Mosleepy - Threapy Thread (ResMed ASV)

[SarcasticDave94]

The bad leak on the 26th might have been a mouth leak. If I'm right, the pattern looks like it on OSCAR.

The events? There's Hypopnea and Unclassified. A possibility is there's somewhat of a Positional Hypopnea issue. The Unclassified possibly indicates the need to bump pressure.

On to settings. What are your pressures set to? I think your EPAP range is needing spread a bit, and PS Max too low.

My guess you are running EPAP 7-9, PS 3-10, which gives us IPAP 10-19.

You likely need more both EPAP and PS Max, a bump of at least 2 cmH2O.

You may need a soft cervical collar to take care of those possible Positional Hypopnea.

And Ramp needs to go bye bye. Ramp and ASV are typically not going to mix well.

[SarcasticDave94]

Here's the link to the other thread

https://www.apneaboard.com/forums/Thread...lease-Help

Maybe the helpful mod comes along to merge it back together.

[OpalRose]

Mosleepy,
Your two threads have been merged.

In the future, if you can't find a prior thread, just go to your profile and you will see a list of your threads. Just click on the thread you wish to post in.

[UnicornRider]

I found your lost thread I am trying to get them combined hang in there.

[Mosleepy]

Thanks.  I figured out how to find it after.

[SarcasticDave94]

Thanks Opal Rose

[Mosleepy]

U guessed right on my settings.  How can I get rid of ramp if  the pressure is too much for me to handle?  Why is ramp not good with asv?   Thanks so much for your input.  I appreciate it.

[jcp519]

Ramp is bad with ASV because it prevents the PS from increasing to combat a central apnea. It will make your PS stay at the min (3 in your case) until the ramp time is over. If you keep waking up and restarting the machine it just restarts the ramp which means you lose the benefit of variable PS that ASV provides.

For me the key to getting used to ASV was just to keep using it consistently without any ramp. I also learned to not fight the machine when it increases the pressure and to just let it help me breath. You can try wearing it while awake to get used to it as well, maybe watch some TV with it on, or read a book. I even had a few nights where I put on some earbuds and listened to music to fall asleep. The less you think about what the pressure is doing, the more likely you'll be to doze off.

[Mosleepy]

Thanks.  I will try to increase pressure tonight.

[SarcasticDave94]

You may have to gradually increase the pressure over time. Right now it's compromised to accommodate aerophagia. However, IPAP has successfully gone to 19 it appears, so maybe there's some getting used to the pressure already.

There's going to be a decision you'll need to make, because it sounds like you neither like the therapy results currently but also still can't handle high pressure. I think you may need to eventually increase EPAP Max to help with the Hypopnea still present. You can leave things as they are, and hopefully over time you'll be able to handle a bit more pressure.

The Ramp is a hindrance to your therapy. For some with Central Apnea, the pressure modification from Ramp can increase Central Apnea. In most cases, Ramp is set on a too low pressure, allowing events to be untreated. And every time you stop therapy and restart, Ramp comes in again, to hinder treatment and reduce total therapy time.

Lastly, I'm not the expert at this, but those Hypopnea look somewhat clustered at times, indicating there may be a Positional component, also known as chin tucking.

So the decision is yours. You do not have to do anything with your settings, but I don't think therapy improves without at least removing or setting Ramp to Auto at a higher pressure and EPAP Max increases. You can slowly edit this if you want, over a drawn out time and/or small fractional upward edits. Your EPAP Max is now 9, the ASV will adjust these on 0.2 cmH2O increments. Also look into whether you're tucking your chin to your chest causing the events in question. The Unclassified isn't too bad compared to the Hypopnea at this time.