New ASV unit. No Doctor help!

[Barry5k]

Hi again
I'm so sorry to keep bothering you with my issues. I know you're busy. 
So still have aerophagia, but a little less now. 
As you look at this screenshot, I woke up around 3:30. I changed from a nasal mask to a full-face mask, as you can see by the leaks. 

EPAP: 4.0 - 6.0
PS: 3.0 - 8.0

Also even after seven hours of sleep ( a few nights ago), still tired and want to take naps during the day. 

Any more suggestions would be gratefully appreciated, as I've given up on my doctor. He didn't know what OSCAR is, so he probably didn't see all that you and I can see. 

Thank you again for your time and effort. 

Barry

[Sleeprider]

Your therapy efficacy and aerophagia create a conflicting set of needs. We would like to increase pressure or pressure support to have better control of events and flow limits, but don't want to tip the scale where aerophagia becomes so uncomfortable that it offsets any therapeutic gains. In your most recent chart, we can clearly see the effect of leaks undermining therapy. With large leaks comes a lower respiratory tidal volume and increased pressure support. The part of your therapy using a full face looks much better for leaks, but we see flow limits in several clusters that are causing higher EPAP pressure and may be contributing to a sense of fatigue. Let's try a minor adjustment to increase minimum PS to address that issue. EPAP min 4.0, EPAP max 6.0, PS min 4.0, PS max 9.0. Stick with the full-face.

[RayBee]

Hi Barry and welcome to AB.

I can't speak on the level of recommending parameter changes like Sleeprider and others on AB, but having lived 6 years on my ASV machine, I have a few notes to share.

I noticed our EPAP and PS settings are close, and we share aerophagia issues too. I suppose my main thought here is that there is a fine line of efficacy and comfort. Exploring different options can take some time, but it's all well worth the effort. I've been through a half-dozen masks, heated and non-heated tubes, countless adjustments on EPAP, PS, and heat settings for the tube and tank. But the bottom line is, if I can't fall asleep, or I wake up because of comfort issues, then what's the point?

The folks here on AB were paramount to my ASV success, so kudos them for generously sharing their expertise and time to help perfect strangers in their xPAP journeys.

I would recommend that your setting changes be in small, incremental steps. Give any change 3 days to a week for proper evaluation unless there is an obvious problem that just doesn't work for you. Resist making multiple parameter changes at the same time. If you want to consider a change/addition of "hardware" (we'll just call all the "stuff" outside the realm adjusting numerical parameters "hardware"), search the topic here on AB before spending your money. And ask lots of questions, again, before spending your hard earned cash.

Not to discourage you, but when I started ASV 6 years ago, I didn't feel any positive changes until 9 months of therapy had passed. I attribute that to my being undiagnosed for decades and my body succumbing to countless years of damage because of it. So recovery for me took a long time to see even a slight improvement. I share this in hopes that all who have a similar experience persevere in their xPAP journey as opposed to throwing in the towel.

On the numbers game. If your AHI reports are doing well, don't worry that it's not 0.0 all the time. It won't be. You probably already know this though. Gage your progress/success on how you feel during the day and how well you sleep. You will find at a certain point in your ASV journey that you will be able to identify the need to tweak your EPAP and/or PS settings. And that even with a +/- 0.1 adjustment, you will feel a positive or negative result. Ditto that thought with slight adjustments to your mask's headgear. People change year-over-year so your settings needs may too. I lost 65 lbs and as a result, ASV adjustments were necessary.

I wish you success on your ASV journey and all the best on AB. Please do ask lots of questions, post screen shots, voice your concerns, success, and set-backs.

All the best.

Ray B