I'm guessing all that "Up & Down RED" on the graph is the machine working hard to support my breathing... ?

That's a bit scary to me... I expected to see the machine having to intervene a few times, but not continuously like that... I wonder what that says about my Central Apnea/Periodic Breathing problems, considering that I had no CA or PB events, during any of my overnight sleep studies...

YIKES...

hi Mike...
the ASV works a bit differently than the other CPAP machines, the ASV follows every breath, that is what the red line is showing, it is making sure you breathe, nothing to be worried about with your graph, we will help you find comfortable settings, breath easily and trust the machine...

all the beat,
Storywizard

[mymontreal]

Thanks everyone - good feedback so far - I am looking forward to making a couple of Pressure Support adjustments tonight, see if I can get a better night...

I'm guessing all that "Up & Down RED" on the graph is the machine working hard to support my breathing... ?

That's a bit scary to me... I expected to see the machine having to intervene a few times, but not continuously like that... I wonder what that says about my Central Apnea/Periodic Breathing problems, considering that I had no CA or PB events, during any of my overnight sleep studies...

YIKES...

hi Mike...
the ASV works a bit differently than the other CPAP machines, the ASV follows every breath, that is what the red line is showing, it is making sure you breathe, nothing to be worried about with your graph, we will help you find comfortable settings, breath easily and trust the machine...

all the beat,
Storywizard

Thank you for your reassurance storywizard...!

I ended up setting PS MIN=2 and PS MAX=8 last night.

Unfortunately it was still a bit of a restless/painful night because of the Aerophagia and bloating...

Aerophagia/Bloating have always been a big problem for me even on regular CPAP and it has always been very hard for me to deal with pressures above about 9 or 10... I hope that I still have a chance in the world of ASV...

If I look at my Sleepyhead data from last night, I have a few H events but nothing else, and if I interpret my Sleepyhead data correctly (?), it looks like the H events only occurred in the Ramp-Up stages - looks like there is no real PS support during the Ramp-Up stage anyway ?

One thing that still confuses me a bit on Resmed ASV machine is the display of CA and OA events ?

I think I read that the Resmed ASV cannot distinguish between OA and CA events, and in fact does not display CA events at all ?  Is that just because when a CA event is detected, the pressure support ramps up so fast, that the CA event is eliminated within a second or two, so it's just not relevant ?

Given my intolerance to high pressures, am I correct in thinking that it would be ok to continue reducing PS MAX as long as it still deals with the CA events - but then how would I know that I had reduced PS MAX too far, if the machine is not capable of distinguishing/displaying CA events... does this make sense... ?  

Here is a link to last night's Sleepyhead results - only a few events and very low AHI, but I feel terrible Today... I'm assuming this is just because of all the Aerophagia/Bloating.




Regards
Mike

[Sleeprider]

Mike, when you and I set the preliminary settings, I used your CPAP titration as a starting point. Since you now have 2 nights with no events to speak of, It is appears we can try a lower EPAP. Since this is an auto adjusting machine, and you're suffering with aerophagia, I'm going to suggest a pretty significant change now.

EPAP min 5.0.
IPAP max 15.0
PSmin 2
PSmax 8

If this lets in too much OA we can deal with it pretty easily, but lets try a much lower pressure tonight and see if that can increase your comfort.

[mymontreal]

Mike, when you and I set the preliminary settings, I used your CPAP titration as a starting point.  Since you now have 2 nights with no events to speak of, It is appears we can try a lower EPAP.  Since this is an auto adjusting machine, and you're suffering with aerophagia, I'm going to suggest a pretty significant change now.

EPAP min 5.0.
IPAP max 15.0
PSmin 2
PSmax 8

If this lets in too much OA we can deal with it pretty easily, but lets try a much lower pressure tonight and see if that can increase your comfort.

Thanks Sleeprider - I am happy to try some lower pressures, as getting rid of the Aerophagia is paramount...

Can you possibly just reconfirm the settings that you suggest ?

At the moment, I have EPAP Min=6.0 and EPAP Max=9.0
I have not set anything specific for IPAP, but looks like the machine is defaulting to: MIN IPAP=8.0 and MAX IPAP=17.0 (according to SH data)

I had not noticed a specific Machine setting for IPAP Max... you are suggesting I just reduce that from the current 17.0 to 15.0 ?

Many Thanks
Mike