Moving to ASV from CPAP

[Barry5k]

This is my first post and want to thank everyone who has helped me understand this issue better. 

Since 9/7 my numbers have gotten really disturbing. (I did have a device called a Watchman put into my heart on 9/5, but not surgery and I was home that same day and up and about the next day. CT scan  said all is well. )

After a month of high numbers I redid a sleep study in the lab and my  sleep doctor had me do an echocardiogram (no problems) All he said was the sleep study showed "a kind of CSAs")
No he wants to change me to the ASV machine. 

I've included part of Oscar from August (I didn't start recording until a month ago). 
Also included a partial Oscar readout from a couple of days ago.

Any idea what caused this sudden change?
Also are there any adjustments you recommend before the ASV machine shows up? 
I've used a nasal mask and full face with the same results. 
Both attachments are about average examples. 

I mostly get details on my own as my doctor just gives me the bare basics! 

Thank you for taking the time to read this.

[SarcasticDave94]

I'm going to have to make the assumption your sleep study has a predominantly high Central component. These CA would probably show up at the initial study without CPAP for some of us.

As you're probably doing now, the ASV too can be tuned by yourself. Besides humidity, Ramp which I suggest be left off especially for ASV, heated hose settings, your actual therapy settings are but a few.

Mode: CPAP, ASV, ASV Auto

CPAP static single pressure, zero Auto modifications while sleeping

ASV static EPAP exhale but PS range

ASV Auto makes EPAP a range too

IPAP inhale pressure is the sum of EPAP and PS, and you cannot edit this directly but via indirect edits to EPAP or PS.

Backup breath rate on this ResMed ASV is automatic, you nor doctor/DME can set this manually. ResMed ASV uses a rolling time of past breath to follow your most recent 3 minutes I think. Call the backup rate Auto configured if doc asks.

What to do in prep? Myself says nothing. You'll probably like ASV Auto mode most, but not all do. Try that first with about 6-8 as your EPAP Min, about 12-13 EPAP Max, PS must have a range of 5 minimum like 0-5 but I consider the zero too low for most. Try for PS 3-15 default then tune as needed.

[Sleeprider]

ASVauto mode wit EPAPmin 4.0, EPAPmax 15.0 , PSmin 3.0 and PSmax 15.0 will probably work great for you. Those are default settings and often work fo individuals like you. If not, just post the chart from the first night and we can help dial you in quickly. Here is the titration protocol from Resmed and it’s dead simple. 

[Barry5k]

Thank you so much for your reply and suggestions. My machine arrived later than expected. This is a two-week trial period, so I probably shouldn't change anything just yet. 
Here is my chart from day two. I used an F20 full face mask. 
1. I notice that my pressure has gone up past the machine's settings quite a bit. 
2. The Sp02 sensor connected to my machine shows lower than expected oxygen. Are these accurate? I'm worried about these low numbers. 

The other chart is when I tried to take a nap with my N20 nasal mask as a test for this evening. I didn't fall asleep and it was really hard to to breathe. I felt oxygen starved. I don't know why as I see there was plenty of pressure the half hour I tried! 

Thank you again for taking the time to take a look. Hopefully someday I can pay this forward.

[SarcasticDave94]

The air starvation feeling will likely be the fault of a Ramp locking your pressure to 4 for a duration of between 5 to 10 minutes. Ramp needs to be turned off if at all possible.

That Ramp was changed by someone, either yourself or at the doctor's order.

You'd probably be better with PS Min of 3, PS Max about 15, so default PS range.

Your SpO2 was at a low of 89%, just above making supplemental oxygen necessary if that level was over 5 minutes.

The 2 week trial, did they tell you an exact purpose for this? Me, I'd consider editing the settings regardless, and tell them what and why you changed it, if you in fact do edit.

[Barry5k]

Thanks for responding. 
This afternoon I did turn the ramp off! I didn’t change it and i know my doctor turned it off on my CPAP machine a long time ago. 
I will change the PS as you recommended tonight and see what happens. 
I’m hoping the oximeter isn’t totally accurate. Who knows how long this rental has been passed around. Plus my Apple Watch shows 98 right now (of course I’m not asleep).  
I guess my sleep doctor wants to see if the ASV makes a difference from my CPAP machine. Thus the 2-week test. 

He actually said not to think about the AHI, and just see if the ASV makes my daily life better (or something like that). Well, how can you not think of that?

[SarcasticDave94]

Maybe doc isn't totally convinced either Central Apnea treatment will help, or that Central Apnea is an issue. If they were on the diagnostic, ASV will help.

So probably your bottom line need will be to subjectively determine does ASV help you sleep better, and objectively do your numbers show improved therapy.

[Crimson Nape]

Barry5k  -  The OSCAR team would be interested in viewing your SD card's data.  If you have no objections, would you please follow the steps listed below and submit it to the link provided.

1. With the SD card in your computer, start OSCAR.
   
2. Go to Help > Troubleshooting > Create zip of CPAP data card
   
3. Rename the card so it will include your AB username
   
4.  Upload it to:  
   OSCAR Data Submission Upload Link
   

Thanks!
- Red

[Barry5k]

I changed my settings according to your recommendations. It has helped. The last two nights were with a nasal mask. Last night woke up with a headache. 
I still feel a kind of struggle to breathe freely and comfortably at times during the night. 
Anyway, much better.
 
That 72 SP02 is a one off. Must've been user error?

[SarcasticDave94]

Maybe the oxygen sensor slipped for the blip. Otherwise, decent therapy numbers, just watch the leak rate as it's somewhat elevated.

If you feel you need more base air, increase EPAP to 5. It's not required, but for comfort can be helpful.