My ASV journey starts

[logart89]

This is a child thread of my original APAP thread
 
So I had a little chat with Dr. Krakow, and he recommended the ASV more than the Aircurve 10 Bipap. He told me that the ASV is a more appropriate device for me, as I’m a super anxious (UARS) person at night and became very intolerant to high exhale pressures. I don’t know exactly his reasons why he recommends more ASV than the Air Curve 10 Bipap, but I just believed him because he knows his stuff.
 
Before anyone tells me I spent a lot of money on something that might not work, I spent only 19300 Mexican pesos (around $1050 US dollars) for a device with less than 400 hours of usage, a basically new device. I could not say no to that super deal I found on the Mexican equivalent of eBay.
 
Let me tell you about my first experience with ASV, which was very positive . Before I do that, I need to tell you the context of yesterday night. I had insomnia yesterday. I was very anxious last night because I had important things to do in the very early morning (way more than usual). When I know I have to do things in the morning and see people, I just can’t sleep. I even took zolpidem pills (I no longer consume benzodiazepines) and still could not sleep until 5:30 AM, when I finally got to sleep something.

In the meantime, I tried several masks with my ASV. I was having insomnia anyway, so I decided to try all my masks. I tried full-face, nasal, and pillow masks. From all of them, the pillow mask (with mouthtape) was the most comfortable. When I was using APAP, pillow masks were horrible; there was too much direct pressure inside my nose, and I could not exhale easily. I felt claustrophobic, but now that I can exhale easily with ASV, I love them. I feel like I can finally exhale. ASV is so comfortable with the pillow mask that it practically does the breathing for me, and leaks with the pillow mask are very manageable. I will never go back to APAP again. Never again. Nightly, anxious UARS persons should stay away from APAP.
 
So when I finally fell asleep at 5:30 AM or so, I slept from 6:00 to 8:00 AM, It might not seem much, but those two hours were very refreshing, It's just a matter of tweaking the settings as i go, I’m using the default ASVauto settings as per Dr. Krakow's recommendation; you can look for the default settings in the ASV tritiation Resmed Manual, He told me to start from there and tweak them as I go.
 
So here’s my OSCAR data screenshot from 5:30 AM to 8.50 AM, It seems I had a deep sleep from 6:00 AM to 8:00 AM, Those high flow limit spikes were because of some leaks when I was probably scratching my nose and air leaked. So not all the flow limit spikes are because I had breathing problems:



Here’s a close-up of the waveforms when I was in deep sleep, I'm aiming to perfect them and make them even rounder:




If you have any tweak settings recommendations, please don't hesitate to suggest them to me. I know just 3 hours of data is very little, but if you have UARS and you are using ASV, please share your setting, or if you have ANY experience with ASV, any suggestions are well welcomed.

   

[Sleeprider]

Based on this, you can reduce PS max significantly. You're comfortable, so I'll let you experiment with it, but you are comfortable, and nothing is out of control. I think you can reduce PS max to 8.0 and rarely hit it. That will satisfy the minimum difference between PS min (3.0) and max (8.0) that Resmed requires for the ASV.

[logart89]

I was given these recommendations by another sleep doctor who gave me my first sleep study:
 
Epap max 9 cmH2O
Epap min 4 cmH2O
Support pressure: max 8 cmH2O
Support pressure: min 4 cmH2O
Ti max 2 seg
Ti min 0.3 seg
 
Does these settings make any sense? looking for second opinions before trying those settings. He is suggesting max support pressure 8 like you, but with Epap Max 9 cmH20 and raising
min support pressure from 3 to 4.
 
Where do i find the Ti Max-Min settings? can't find them anywhere. 

[boxofrain]

Hey Logart!!! Congratulations on your ASV success so far. I went from APAP (and BiPAP) to ASV about two years ago and it's life changing. My results are similar to yours every night. My AHI is often 0 and it's uncommon that it would ever be over .3. And I feel a thousand times better than I ever did on the APAP. I think you made the right decision!

[logart89]

Hey Logart!!! Congratulations on your ASV success so far. I went from APAP (and BiPAP) to ASV about two years ago and it's life changing. My results are similar to yours every night. My AHI is often 0 and it's uncommon that it would ever be over .3. And I feel a thousand times better than I ever did on the APAP. I think you made the right decision!

Thanks if 2 hours of quality sleep was good enough i can't wait to see how i feel with 7 hours of sleep, and now with this sleep debt i have i need those hours of quality sleep, guessing you are a UARS sufferer as well, what are your ASV settings by the way?

[logart89]

Based on this,  you can reduce PS max significantly. You're comfortable, so I'll let you experiment with it, but you are comfortable, and nothing is out of control.  I think you can reduce PS max to 8.0 and rarely hit it.  That will satisfy the minimum difference between PS min (3.0) and max (8.0) that Resmed requires for the ASV.

I lowered the PS max to 9.0 and your recommendation, PS min to 4.0, it wouldn't let me lower it to 8 because i had PS min 4. Which setting is more appropriate PS max 9 PS min 4 or PS max 8 PS min 3?

I leaved Max EPAP at 15 as it was. This is a full night data, I was using pillow mask i don't know why it says i used full face mask, i just tried full face mask in the morning a little bit, but all night was pillow mask. Any recommendations? 

[YouTakeMyBreathAway]

You could try switching to regular ASV instead of ASVAuto. It could make treatment even more comfortable with no/negligible effect on efficiency if you don’t have obstructive apneas.

What type of and amount of events did your titration study show?

FWIW I had the exact same experience w/ Full Face masks working the best for me on BiLevel but on ASV Pillows work extremely well - it feels like it blows open my nose vs a/ Full Face I feel congested.

[Uphold9887]

How did you confirm your diagnosis of UARS? What made you suspect this?

I'm beginning to suspect I may have this as well.... using a nasal mask with mouth tape and an AirSense 10 Autoset machine and I feel absolutely awful all the time, despite a reasonably low AHI. My current sleep doctor refuses to do another sleep study even though I continually tell him I feel awful with my current machine/settings. Trying to switch doctors now and hopefully I can get some answers soon...