New ASV unit. No Doctor help!

[Barry5k]

Hi. I'm hoping for some help. After a two-week trial I finally got my Resmed 11 ASV (had Resmed 10 CPAP before).  It came with DEFAULT settings on ASV, except for ramp set at 20 minutes and another time zone! After turning the ramp off and getting the time right, I contacted my doctor (a pulmonologist) and he said it was set wrong and he would change it. After asking twice, no changes. So I changed it myself, told him and without acknowledging his mistake, he said I shouldn't change the settings, but it seem to be ok and he would leave it, so I am leaving him hoping for help here. 

Main problems: major aerophagia and high pressure waking me up. The changes I made somewhat alleviated those issues but the machine needs tweaking more. 
I breathe slower than the machine.
My Ahi has been below one except for last night. No complaints there. 

 My settings:

ASV Auto
Min epap:4
Max pap: 10
Min PS: 3
Max PS: 10
No ramp

Thank you beforehand for your help!

[Sleeprider]

The next version of OSCAR that will fully support the Aircurve 11 ASV is currently in Beta. If you would like to join the Beta test team, send a DM to Crimson Nape, and you can help test the next version and better see what is going on.

Default starting setup on ASV in auto mode is EPAP min 4.0, EPAP max 15.0, PS min 3.0, PS max 15.0. We can see on your chart that your current EPAP min is 4.0 and does not rise above EPAP max 7.4, so you have plenty of range. Your events are reasonably well controlled and occur mostly in two clusters at about 03:45 and 06:05. This pattern suggests mild positional apnea issues and is at a tolerable level, but worth keeping an eye on https://www.apneaboard.com/wiki/index.ph...onal_Apnea

Since your major complaints are aerophagia, and high disruptive pressure, we can trial some alternative settings that we have observed to be effective in many members here, but that contain the pressure to lower pressure and pressure support levels. With these settings we rely on the ASV to stimulate normal respiration rate and volume, but not to do all the work by brute force pressure. Hope the difference is clear. I will suggest some alternate pressure settings, and would like to follow-up by seeing a chart once you have tried them. Please follow the chart organization tutorial in my signature links. We don't need to see the AHI chart, but would like to get a better view of the flow rate. Suggested settings are:
Mode: ASVauto
EPAP min 4.0
EPAP max 6.0
PS min: 3.0
PS max 8.0

These settings have a potential maximum pressure of 14.0 (EPAP max + PS Max), and is just a bit lower than your current chart shows, but you should reach that maximum less often with the lower EPAP max. We will take a look at the results and decide if further reductions are possible, or needed based on your qualitative feedback and chart results.

[SarcasticDave94]

Yes this info will help you get started. Sleeprider gives much more detailed answer than I could offer.

[Barry5k]

Hi, and happy Thanksgiving. 
Last night I reset my machine to the pressures you suggested. 
I'm really tired today, but only got 5+ hours of sleep.
I felt aerophagia when I woke up, but felt good after a few hours.

[Sleeprider]

This is very similar to the original settings with several clusters of obstructive hypopnea and flow limitations that are likely positional in nature. Your AHI was slightly lower and no UA (obstructive apnea) events were recorded. It seems you may have had some relief of aerophagia. We could reduce EPAP max from 6.0 to 5.0 and see what we get. Can you describe your preferred sleep position and pillows?

[Barry5k]

Hi. Thank you for your new suggestions.  Before I saw that, I changed the pressure a little higher due to being tired do much after the last change. 
I changed to:
Epap 4-7
PS 3-9
Not quite to what it was before. I noticed with both changes there are sudden "dead" points in pressure for a second or two. Not sure how to describe that. 
Anyway, I'll try the settings you mentioned tonight.  Pap max 6.0 to 5.0,
I sleep on my side and use one memory foam pillow.

[SarcasticDave94]

Note you've got sometimes higher than ideal leak rates. This will hinder ASV therapy and drive it to the higher pressures you wanted to avoid.

[Sleeprider]

Your most recent results show no increase, or perhaps an improvement in AHI with the lower pressures. Our objective is to minimize sleep disruption from aerophagia and the high pressure transitions. Do you think we're on the right track? Positional apnea was not apparent in the most recent chart. With that said, I'm not a fan of memory foam pillows which tend to raise the head and drop the chin, but everyone has their individual preference.