New on Bipap ASV, have a few questions

[tcolar]

So I took a few months of Cpap due to my aerophagia issues, I would say overall I slept better because of not waking bloated at 2am, but of course the sleep apnea didn't go away and still had so-so pretty resteless sleep

Finally got A ResMed ASV yesterday and I have questions

I used the default titration settings and Eson2 mask, I was only able to use it for 2 hours before bad aerophobia, but Oscar reports absoluttely no events and an AHI of zero ....
- First , does Oscar work with this machine, no events whatsoever, seems too good to be true
- My breathing is low (10-12) and often dips slower during sleep (like down to 8), it always seemed to me that the dream station would think those where apnea and kicked in when maybe it was not needed, this machine does not seem to have that issue
- I see the pressure was all over the place, since aerophobia was an issue I'll to lower the max, at least as long as the AHI stays low
- Is that common to have long periods where everything is calmer and steady (1 to 1:30), is that deep sleep maybe ?

[SarcasticDave94]

I would say the low event rate is due to a ResMed ASV doing a great job not a false reading and misrepresentation. How did you feel after therapy?

On the aerophagia, tell us specifically what the ASV was set to. I want Mode which will be CPAP, ASV, or ASV Auto. I believe best results will be on ASV Auto BTW. And I'd think you're not getting results like that on CPAP.

So the pressure settings you will find is this:

EPAP in ASV or EPAP Min Max in ASV Auto
PS Min Max
You will not have a setting for IPAP as the ASV adds the this second EPAP to PS which equals IPAP.
I would suggest you put those settings on your UserCP left panel for members to see.

OK back to addressing aerophagia, depending on your settings, this will tell me what numbers you have room to drop to help the air swallowing discomfort.

PS I went to your chart again. You seem to be running ASVAuto with EPAP 4-15 PS 3-15. Verify this and I think you then should edit EPAP Max down. You may want to add a slight bump in EPAP Min to 5 or 6 if at the beginning if you seem not be getting enough air. Then to address Aerophagia, lower EPAP Max to around 10-12. Tell us the results if you do this by words and an OSCAR chart. BTW the reason I think you have the room to edit EPAP is the machine shows EPAP went from 4 to something like 4.98, indicating EPAP range can be made smaller.

[tcolar]

You can see the setting on the screenshot, but yes the AutoASV defaults from the titration manual.
AutoASV:  Epap:4-15,PS: 3-15, which means Ipap: 7-30

So I'm thinking of lowering either Epap or Ps Max (probably Epap so PS can do it's job when it needs to) to try to help with aerophobia and see if AHI stays good.

As far as how I felt .... well waking up with aerophagia at 2am never feels great, FWIW I have a sleep tracker (oura ring) and it gave me a better score than usual with some deep sleep while the mask was on, so that's somewhat encouraging. Without cpap I sleep "ok", but he sleep tracker reports a lot of restless/awake periods, which are very likely arousals, if I can spend a night with the mask on, it will be interesting to see if that changes.

[SarcasticDave94]

OK good. Try this EPAP Max 10 PS Max 12. Give a how do you feel feedback and chart next use.

When you first started the ASV, was there a feeling of not enough air?

PS if doing an edit, and you do not like the feel in any way, immediately go back to previous setting and we'll go another route.

[tcolar]

Yeah will try that, I have not had issues feeling like not enough air, the only time I had that was with my original "plain" Cpap set to a fixed 4-9 IIRC, the 4 definitely felt like not enough air, but with the Bipap and ASV that hasn't felt like a problem.

I'm thinking it was mostly because of inspiration time rather than pressure, I have a pretty long inspiration time (2.5 s IIRC), on the Bipap ST I remember the default of 1.2 felt horrible, but the AutoASV does not have a fixed value for that and adapt so does not seem to be an issue.

[SarcasticDave94]

OK that's fine. So again drop EPAP Max to 10, PS Max to 12. This means your IPAP Max is 22 not 30.

Keep in mind if you do get the feeling of not enough air, bump your EPAP Min to 5-6 in that case, and note if it helps.

