New to ASV-Need help getting more symptom relief

[jteetie]

So how do I get rid of all the hyponeas like I did the OA and CAs?

[vsheline]

Hi jteetie,

I suppose it depends on whether your titration study showed you needed Min EPAP of 12 to eliminate hypopneas.

[jaswilliams]

So how do I get rid of all the hyponeas like I did the OA and CAs?

Depends on the nature of the hypopnoea and why it’s being scored. The PS of the ASV will blast through Hypopnoea

[ajack]

You might fix the H with more min epap and bring your PS to the Med/median, by the left column. You could try min epap 7 and min PS 4. I'd leave the max set as they are. Then review.

[vsheline]

The PS of the ASV will blast through Hypopnoea

Agreed that PS tends to blast through Central Hypopneas, but in ASV titrations Min EPAP is commonly increased until Obstructive Hypopneas are no longer present.

ASV Titration guides from both ResMed and Philips have said the Min EPAP setting should be increased until obstructive events are no longer present.

ResMed Titration Guide: https://www.resmed.com/us/dam/documents/...er_eng.pdf

Philips Titration Guide: https://www.sleepapnea.com/downloads/100...fGuide.pdf

If an ASV titration resulted in a prescribed Min EPAP of 12, the implication is that on the night of the ASV titration Min EPAP of 12 was needed to eliminate these obstructive events.

[ajack]

I second this, It is also suggested by resmed titration, that H are treated with epap on an ASV, as opposed to PS with a normal bpap. Where increasing PS is the norm

[jteetie]

Thanks for all the info. Really helpful. But what if the EPAP of 12 is too high for me to actually sleep? That was the reason we lowered it. I couldn't fall asleep at that pressure.

[Sleeprider]

The main point of therapy is to resolve sleep disordered breathing to an extent that you can sleep with minimal disturbance. Your efficacy is currently acceptable, and the objective of eliminating "all hypopnea" is not as important at this point as achieving good rest. The point of making adjustments in therapy pressure is to trial a setting to determine if it works better from BOTH a therapy and comfort standpoint. It is not unusual to go beyond the optimal pressure, then drop back in response to comfort or therapy findings.

I don't know if you are familiar with auto mechanics, but we often use slip gauges (thin pieces of metal with a known thickness) to measure the gap in spark plugs or valve lifters. We insert increasingly thicker gauges into the gap until we get to the one that won't fit, then the gap is determined to be the last one that fit. This is like pressure titration. We will often keep trying more pressure until we find one that doesn't work as well, and conclude the previous setting was the better option.

[Technopauper]

I know this is heresy around these part to suggest this but my sleep doc said something that stuck - use ramp from a comfortable pressure to get you off to sleep and then once asleep it doesn't matter what the pressure is....you're asleep and won't notice it.

If you set the ramp as t+1 where t=how long it takes to fall asleep then you're golden !

Rob