[jaswilliams]

I will disagree with Dave on settings I would just reduce the PS max to a lower value such as 12 and see how you get on event wise

[SarcasticDave94]

That's OK as well to adjust PS only. I was seeing the OSCAR data indication of EPAP ranging only a small amount and suggested adjustments there also. If taken one at a time, then it's possibly easier to note results, so there is that on the advantage side.

[Sleeprider]

I don't see EPAP needing any adjustment at all, so you could get away with EPAP 4-5 and PS 3-12. We would be looking to lower PS max to below a level that causes aerophagia. Obviously results are outstanding and we are looking for a balance between comfort and AHI.

[tcolar]

Just wanted to post an update and say I have been very happy with this machine, if you look at this thread you will see I never got good results with Phillips machines (which is all that the DME carried), at best I was getting AHI in the 5-10 range and the machine reacted to slow to CA and was juts turning them into HA.

Now with the Resmed it's much much better, I;'m able to get an AHI around 1 consistently.

Aerophagia is still a struggle so I had to experiment a bit to find a setting that works for me, TLDR is that I get aerophagia very easily, a pressure of 10 and 11 is the threshold. I also did test that ASV is clearing my centrals while CPAP not so much (as expected). 
Anyway to be able to not wake of aerophagia I had to set the ASV to the lowest settings EPAP of 4, PS os 0-5, anything above that and aerophagia starts :-/ , but my apnea is treated well at those setting so no complaints.

I wish I could have the PS higher, and the ASV only use it in a short burst when needed, but t tends to go and stay at the higher pressure for a while, to prevent further events I guess, but if it stay over 10 or 11 for more than 30mn, I wake up bloated.

I have a sleep tracker and observed the following:
- Number of "awake" (~arousal) events  at night greatly diminished, 0-2 instead of 4-8.
- My night BPM is increasing from ~40 to 45, the increase is unexpected, but 45 is still plenty good so that's fine, might have as much to do with isolation than the ASV.
- HRV has diminished from 70 to 60, but again this is probably just dued to be stuck at home, even though I try to exercise.

-- Log
Date AHI UA/CA OA HA Mask time Mode Aeropagia EPAP PS Mask
4/3/2020 0 0 0 0 2:00 ASV a V bad 4-15 3-15 Eson 2 Woke at 18 ipap
4/4/2020 1 0 0 1 2:30 ASV a V bad 4-6 2-10 Eson 2 Woke at 15 ipap
4/5/2020 1 0 0 1 3:00 ASV a bad 5-6 2-10 Eson 2 Woke at 15 ipap
4/6/2020 0.79 0 0 0.79 3:50 ASV bad 5 1-6 Eson 2 Woke at 11 ipap
4/7/2020 9 6.5 0 2.5 7:00 Cpap good 6 Eson 2 ok
4/8/2020 1.1 0.12 0 0.98 7:10 ASV a a little 4-4 0-5 Eson 2 ok
4/10/2020 2.58 0.46 0 2.13 6:35 ASV a good 4-4 0-5 Dreamwear FF Leaks more (~20)
4/11/2020 4.1 0.52 0 3.58 3:45 ASV a bad 4-4 0-5 DM pillows Leaks more
4/12/2020 1.3 0.15 0 1.15 6:30 ASV a a little 4-4 0-5 Eson 2
4/13/2020 1.8 0.4 0 1.4 7:15 ASV a good 4-4 0-5 Eson 2
4/14/2020 0.9 0 0 0.9 4:10 ASV a good 4-4 0-5 Eson 2
4/15/2020 1.1 0.2 0 0.9 8:08 ASV a good 4-4 0-5 Eson 2
4/16/2020 1.6 0 0 1.6 3:02 ASV a good 4-4 0-5 Eson 2
4/17/2020 1.4 0.1 0 1.3 8:29 ASV a good 4-4 0-5 Eson 2
4/18/2020 1.4 0.1 0 1.3 8:08 ASV a good 4-4 0-5 Eson 2